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González-Mendibil I, García-Pascual E, Villanueva A, García-Gutiérrez S. Bispectral index monitoring for sedation in scheduled adult colonoscopy: A randomized controlled trial. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00079-9. [PMID: 38663652 DOI: 10.1016/j.redare.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/02/2023] [Accepted: 12/06/2023] [Indexed: 05/01/2024]
Abstract
BACKGROUND Patients should be closely monitored during procedures under sedation outside the operating room, but it is unclear which type of monitoring is best. We investigated the efficacy and safety of BIS monitoring vs conventional monitoring for sedation during colonoscopy. METHODS We performed a double-blind clinical trial in 180 patients undergoing elective colonoscopy. Patients were randomized to 1) the BIS group or 2) a control group, in which sedation was monitored with a BIS monitor or the Ramsay Sedation Score, respectively. The primary outcome was the rate of sedation-induced adverse events in both groups. Secondary outcomes were the characteristics of patients who developed adverse events, and time during colonoscopy when these events occurred, propofol and remifentanil dosage, and patient satisfaction. RESULTS Univariate analysis showed fewer cardiopulmonary complications in the BIS group (41.11% vs 57.78% in controls; p = 0.02). Multivariate analysis found a significantly higher risk of adverse events in older patients (95% CI, 1.013-1.091; p = 0.0087) and in men (95% CI, 1.129-7.668; p = 0.0272). These events were observed at the hepatic flexure. No significant differences between propofol or remifentanil dosage, use of rescue medication, and patient satisfaction were observed between groups. CONCLUSIONS Our data suggest that BIS monitoring during sedation in scheduled colonoscopies reduces adverse respiratory events. Although its routine use in sedation does not appear to be warranted, clinicians should take steps to identify patients with a higher risk of complications who might benefit from this type of monitoring.
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Affiliation(s)
- I González-Mendibil
- Department of Anesthesiology, Galdakao University Hospital, Galdakao, Bizkaia, Spain.
| | - E García-Pascual
- Department of Anesthesiology, Galdakao University Hospital, Galdakao, Bizkaia, Spain
| | - A Villanueva
- Research Unit, Galdakao University Hospital, Galdakao, Bizkaia, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Bizkaia, Spain
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Hernando Vela B, Jarén Cubillo P, Bueno Fernández C, Gallego Ligorit L, Ferrer García MC, Diarte JA. Sedation with propofol/remifentanil versus dexmedetomidine / remifentanil for patients undergoing transcatheter aortic valve implant: A retrospective study between 2012 and 2019. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71:68-75. [PMID: 38065297 DOI: 10.1016/j.redare.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/26/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Percutaneous implantation of an aortic valve prosthesis is a therapeutic alternative for patients with severe aortic stenosis. The procedure is traditionally performed under general anaesthesia; however, sedation is now gaining in popularity because it reduces the need for vasoactive drugs and shortens the patient's stay in the critical care unit and on the ward. The aim of this study is to evaluate the clinical efficacy, safety and potential benefits of sedation with dexmedetomidine in patients undergoing percutaneous implantation of an aortic valve prosthesis in terms of haemodynamic and respiratory complications. MATERIALS AND METHODS We performed a retrospective study of 222 patients that had undergone percutaneous implantation of an aortic valve prosthesis between 2012 and 2019 under sedation with either dexmedetomidine plus remifentanil (DEX-RMF) or propofol plus remifentanil (PROPO-RMF). We collected data on complications, mainly haemodynamic and respiratory, during and after the procedure. RESULTS No significant differences were found between sedation with dexmedetomidine and propofol (in combination with remifentanil) in terms of haemodynamic stability and intraprocedural cerebral blood oxygen. In the DEX-RMF group, however, mean blood pressure, midazolam dose, and duration of anaesthesia were lower compared with the PROPO-RMF group, but the incidence of haemodynamic and respiratory complications did not differ significantly between groups. CONCLUSIONS Our results show that sedation, particularly with adjuvant dexmedetomidine, is a valid anaesthetic techniques in percutaneous aortic valve prosthesis implantation.
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Affiliation(s)
- B Hernando Vela
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario "Miguel Servet", Zaragoza, Spain.
| | - P Jarén Cubillo
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario "Miguel Servet", Zaragoza, Spain; Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - C Bueno Fernández
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario "Miguel Servet", Zaragoza, Spain
| | - L Gallego Ligorit
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario "Miguel Servet", Zaragoza, Spain
| | - M C Ferrer García
- Servicio de Cardiología, Hospital Universitario "Miguel Servet", Zaragoza, Spain
| | - J A Diarte
- Servicio de Cardiología, Hospital Universitario "Miguel Servet", Zaragoza, Spain
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3
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Viderman D, Bilotta F, Badenes R, Abdildin Y. Anesthetic management of endovascular neurosurgical procedures in acute ischemic stroke patients: A systematic review of meta-analyses. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:580-592. [PMID: 37678462 DOI: 10.1016/j.redare.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 02/06/2023] [Indexed: 09/09/2023]
Abstract
Restoration of cerebral circulation in the ischemic area is the most critical treatment task for reducing irreversible neuronal injury in ischemic stroke patients. The recanalización of appropriately selected patients became indispensable for improving clinical outcomes and resulted in the widespread revascularization techniques. There is no clear answer as to which anesthetic modality to use in ischemic stroke patients undergoing neuro-endovascular procedures. The purpose of this systematic review is to conduct a qualitative analysis of systematic reviews and meta-analyses (RSs & MAs) comparing general anesthesia and non-general anesthesia methods for cerebral endovascular interventions in acute ischemic stroke patients. We developed a protocol with the inclusion and exclusion criteria for matched publications and conducted a literature search in PubMed and Google Scholar. The literature search yielded 52 potential publications. Ten relevant RSs & MAs were included and analysed in this review. The decision about which anesthesia method to use for endovascular procedures in managing acute ischemic stroke patients should be made based on the patient's personal characteristics, pathophysiological phenotypes, clinical characteristics, and institutional experience.
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Affiliation(s)
- D Viderman
- Department of Surgery (Section of Anesthesiology, Intensive Care, and Pain Medicine), Nazarbayev University School of Medicine (NUSOM), Astana, Kazakhstan.
| | - F Bilotta
- Departamento de Anestesia y Cuidado Intensivo, Universidad de Roma La Sapienza, Roma, Italy
| | - R Badenes
- Departamento de Anestesiología y Cuidado Intensivo, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Y Abdildin
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
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Pérez Lucendo A, Piñeiro Otero P, Matía Almudévar P, Alcántara Carmona S, López López E, Ramasco Rueda F. Individualised analgesia, sedation, delirium and comfort management strategies in the ICU: a narrative review. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:509-535. [PMID: 37742996 DOI: 10.1016/j.redare.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023]
Abstract
This group is a product of the collaboration agreement signed by SOMIAMA (Sociedad de Medicina Intensiva de Madrid) and SAR MADRID (Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid) under which the organisations agreed to create joint working groups to improve critical patient care. Pain, discomfort, agitation, and delirium cause suffering, delay discharge, and can lead to serious complications in patients admitted to medical and surgical critical care units and post-anaesthesia care units. The main objectives in this type of unit include: Ensuring the comfort of patients suffering or recovering from a critical illness.Avoiding complications associated with the measures, particularly pharmacological, taken to ensure that comfort.
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Affiliation(s)
- A Pérez Lucendo
- Servicio de Medicina Intensiva, Hospital Universitario de La Princesa, Madrid, Spain.
| | - P Piñeiro Otero
- Servicio de Anestesiología y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - P Matía Almudévar
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - S Alcántara Carmona
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - E López López
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Ramasco Rueda
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain
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Likhvantsev V, Landoni G, Ermokhina N, Yadgarov M, Berikashvili L, Kadantseva K, Grebenchikov O, Okhinko L, Kuzovlev A. Halogenated anesthetics vs intravenous hypnotics for short and long term sedation in the intensive care unit: A meta-analysis. Med Intensiva 2023; 47:267-279. [PMID: 36344342 DOI: 10.1016/j.medine.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/01/2022] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To comprehensively assess peer-reviewed studies using volatile (VA) or intravenous (i/v) anesthetics for sedation in intensive care units (ICUs), with the hypothesis that the type of sedation may have an impact on survival and other clinically relevant outcomes. DESIGN Systematic review and meta-analysis of randomized and non-randomized trials. SETTING ICUs. PARTICIPANTS Critically ill and postoperative patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Studies comparing VA versus i/v anesthetics used in the ICU settings were independently systematically searched. Finally, 15 studies (1520 patients of predominantly surgical profile needed VA sedation for less than 96h) were included. VA had no impact on all-cause mortality (very low quality of evidence, Odds Ratio=0.82 [0.60-1.12], p=0.20). However, VA were associated with a reduction in duration of mechanical ventilation (p=0.03) and increase in ventilator-free days (p<0.001). VA also reduced postoperative levels of cardiac troponin (24h), time to extubation (p<0.001) and awakening (p=0.04). CONCLUSIONS In this meta-analysis, volatile sedation vs propofol caused the increase in ventilator-free days, the reduction in the duration of mechanical ventilation, time to extubation and the troponin release in medical or surgical ICU patients, while in surgical ICU patients the time to awakening was shortened.
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Affiliation(s)
- V Likhvantsev
- V. Negovsky Reanimatology Research Institute, Moscow, Russia.
| | - G Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - N Ermokhina
- V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - M Yadgarov
- V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - L Berikashvili
- V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - K Kadantseva
- V. Negovsky Reanimatology Research Institute, Moscow, Russia; A. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - O Grebenchikov
- V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - L Okhinko
- V. Demikhov Municipal Hospital №. 68, Moscow, Russia
| | - A Kuzovlev
- V. Negovsky Reanimatology Research Institute, Moscow, Russia
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Torres Soblechero L, Ocampo Benegas DE, Manrique Martín G, Butragueño Laiseca L, Leal Barceló AM, Parreño Marchante A, López-Herce Cid J, Mencía Bartolome S. Prospective observational study on the use of continuous intravenous ketamine and propofol infusion for prolonged sedation in critical care. An Pediatr (Barc) 2023; 98:276-282. [PMID: 36925340 DOI: 10.1016/j.anpede.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 03/15/2023] Open
Abstract
INTRODUCTION Analgesia and sedation are a priority in paediatric intensive care. The combination of ketamine and propofol is a possible option in patients requiring prolonged or difficult sedation and to reduce the use of benzodiazepines and opiates. The aim of this study was to assess the efficacy and safety of combination ketamine and propofol in continuous infusion for prolonged analgesia/sedation in the paediatric intensive care setting. PATIENTS AND METHODS Prospective, observational single-group cohort study in patients aged 1 month to 16 years admitted to the paediatric intensive care unit in 2016-2018 that received ketamine and propofol in continuous infusion for analgesia and sedation. We collected data on demographic and clinical characteristics, analgesia and sedation scores (MAPS, COMFORT-B and SOPHIA), haemodynamic parameters and adverse events. RESULTS The study included 32 patients. The maximum dose of ketamine was 1.5 mg/kg/h (interquartile range [IQR], 1-2 mg/kg/h) and the infusion duration was 5 days (IQR, 3-5 days). The maximum dose of propofol was 3.2 mg/kg/h (IQR, 2.5-3.6 mg/kg/h) and the infusion duration, 5 days (IQR, 3-5 days). Thirty (93.7%) patients had previously received midazolam and 29 (90.6%) fentanyl. Analgesia scores did not change after initiation of the ketamine and propofol infusion. There was a statistically significant increase in the COMFORT-B score, but the score remained in the adequate sedation range (12-17). There were small but statistically significant decreases in the mean arterial pressure (from 64 mmHg to 60 mmHg; P = .006) and the diastolic blood pressure (from 50.5 to 48 mmHg; P = .023) 1 h after the initiation of the ketamine and propofol infusion, but this difference was not observed 12 h later and did not require administration of vasoactive drugs. No other major adverse events were detected during the infusion. CONCLUSIONS The combination of ketamine and propofol in continuous infusion is a safe treatment in critically ill children that makes it possible to achieve an appropriate level of analgesia and sedation without relevant haemodynamic repercussions.
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Affiliation(s)
- Laura Torres Soblechero
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Doris Elena Ocampo Benegas
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gema Manrique Martín
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laura Butragueño Laiseca
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrea María Leal Barceló
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jesús López-Herce Cid
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Santiago Mencía Bartolome
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Sistac Ballarín JM, Solé Guixes J, Groizard Botella MJ, Sistac Palacín JM. Use of a single dose of 70mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3132 cases. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:355-359. [PMID: 35753930 DOI: 10.1016/j.redare.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/04/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). MATERIAL AND METHODS Prospective study conducted from January 2000 to January 2020 in which 3132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. RESULTS No notable hemodynamic alterations were observed. The incidence of desaturation was .41%, awakening during the test was .16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of .73%. The P value in all cases was <.05%. CONCLUSIONS Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.
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Affiliation(s)
- J M Sistac Ballarín
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Facultad de Medicina, Universitat de Lleida, Lleida, Spain.
| | - J Solé Guixes
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - M J Groizard Botella
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - J M Sistac Palacín
- Hospital Universitario de Leganés, Facultad de Medicina, Universidad Alfonso X el Sabio, Leganés, Madrid, Spain
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Bosch-Alcaraz A, Tamame-San Antonio M, Luna-Castaño P, Garcia-Soler P, Falcó Pegueroles A, Alcolea-Monge S, Fernández Lorenzo R, Piqueras-Rodríguez P, Molina-Gallego I, Potes-Rojas C, Gesti-Senar S, Orozco-Gamez R, Tercero-Cano MC, Saz-Roy MÁ, Jordan I, Belda-Hofheinz S. Specificity and sensibility of the Spanish version of the COMFORT Behaviour Scale for assessing pain, grade of sedation and withdrawal syndrome in the critically ill paediatric patient. Multicentre COSAIP study (Phase 1). Enferm Intensiva (Engl Ed) 2022; 33:58-66. [PMID: 35534412 DOI: 10.1016/j.enfie.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/15/2021] [Indexed: 06/14/2023]
Abstract
AIM The main aim of this investigation was to analyse the specificity and sensibility of the COMFORT Behaviour Scale (CBS-S) in assessing grade of pain, sedation, and withdrawal syndrome in paediatric critical care patients. METHOD An observational, analytical, cross-sectional and multicentre study conducted in Level III Intensive Care Areas of 5 children's university hospitals. Grade of sedation was assessed using the Spanish version of the CBS-S and the Bispectral Index on sedation, once per shift over one day. Grade of withdrawal was determined using the CBS-S and the Withdrawal Assessment Tool-1, once per shift over three days. RESULTS A total of 261 critically ill paediatric patients with a median age of 5.07 years (P25:0.9-P75:11.7) were included in this study. In terms of the predictive capacity of the CBS-S, it obtained a Receiver Operation Curve of .84 (sensitivity of 81% and specificity of 76%) in relation to pain; .62 (sensitivity of 21% and specificity of 78%) in relation to sedation grade, and .73% (sensitivity of 40% and specificity of 74%) in determining withdrawal syndrome. CONCLUSIONS The Spanish version of the COMFORT Behaviour Scale could be a useful, sensible and easy scale to assess the degree of pain, sedation and pharmacological withdrawal of critically ill paediatric patients.
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Affiliation(s)
- A Bosch-Alcaraz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain.
| | | | - P Luna-Castaño
- Unidad de Apoyo a la Investigación Enfermera, Hospital Universitario La Paz, Madrid, Spain
| | - P Garcia-Soler
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario Carlos Haya, Málaga, Spain
| | - A Falcó Pegueroles
- Departamento de Enfermería Fundamental y Medicoquirúrgica, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Spain. Miembro de un grupo de investigación consolidado en torno a técnicas estadísticas aplicadas a la psicología (SGR 2014-326)
| | - S Alcolea-Monge
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - R Fernández Lorenzo
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - P Piqueras-Rodríguez
- Máster en Cuidados Críticos, Supervisor Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, Spain
| | - I Molina-Gallego
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, Spain
| | - C Potes-Rojas
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - S Gesti-Senar
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - R Orozco-Gamez
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M C Tercero-Cano
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Á Saz-Roy
- Departamento de Enfermería de Salud Pública, Salud Mental y Maternoinfantil, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Spain
| | - I Jordan
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - S Belda-Hofheinz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
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9
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Bosch-Alcaraz A, Luna-Castaño P, Garcia-Soler P, Tamame-San Antonio M, Falcó-Pegueroles A, Alcolea-Monge S, Fernández Lorenzo R, Piqueras-Rodríguez P, Molina-Gallego I, Potes-Rojas C, Gesti-Senar S, Orozco-Gamez R, Tercero-Cano MC, Saz-Roy MÁ, Jordan I, Belda-Hofheinz S. Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2). An Pediatr (Barc) 2021; 95:397-405. [PMID: 34824043 DOI: 10.1016/j.anpede.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. METHODS An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24 h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneously assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). RESULTS A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR = 0.35-6.55) were included. An overall discomfort score of 10.79 ± 3.7 was observed during morning compared to 10.31 ± 3.3 during the night. When comparing analgosedation and non-analgosedation groups, statistical differences were found in both shifts (χ2: 45.48; P = .001). At the same time, an association was observed (P < .001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. CONCLUSIONS As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.
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10
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Bosch-Alcaraz A, Alcolea-Monge S, Fernández Lorenzo R, Luna-Castaño P, Belda-Hofheinz S, Falcó Pegueroles A, Piqueras-Rodríguez P, Molina-Gallego I, Potes-Rojas C, Gesti-Senar S, Orozco-Gámez R, Tercero-Cano MC, Saz-Roy MÁ, Jordan I, García-Soler P, Tamame-San Antonio M. Grade of sedation in the critically ill pediatric patient and its correlation with sociodemographic and clinical variables. Multicentre COSAIP study. Enferm Intensiva (Engl Ed) 2021; 32:189-97. [PMID: 34772640 DOI: 10.1016/j.enfie.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022]
Abstract
AIMS To determine the grade of sedation in the critically ill paediatric patient using Biespectral Index Sensor (BIS) and to analyse its relationship with sociodemographic and clinical patient variables. METHODS Observational, analytical, cross-sectional and multicentre study performed from May 2018 to January 2020 in 5 Spanish paediatric critical care units. Sex, age, reason for admission, presence of a chronic pathology, type and number of drugs and length of stay were the sociodemographic and clinical variables registered. Furthermore, the grade of sedation was assessed using BIS, once per shift over 24 h. RESULTS A total of 261 paediatric patients, 53.64% of whom were male, with a median age of 1.61 years (0.35-6.55), were included in the study. Of the patients, 70.11% (n = 183) were under analgosedation and monitored using the BIS sensor. A median of BIS values of 51.24 ± 14.96 during the morning and 50.75 ± 15.55 during the night were observed. When comparing BIS values and sociodemographic and clinical paediatric variables no statistical significance was detected. CONCLUSIONS Despite the limitations of the BIS, investigations and the present study show that BIS could be a useful instrument to assess grade of sedation in critically ill paediatric patients. However, further investigations which determine the sociodemographic and clinical variables involved in the grade of paediatric analgosedation, as well as studies that contrast the efficacy of clinical scales like the COMFORT Behaviour Scale-Spanish version, are required.
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Caro-Domínguez P, Hernández-Herrera C, Le Cacheux-Morales C, Sánchez-Tatay V, Merchante-García E, Vizcaíno R, Fernández-Pineda I. Ileocolic intussusception: Ultrasound-guided hydrostatic reduction with sedation and analgesia. Radiologia (Engl Ed) 2021; 63:406-414. [PMID: 34625196 DOI: 10.1016/j.rxeng.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The first-choice treatment for ileocolic intussusception is imaging-guided reduction with water, air, or barium. The objectives of the current study were to evaluate the efficacy and safety of ultrasound-guided reduction of intussusception using water in patients under sedation and analgesia. We compare this approach with our previous experience in reduction using barium under fluoroscopic guidance without sedation and analgesia and investigate what factors predispose to surgical correction. MATERIAL AND METHODS We retrospectively reviewed cases of children with ileocolic intussusception treated in a third-level pediatric hospital during a 52-month period: during the first 24 months, reduction was done using barium and fluoroscopy without sedoanalgesia, and during the following 28 months, reduction was done using water and ultrasound with sedoanalgesia. A pediatric radiologist and a pediatrician reviewed the clinical history, surgical records, and imaging studies. RESULTS In the 52-month period, 59 children (41 boys and 18 girls; mean age, 16.0 months) were diagnosed with ileocolic intussusception at our hospital. A total of 33 reductions (28 patients and 5 recurrences) were done using barium under fluoroscopic guidance, achieving a 61% success rate. A total of 38 reductions (31 patients and 7 recurrences) were done using water under ultrasound guidance with patients sedated, achieving a success rate of 76%. No significant adverse effects were observed in patients undergoing ultrasound-guided hydrostatic reduction under sedation, and the success rate in this group was higher (p = 0.20). The factors that predisposed to surgical reduction were greater length of the intussusception (p = 0.03), location in areas other than the right colon (p = 0.002), and a greater length of time between symptom onset and imaging tests (p = 0.08). CONCLUSION Ultrasound-guided hydrostatic reduction of ileocolic intussusception under sedoanalgesia is efficacious and safe.
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Affiliation(s)
- P Caro-Domínguez
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - C Hernández-Herrera
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - C Le Cacheux-Morales
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - V Sánchez-Tatay
- Servicio de Urgencias Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - E Merchante-García
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - R Vizcaíno
- Departamento de Cirugía Pediátrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - I Fernández-Pineda
- Departamento de Cirugía Pediátrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Yuguero-Torres O, López MJ, Cortés E, Boqué C, Navarra M, Jiménez S. Palliative sedation and mortality in emergency departments: descriptive study of cases in the MORCAT registry. Emergencias 2021; 32:118-121. [PMID: 32125111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe the clinical management of palliative sedation and the characteristics of sedated patients in 11 Catalan hospital emergency departments. MATERIAL AND METHODS Prospective descriptive study of a cohort of patients given palliative sedation between April and July 2018. We registered patient demographic and disease data, the Charlson comorbidity index (CCI), patient's point of origin before emergency department arrival, times related to emergency care, and medications used. RESULTS We included 323 patients (48.9% men) with a mean (SD) age of 84 (12) years. The CCIs were significantly higher in patients attended in level-I hospitals. Palliative sedation was the first option in 27% and was initiated within 18 (28) hours of arrival on average, an interval that was significantly shorter in level-II hospitals. Most patients (74.2%) died in the emergency department. CONCLUSION Patients treated with palliative sedation in hospital emergency departments are older and have serious concomitant conditions. Most patients are first treated with intention to cure. Time until the start of palliative sedation differs significantly according to hospital level.
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Affiliation(s)
- Oriol Yuguero-Torres
- Instititut d'Investigació Biomedica de Lleida, IRBLleida, Lleida, España. Grupo de Trabajo Bioética. Sociedad Española de Medicina Urgencias y Emergencias, España
| | - María Jesús López
- Grupo de Trabajo Bioética. Sociedad Española de Medicina Urgencias y Emergencias, España. Servicio de Urgencias, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | - Emilia Cortés
- Grupo de Trabajo Bioética. Sociedad Española de Medicina Urgencias y Emergencias, España. Servicio de Urgencias, Hospital de Calella, Calella, Barcelona, España
| | - Carme Boqué
- Grupo de Trabajo Bioética. Sociedad Española de Medicina Urgencias y Emergencias, España. Servicio de Urgencias. Hospital Universitari Joan XXIII, Tarragona, España
| | - Montse Navarra
- Grupo de Trabajo Bioética. Sociedad Española de Medicina Urgencias y Emergencias, España. Servicio de Urgencias, Hospital Comarcal del Pallars, Tremp, España
| | - Sònia Jiménez
- Grupo de Trabajo Bioética. Sociedad Española de Medicina Urgencias y Emergencias, España. Área de Urgencias, Hospital Clínic, Grupo: Urgencies Procesos y Patologías, Área 1, IDIBAPS, Barcelona, España
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Sistac Ballarín JM, Solé Guixes J, Groizard Botella MJ, Sistac Palacín JM. Use of a single dose of 70mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3,132 cases. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00135-3. [PMID: 34565574 DOI: 10.1016/j.redar.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI). MATERIAL AND METHODS Prospective study conducted from January 2000 to January 2020 in which 3,132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO2, and incidence of complications such as respiratory depression (SatO2 below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home. RESULTS No notable hemodynamic alterations were observed. The incidence of desaturation was 0.41%, awakening during the test was 0.16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of 0.73%. The P value in all cases was<.05%. CONCLUSIONS Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.
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Affiliation(s)
- J M Sistac Ballarín
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Facultad de Medicina, Universitat de Lleida, Lleida, España.
| | - J Solé Guixes
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - M J Groizard Botella
- Servicio de Anestesiología y Reanimación, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - J M Sistac Palacín
- Hospital Universitario de Leganés, Facultad de Medicina, Universidad Alfonso X el Sabio, Leganés, Madrid, España
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Jimeno Ruiz S, Riaza Gómez M, Cárdenas Rebollo JM, López-Escobar A. Material and sedation-analgesia in the neonatal lumbar puncture procedure. An Pediatr (Barc) 2021; 95:246-252. [PMID: 34521603 DOI: 10.1016/j.anpede.2020.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/30/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Lumbar puncture (LP) is a frequent procedure during the neonatal period. Correctly performing this technique can avoid many of its complications. OBJECTIVE To evaluate the LP procedure in neonates in Spanish hospitals, studying the type of material and the sedation-analgesia used. MATERIAL AND METHODS Cross-sectional study conducted in Spain gathering data through a survey research distributed by email through the Segurneo-SEN Hospital Network and the Spanish Neonatal Society. Data on the LP technique in neonates were collected. RESULTS A total of 301 participants were analysed. Most professionals used a trocar needle with a stylet as the first option (89.7%); however, when the LP failed or was blood-stained, 32.2% changed the type of needle. A total of 143 doctors gave their subjective feeling about the type of needle: they only use trocar needles with stylet (41.3%), the technique is easier using scalp-vein needles (32.2%), there is less probability of a blood-stained LP, or failed using scalp-vein needles (7.7%), they choose the type of needle depending on the size of the newborn (10.5%), indifference when using one type or another needle (8.4%). Almost all (99%) of the surveyed doctors used some type of analgesia. The most widely used measures were topical anaesthetics (90.3%) and sucrose (82.2%). CONCLUSIONS Currently, the LP procedure in the neonatal period is mainly performed with a trocar needle with a stylet and with the widespread use of different analgesic measures.
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Affiliation(s)
- Sara Jimeno Ruiz
- Unidad de Neonatología, Departamento de Pediatría, HM Hospitales, Madrid, Spain; Facultad de Medicina, Universidad San Pablo CEU, Madrid, Spain; Fundación de Investigación HM Hospitales, HM Hospitales, Madrid, Spain
| | - Mónica Riaza Gómez
- Unidad de Neonatología, Departamento de Pediatría, HM Hospitales, Madrid, Spain; Comisión Segurneo, Sociedad Española de Neonatología, Spain
| | - José Miguel Cárdenas Rebollo
- Departamento de Matemática Aplicada y Estadística, Facultad de Ciencias Económicas, Universidad San Pablo CEU, Madrid, Spain
| | - Alejandro López-Escobar
- Fundación de Investigación HM Hospitales, HM Hospitales, Madrid, Spain; Servicio de Pediatría. Hospital Vithas Madrid La Milagrosa; Unidad de Investigación Clínica. Fundación Vithas. Grupo Vithas.
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Bosch-Alcaraz A, Tamame-San Antonio M, Luna-Castaño P, Garcia-Soler P, Falcó Pegueroles A, Alcolea-Monge S, Fernández Lorenzo R, Piqueras-Rodríguez P, Molina-Gallego I, Potes-Rojas C, Gesti-Senar S, Orozco-Gamez R, Tercero-Cano MC, Saz-Roy MÁ, Jordan I, Belda-Hofheinz S. Specificity and sensibility of the Spanish version of the COMFORT Behaviour Scale for assessing pain, grade of sedation and withdrawal syndrome in the critically ill paediatric patient. Multicentre COSAIP study (Phase 1). Enferm Intensiva (Engl Ed) 2021; 33:S1130-2399(21)00055-9. [PMID: 34226130 DOI: 10.1016/j.enfi.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/01/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
AIM The main aim of this investigation was to analyse the specificity and sensibility of the COMFORT Behaviour Scale (CBS-S) in assessing grade of pain, sedation, and withdrawal syndrome in paediatric critical care patients. METHOD An observational, analytical, cross-sectional and multicentre study conducted in Level III Intensive Care Areas of 5 children's university hospitals. Grade of sedation was assessed using the Spanish version of the CBS-S and the Bispectral Index on sedation, once per shift over one day. Grade of withdrawal was determined using the CBS-S and the Withdrawal Assessment Tool-1, once per shift over three days. RESULTS A total of 261 critically ill paediatric patients with a median age of 5.07 years (P25:0.9-P75:11.7) were included in this study. In terms of the predictive capacity of the CBS-S, it obtained a Receiver Operation Curve of .84 (sensitivity of 81% and specificity of 76%) in relation to pain; .62 (sensitivity of 21% and specificity of 78%) in relation to sedation grade, and .73% (sensitivity of 40% and specificity of 74%) in determining withdrawal syndrome. CONCLUSIONS The Spanish version of the COMFORT Behaviour Scale could be a useful, sensible and easy scale to assess the degree of pain, sedation and pharmacological withdrawal of critically ill paediatric patients.
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Affiliation(s)
- A Bosch-Alcaraz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España.
| | | | - P Luna-Castaño
- Unidad de Apoyo a la Investigación Enfermera, Hospital Universitario La Paz, Madrid, España
| | - P Garcia-Soler
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario Carlos Haya, Málaga, España
| | - A Falcó Pegueroles
- Departamento de Enfermería Fundamental y Medicoquirúrgica, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, España. Miembro de un grupo de investigación consolidado entorno a técnicas estadísticas aplicadas a la psicología (SGR 2014-326)
| | - S Alcolea-Monge
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - R Fernández Lorenzo
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - P Piqueras-Rodríguez
- Máster en Cuidados Críticos, Supervisor Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, España
| | - I Molina-Gallego
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, España
| | - C Potes-Rojas
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - S Gesti-Senar
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - R Orozco-Gamez
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
| | - M C Tercero-Cano
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Á Saz-Roy
- Departamento de Enfermería de Salud Pública, Salud Mental y Maternoinfantil, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, España
| | - I Jordan
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - S Belda-Hofheinz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
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16
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Bosch-Alcaraz A, Alcolea-Monge S, Fernández Lorenzo R, Luna-Castaño P, Belda-Hofheinz S, Falcó Pegueroles A, Piqueras-Rodríguez P, Molina-Gallego I, Potes-Rojas C, Gesti-Senar S, Orozco-Gámez R, Tercero-Cano MC, Saz-Roy MÁ, Jordan I, García-Soler P, Tamame-San Antonio M. Grade of sedation in the critically ill paediatric patient and its correlation with sociodemographic and clinical variables. Multicentre COSAIP study. Enferm Intensiva (Engl Ed) 2021; 32:S1130-2399(21)00002-X. [PMID: 33824050 DOI: 10.1016/j.enfi.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/19/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Abstract
AIMS To determine the grade of sedation in the critically ill paediatric patient using Biespectral Index Sensor (BIS) and to analyse its relationship with sociodemographic and clinical patient variables. METHODS Observational, analytical, cross-sectional and multicentre study performed from May 2018 to January 2020 in 5 Spanish paediatric critical care units. Sex, age, reason for admission, presence of a chronic pathology, type and number of drugs and length of stay were the sociodemographic and clinical variables registered. Furthermore, the grade of sedation was assessed using BIS, 11per shift over 24hours. RESULTS A total of 261 paediatric patients, 53.64% of whom were male, with a median age of 1.61 years (0.35-6.55), were included in the study. Of the patients, 70.11% (n=183) were under analgosedation and monitored using the BIS sensor. A median of BIS values of 51.24±14.96 during the morning and 50.75±15.55 during the night were observed. When comparing BIS values and sociodemographic and clinical paediatric variables no statistical significance was detected. CONCLUSIONS Despite the limitations of the BIS, investigations and the present study show that BIS could be a useful instrument to assess grade of sedation in critically ill paediatric patients. However, further investigations which determine the sociodemographic and clinical variables involved in the grade of paediatric analgosedation, as well as studies that contrast the efficacy of clinical scales like the COMFORT Behaviour Scale-Spanish version, are required.
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Affiliation(s)
- A Bosch-Alcaraz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España.
| | - S Alcolea-Monge
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - R Fernández Lorenzo
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - P Luna-Castaño
- Unidad de Apoyo a la Investigación Enfermera, Hospital Universitario La Paz, Madrid, España
| | - S Belda-Hofheinz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Falcó Pegueroles
- Departamento de Enfermería Fundamental y Medicoquirúrgica, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España
| | - P Piqueras-Rodríguez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, España
| | - I Molina-Gallego
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, España
| | - C Potes-Rojas
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell (Barcelona), España
| | - S Gesti-Senar
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell (Barcelona), España
| | - R Orozco-Gámez
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
| | - M C Tercero-Cano
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Á Saz-Roy
- Departamento de Enfermería de Salud Pública, Salud Mental y Maternoinfantil, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, España
| | - I Jordan
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - P García-Soler
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario Carlos Haya, Málaga, España
| | - M Tamame-San Antonio
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell (Barcelona), España
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Valente MF, Simões FJ, Mourão J. General anesthesia vs. sedation in transcatheter aortic valve implantation (TAVI): retrospective study of the incidence of acute kidney injury. ACTA ACUST UNITED AC 2021; 68:121-127. [PMID: 33487457 DOI: 10.1016/j.redar.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Anesthetic techniques have been reported as having an impact on acute kidney injury (AKI) incidence in the postoperative period in patients undergoing transcatheter aortic valve implantation (TAVI). This study aimed to assess whether exists an association between anesthetic approach in patients undergoing TAVI and the post-operative AKI incidence. The existence of association between anesthetic approach and mortality was also assessed. MATERIALS AND METHODS A retrospective, single-center, observational study was conducted at the Centro Hospitalar Universitário de São João, a Portuguese reference center. All patients undergoing TAVI from January 2015 to June 2018 were recruited and were divided into two groups for analysis: general anesthesia (GA) and sedation. RESULTS One hundred and seven patients underwent TAVI (GA: n = 24; sedation: n = 83) and the overall incidence of AKI was 14.02%. We found a higher incidence of intraoperative hypotension in the GA group (83.3 vs. 33.7%, p < 0.001). Regarding postoperative outcomes, there were no significant differences in AKI incidence (20.8 vs. 12.0%, p = 0.319) and mortality. A significant association was found between postoperative AKI and preexisting chronic kidney disease (CKD), preoperative heart failure functional class, intraoperative hypotension, longer length of stay in level II unit, longer hospital stay and worsening of previous CKD stage. CONCLUSIONS It was not possible to established association between the anesthetic approach for TAVI procedures and postoperative AKI and mortality. Our study reinforces the importance of preventing AKI incidence, considering its impact on the worsening of baseline CKD and on the length of stay, leading to higher hospitalization costs.
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Affiliation(s)
- M F Valente
- Servicio de Anestesiología, Centro Hospitalar Universitario Sao Joao, Porto, Portugal; MEDCIDS, Departamento de Medicina da Comunidad, Información y Decisión en Salud, Facultad de Medicina de Universidad de Porto, Porto, Portugal.
| | - F J Simões
- Facultad de Medicina de Universidad de Porto, Porto, Portugal
| | - J Mourão
- Servicio de Anestesiología, Centro Hospitalar Universitario Sao Joao, Porto, Portugal; Departamento de Cirugía y Fisiología, Facultad de Medicina de Universidad de Porto, Porto, Portugal
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León-Valenzuela A, Román Malo C, González López M, Sánchez Palacios J, Sánchez Tarifa P, Del Pino Algarrada R. [Sevoflurane sedation protocol in children with cerebral palsy undergoing botulinum toxin-A injections]. Rehabilitacion (Madr) 2021; 55:266-272. [PMID: 33468348 DOI: 10.1016/j.rh.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to describe our experience with a protocol based on sevoflurane sedation to control pain and agitation during botulinum toxin-A (BoNT-A) infiltration in children with cerebral palsy (CP), especially in terms of safety and efficacy. MATERIAL AND METHODS We conducted a retrospective observational study of patients diagnosed with CP who underwent BoNT-A infiltration with sevoflurane sedation from November 2012 to December 2019. Demographic, clinical and functional characteristics, the effectiveness of sedation, adverse events (AE) and professional satisfaction were reviewed. RESULTS A total of 387 sedations were successfully performed in 74 patients. Effective sedation was achieved in 100% of procedures, facilitating collaboration during infiltration and improving professional satisfaction. AE were reported in 6.02% of the procedures, the most frequent being nausea and vomiting (3.88%) and transient hypoxemia (2.07%). There were no severe AE. No association was found between the incidence of AE and the clinical and functional variables or risk before anaesthesia. CONCLUSION Sevoflurane sedation shows promising results in terms of safety and effectiveness for the management of agitation and pain during BoNT-A infiltration in our daily clinical practice. In addition, it can facilitate infiltration, allowing examination under sedation and multilevel infiltration with good tolerance.
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Affiliation(s)
- A León-Valenzuela
- Unidad Gestión Clínica Medicina Física y Rehabilitación, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España; Departamento Materno Infantil, Facultad de Medicina, Universidad de Cádiz, Cádiz, España; Grupo iRehab, Instituto de Investigación e Innovación Biomédica de Cádiz, Cádiz, España.
| | - C Román Malo
- Unidad Gestión Clínica Medicina Física y Rehabilitación, Hospital Universitario Puerta del Mar, Cádiz, España
| | - M González López
- Unidad Gestión Clínica Medicina Física y Rehabilitación, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España
| | - J Sánchez Palacios
- Unidad Gestión Clínica Medicina Física y Rehabilitación, Hospital Universitario Puerta del Mar, Cádiz, España
| | - P Sánchez Tarifa
- Unidad Gestión Clínica Medicina Física y Rehabilitación, Hospital Universitario Puerta del Mar, Cádiz, España
| | - R Del Pino Algarrada
- Unidad Gestión Clínica Medicina Física y Rehabilitación, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España; Grupo iRehab, Instituto de Investigación e Innovación Biomédica de Cádiz, Cádiz, España
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Bosch-Alcaraz A, Luna-Castaño P, Garcia-Soler P, Tamame-San Antonio M, Falcó-Pegueroles A, Alcolea-Monge S, Fernández Lorenzo R, Piqueras-Rodríguez P, Molina-Gallego I, Potes-Rojas C, Gesti-Senar S, Orozco-Gamez R, Tercero-Cano MC, Saz-Roy MÁ, Jordan I, Belda-Hofheinz S. [Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2)]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30475-6. [PMID: 33317976 DOI: 10.1016/j.anpedi.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/11/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. METHODS An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneous assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). RESULTS A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR=0.35-6.55) were included. An overall discomfort score of 10.79±3.7 was observed during morning compared to 10.31±3.3 observed during the night. When comparing analgosedation and non-analgosedation groups, statistically differences were found in both shifts (χ2: 45.48; P=.001). At the same time, an association was observed (P<.001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. CONCLUSIONS As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.
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Affiliation(s)
- Alejandro Bosch-Alcaraz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu de Barcelona, Barcelona, España; Departamento de Enfermería de Salud Pública, Salud Mental y Maternoinfantil. Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España.
| | - Patricia Luna-Castaño
- Unidad de Apoyo a la Investigación Enfermera, Hospital Universitario La Paz, Madrid, España
| | - Patricia Garcia-Soler
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario Carlos Haya, Málaga, España
| | | | - Anna Falcó-Pegueroles
- Departamento de Enfermería Fundamental y Medicoquirúrgica, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España
| | - Sandra Alcolea-Monge
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu de Barcelona, Barcelona, España
| | - Rocío Fernández Lorenzo
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu de Barcelona, Barcelona, España
| | | | - Irene Molina-Gallego
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, España
| | - Cristina Potes-Rojas
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Silvia Gesti-Senar
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Rocío Orozco-Gamez
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - M Ángeles Saz-Roy
- Departamento de Enfermería de Salud Pública, Salud Mental y Maternoinfantil. Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España
| | - Iolanda Jordan
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu de Barcelona, Barcelona, España
| | - Sylvia Belda-Hofheinz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
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Jimeno Ruiz S, Riaza Gómez M, Cárdenas Rebollo JM, López-Escobar A. [Material and sedation-analgesia in the neonatal lumbar puncture procedure]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30284-8. [PMID: 32998845 DOI: 10.1016/j.anpedi.2020.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Lumbar puncture (LP) is a frequent procedure during the neonatal period. Correctly performing this technique can avoid many of its complications. OBJECTIVE To evaluate the LP procedure in neonates in Spanish hospitals, studying the type of material and the sedation-analgesia used. MATERIAL AND METHODS Cross-sectional study conducted in Spain gathering data through a survey research distributed by email through the Segurneo-SEN Hospital Network and the Spanish Neonatal Society. Data on the LP technique in neonates were collected. RESULTS A total of 301 participants were analysed. Most professionals used a trocar needle with a stylet as the first option (89.7%); however, when the LP failed or was blood-stained, 32.2% changed the type of needle. A total of 143 doctors gave their subjective feeling about the type of needle: they only use trocar needles with stylet (41.3%), the technique is easier using scalp-vein needles (32.2%), there is less probability of a blood-stained LP, or failed using scalp-vein needles (7.7%), they choose the type of needle depending on the size of the new-born (10.5%), indifference when using one type or another needle (8.4%). Almost all (99%) of the surveyed doctors used some type of analgesia. The most widely used measures were topical anaesthetics (90.3%) and sucrose (82.2%). CONCLUSIONS Currently, the LP procedure in the neonatal period is mainly performed with a trocar needle with a stylet and with the widespread use of different analgesic measures.
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Affiliation(s)
- Sara Jimeno Ruiz
- Unidad de Neonatología, Departamento de Pediatría, HM Hospitales, Madrid, España; Facultad de Medicina, Universidad San Pablo CEU, Madrid, España; Fundación de Investigación HM Hospitales, HM Hospitales, Madrid, España
| | - Mónica Riaza Gómez
- Unidad de Neonatología, Departamento de Pediatría, HM Hospitales, Madrid, España; Comisión Segurneo, Sociedad Española de Neonatología, España
| | - José Miguel Cárdenas Rebollo
- Departamento de Matemática Aplicada y Estadística, Facultad de Ciencias Económicas, Universidad San Pablo CEU, Madrid, España
| | - Alejandro López-Escobar
- Unidad de Neonatología, Departamento de Pediatría, HM Hospitales, Madrid, España; Facultad de Medicina, Universidad San Pablo CEU, Madrid, España; Fundación de Investigación HM Hospitales, HM Hospitales, Madrid, España.
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Sanllorente-Sebastián R, Rodríguez-Joris E, Avello-Taboada R, Fernández-López L, Ayerza-Casas V, Robador-Martínez D. Addition of serratus-intercostal plane block/BRILMA for arteriovenous access surgery. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:343-346. [PMID: 32439231 DOI: 10.1016/j.redar.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/14/2019] [Accepted: 10/29/2019] [Indexed: 06/11/2023]
Abstract
ARTERIOVENOUS: access creation is mandatory in patients with end stage renal disease for hemodialysis treatment. It frequently involves upper arm or axillary dissection and general anesthesia is predominantly used as axillary compartment innervation is complex. Avoiding general anesthesia may be beneficial in these risk patients. We present two cases where serratus-intercostal plane block (SIPB/BRILMA) was used, along with ultrasound guided supraclavicular block and multimodal analgesia for proximal arm and axillary AV access surgery. Regional anesthesia combination of supraclavicular and serratus-intercostal/BRILMA block in arteriovenous fistula surgery was successful and should be considered by anesthesiologist in order to avoid general anesthesia.
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Affiliation(s)
| | - E Rodríguez-Joris
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - R Avello-Taboada
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - L Fernández-López
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - V Ayerza-Casas
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - D Robador-Martínez
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
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Nacher-Fuentes L, Sanchez-Pujol A, Rodriguez-Navarro S, Duran-Ayra L. Dexmedetomidine implementation in pain management in the immediate postoperative period of cardiac surgery. Enferm Intensiva (Engl Ed) 2019; 31:105-112. [PMID: 31694783 DOI: 10.1016/j.enfi.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study arose from the need to improve all tasks related to monitoring pain in post cardiac surgery patients. OBJECTIVES Checking and quantifying the pain suffered by patients undergoing cardiac surgery in the first 24hours of their stay in the intensive care unit (ICU), treated with Dexmedetomidine (Dex) as analgesic adjuvant, as well as their degree of sedation and the need for opiates such as rescue analgesia. MATERIAL AND METHODS Unicentric study, observational, descriptive, from April 2016 to September 2017. Both genders, all adult, undergoing cardiac surgery, operating theatre-extubated and Dex continuous infusion carriers. Pain degree level was evaluated by the Visual analogue Scale of Pain (VAS), from immediately post-surgery until 24hours from ICU entry and sedation degree, by the Richmond Sedation Agitation Scale (RASS), only while the Dex infusion lasted. RESULTS 109 patients were included. The results obtained showed that the average pain suffered by patients during the first 24hours was .47 with standard deviation (SD) of 1.25; the average maximum pain experienced was 3.58 with a range of 0 to 8 and the RASS average was -.68 (SD: 0,80). In addition, 44.04% of the patients needed rescue opiates, although only 7.32% showed severe pain greater than 6. CONCLUSIONS The Dex infusion patients showed mild levels of pain, however, a small percentage, who must be taken into account, suffered severe pain.
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Affiliation(s)
- L Nacher-Fuentes
- Unidad de Cuidados Intensivos (UCI), Centro Médico Teknon Quirón-Salud, Barcelona, España.
| | - A Sanchez-Pujol
- Unidad de Cuidados Intensivos (UCI), Centro Médico Teknon Quirón-Salud, Barcelona, España
| | - S Rodriguez-Navarro
- Unidad de Cuidados Intensivos (UCI), Centro Médico Teknon Quirón-Salud, Barcelona, España
| | - L Duran-Ayra
- Unidad de Cuidados Intensivos (UCI), Centro Médico Teknon Quirón-Salud, Barcelona, España
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Celis-Rodríguez E, Díaz Cortés JC, Cárdenas Bolívar YR, Carrizosa González JA, Pinilla DI, Ferrer Záccaro LE, Birchenall C, Caballero López J, Argüello BM, Castillo Abrego G, Castorena Arellano G, Dueñas Castell C, Jáuregui Solórzano JM, Leal R, Pardo Oviedo JM, Arroyo M, Raffán-Sanabria F, Raimondi N, Reina R, Rodríguez Lima DR, Silesky Jiménez JI, Ugarte Ubiergo S, Gómez Escobar LG, Díaz Aya DP, Fowler C, Nates JL. Evidence-based clinical practice guidelines for the management of sedoanalgesia and delirium in critically ill adult patients. Med Intensiva 2019; 44:171-184. [PMID: 31492476 DOI: 10.1016/j.medin.2019.07.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/02/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022]
Abstract
Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented.
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Affiliation(s)
- E Celis-Rodríguez
- Anestesiología y Medicina Crítica y Cuidado Intensivo, Departamento de Medicina Crítica y Cuidado Intensivo, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad del Rosario, Universidad de Los Andes, Bogotá, Colombia.
| | - J C Díaz Cortés
- Anestesiología, Medicina Crítica y Epidemiología, Clínica Marly JCG, Universidad del Rosario, Bogotá, Colombia
| | - Y R Cárdenas Bolívar
- Medicina Crítica y Cuidado Intensivo, Universidad del Rosario, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J A Carrizosa González
- Medicina Crítica y Cuidado Intensivo, Epidemiología, Universidad del Rosario, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D-I Pinilla
- Anestesiología, Medicina Crítica, Hospital Universitario Fundación Santa Fe de Bogotá, Hospital Mayor de Mederi, Bogotá, Colombia
| | - L E Ferrer Záccaro
- Anestesiología y Medicina Crítica, Universidad de Los Andes, Universidad El Bosque, Universidad del Rosario, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - C Birchenall
- Medicina Interna y Cuidado Intensivo, Clínica Universitaria Colombia, Hospital Universitario Mayor-Mederi, Bogotá, Colombia
| | - J Caballero López
- Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova de LLeida, Institut de Recerca Biomèdica de LLeida IRBLleida, Departament de Medicina de la Universitat Autònoma de Barcelona UAB, España
| | - B M Argüello
- Anestesiología y Medicina Crítica y Cuidado Intensivo, Hospital Central de Managua, Managua, Nicaragua
| | - G Castillo Abrego
- Cirugía General, Medicina Crítica y Cuidado Intensivo, Pacífica Salud-Hospital Punta Pacífica, Panamá, República de Panamá
| | - G Castorena Arellano
- Anestesiología y Medicina Crítica, Hospital General Manuel Gea González, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - C Dueñas Castell
- Neumología y Medicina Crítica, Universidad de Cartagena, UCI Gestión Salud, UCI Santa Cruz de Bocagrande, Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva, Cartagena, Colombia
| | | | - R Leal
- Anestesiología, Fundación Clínica Médica Sur, Ciudad de México, México
| | - J M Pardo Oviedo
- Medicina Interna y Medicina Crítica y Cuidados Intensivos, Universidad del Rosario, Universidad del Bosque, Hospital Universitario Mayor-Mederi, Fundación Cardio-infantil, Universidad del Rosario, Bogotá, Colombia
| | - M Arroyo
- Medicina Crítica y Cuidado Intensivo, Servicio de Terapia Intensiva, Hospital Universitario de Caracas, Universidad Central de Venezuela, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - F Raffán-Sanabria
- Anestesiología y Medicina Crítica, Universidad del Bosque, Universidad de Los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - N Raimondi
- Medicina Crítica y Cuidado Intensivo, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - R Reina
- Medicina Crítica y Cuidado Intensivo, Hospital Interzonal de Agudos General José de San Martín, Buenos Aires, Argentina
| | - D R Rodríguez Lima
- Medicina de Emergencias y Medicina Crítica y Cuidado Intensivo Universidad del Rosario, Hospital Mayor Mederi, Bogotá, Colombia
| | - J I Silesky Jiménez
- Medicina Crítica y Cuidado Intensivo, Casa Hospital San Juan de Dios/ Hospital CIMA, San José, Costa Rica
| | - S Ugarte Ubiergo
- Medicina Interna y Medicina Crítica y Cuidado Intensivo, Universidad Andrés Bello, Clínica INDISA, Red de Medicina Intensiva, Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva, Santiago de Chile, Chile
| | - L G Gómez Escobar
- Medicina, Universidad de Los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D P Díaz Aya
- Medicina, Universidad de Los Andes, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - C Fowler
- Research Services & Assessment Manager, Research Medical Library, The University of Texas MD Anderson Cancer Center, Texas, EE. UU
| | - J L Nates
- Anestesiología y Medicina Crítica y Cuidado Intensivo, Departamento de Medicina Crítica, Cuidado Intensivo y Terapia Respiratoria; The University of Texas MD Anderson Cancer Center, Houston, Texas, EE. UU
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Arias-Rivera S, López-López C, Frade-Mera MJ, Via-Clavero G, Rodríguez-Mondéjar JJ, Sánchez-Sánchez MM, Acevedo-Nuevo M, Gil-Castillejos D, Robleda G, Cachón-Pérez M, Latorre-Marco I. Assessment of analgesia, sedation, physical restraint and delirium in patients admitted to Spanish intensive care units. Proyecto ASCyD. Enferm Intensiva (Engl Ed) 2019; 31:3-18. [PMID: 31003871 DOI: 10.1016/j.enfi.2018.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/15/2018] [Accepted: 11/23/2018] [Indexed: 01/25/2023]
Abstract
AIMS Main aim: To determine the Spanish intensive care units (ICU) that assess and record pain levels, sedation/agitation, delirium and the use of physical restraint (PR) as standard practice. Secondary aims: To determine the use of validated assessment tools and to explore patients' levels of pain and sedation/agitation, the prevalence of delirium, and the use of PR. METHOD An observational, descriptive, cross-sectional, prospective and multicentre study using an ad hoc survey with online access that consisted of 2 blocks. Block I: with questions on the unit's characteristics and routine practice; Block II: aspects of direct care and direct assessments of patients admitted to participating units. RESULTS One hundred and fifty-eight units and 1574 patients participated. The pain of communicative patients (CP) was assessed and recorded as standard in 109 units (69%), the pain of non-communicative patients (NCP) in 84 (53%), sedation/agitation in 111 (70%), and delirium in 39 units (25%). There was recorded use of PR in 39 units (25%). Validated scales were used to assess the pain of CP in 139 units (88%), of NCP in 102 (65%), sedation/agitation in 145 (92%), delirium in 53 units (34%). In 33 units (21%) pain, sedation/agitation and delirium of PC and NPC was assessed, and in 8 of these units there was a specific PR protocol and register. Among the patients who could be assessed, an absence of pain was reported in 57%, moderate pain in 27%; 48% were calm and collaborative, and 10% agitated; 21% had PR, and 12.6% of the patients had delirium. CONCLUSIONS The assessment of pain, sedation and delirium is demonstrated, and low percentages of agitation and delirium achieved. We observed a high percentage of patients with pain, and moderate use of PC. We should generalise the use of protocols to assess, prevent and treat pain and delirium by appropriately managing analgesia, sedation, and individual and well-considered use of PC. (ClinicalTrials.gov Identifier: NCT03773874).
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Affiliation(s)
- S Arias-Rivera
- Hospital Universitario de Getafe, Getafe, Madrid, España; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España.
| | - C López-López
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitario 12 de Octubre, Madrid, España; Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, España; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Madrid, España
| | - M J Frade-Mera
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitario 12 de Octubre, Madrid, España; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Madrid, España
| | - G Via-Clavero
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitari de Bellvitge (GRIN-IDIBELL), Hospitalet de Llobregat, Barcelona, España
| | - J J Rodríguez-Mondéjar
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Gerencia de Urgencias y Emergencias 061, Servicio Murciano de Salud, Murcia, España; Universidad de Murcia, Instituto Murciano de Investigación Biomédica del HCU Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España
| | - M M Sánchez-Sánchez
- Hospital Universitario de Getafe, Getafe, Madrid, España; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España
| | - M Acevedo-Nuevo
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España; Facultad de Ciencias de la Salud, Universidad Autónoma de Madrid, Madrid, España
| | - D Gil-Castillejos
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitario Juan XXIII, Tarragona, España
| | - G Robleda
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Escuela Superior de Enfermería Mar (ESIMar), Universidad Pompeu Fabra, Barcelona, España; Centro Cochrane Iberoamericano, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Cachón-Pérez
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - I Latorre-Marco
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España
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Cantador-Hornero M, Jiménez-Espuch P, de Torres-Garcia I, Contreras-Jiménez M, Martínez-Mezo GL, Morales de Los Santos JM, Fernández-Jurado MI, Tirado-Reyes M. [Sedation-analgesia protocol for the injection of botulinum toxin A in cerebral palsy]. An Pediatr (Barc) 2019; 91:317-27. [PMID: 30795881 DOI: 10.1016/j.anpedi.2018.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/05/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the sedation-analgesia technique on the pain experienced by the patient. METHODS This cross-sectional study was conducted on consecutive patients with cerebral palsy (CP) who underwent infiltration with botulinum toxin A (BoTNA). The patients were divided into 4 different groups according to the analgesic strategy assigned: Group I, without sedation or topical anaesthetic cream; Group II, inhalation of nitrous oxide; Group III, deep intravenous sedation; and Group IV, light sedation with benzodiazepines. Pain was assessed with different scales depending on patient age. Parents were asked to rate their satisfaction with their child's comfort by using a 5-point Likert-type scale. The primary end-point was the proportion of patients that experienced a pain level equal or lower than 2, according to pain scales, in the different study groups. RESULTS Of the 124 patients included in the study, 56 (45.2%) experienced a pain level ≤2. In the Group III a significantly greater proportion of patients were classified with a pain level score ≤2, P<.001, as compared with all the study groups, respectively. The BoTNA injection was guided by ultrasonography in 109 (87.9%) patients, and by palpation in 15 (12.1%). CONCLUSION The results of this study suggested that, in patients with CP treated with BoTNA injections, the sedation-analgesic strategy had a significant impact on the pain experienced by the subject. Selecting an appropriate analgesic strategy is crucial for reducing the stress associated with the administration of BoTNA injections in children with CP.
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Sanllorente-Sebastián R, de Vicente-Lorenzo JM, Mediavilla-Herrera FJ, Gutiérrez-García S, Alario-Poza IS, Bustinza-Beaskoetxea Z. Case report: serratus intercostal plane block/BRILMA and sedation for mastectomy in a high risk patient. Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:46-48. [PMID: 30115502 DOI: 10.1016/j.redar.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
Breast cancer surgery can benefit from regional anaesthesia techniques, which can be used as a sole anaesthetic procedure in some cases where risk for general anaesthesia is high. Regional anaesthesia allows early recovery, reduces postoperative opioid and non opioid analgesics consumption and helps early home discharge, reducing thus costs. We present a case of an 87-year-old woman with multiple comorbidities who underwent breast cancer surgery. The patient was successfully surgically treated under serratus intercostal plane block anaesthesia. We discuss the use and benefits of the serratus intercostal plane block in thoracic procedures.
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Affiliation(s)
| | - J M de Vicente-Lorenzo
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - F J Mediavilla-Herrera
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - S Gutiérrez-García
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Burgos, Burgos, España
| | - I S Alario-Poza
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Burgos, Burgos, España
| | - Z Bustinza-Beaskoetxea
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Burgos, Burgos, España
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Fernández-Landa MJ, Aginagalde AH, Arana-Arri E, Bujanda L, Idígoras I, Bilbao I, Portillo I, Jover R. Quality indicators and patient satisfaction in colonoscopy. Gastroenterol Hepatol 2019; 42:73-81. [PMID: 30170708 DOI: 10.1016/j.gastrohep.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/29/2018] [Accepted: 07/17/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Colonoscopy is the diagnostic/therapeutic confirmation test for colorectal cancer. The monitoring of the experience of people who have undergone the test is interesting to improve the quality of the colonoscopy. The aim of the project was to study factors affecting patients' experience and their relationship with the quality indicators of the Clinical Practice Guidelines. PATIENTS AND METHODS An observational cross-sectional study was conducted, including quality and experience indicators (adapted mGHAA-9 questionnaire and clinical history) in a sample of 432 participants aged between 40- and 75-years-old who had undergone a colonoscopy in 2015. Univariate and multivariate analysis with multiple logistic regression. RESULTS Satisfaction was associated in the multivariate analysis with evaluating the waiting time for the colonoscopy as short (OR=3.80) (1.76-10.90, 95% CI),>55-years-old (OR=2.60) (1.19-5.68, 95% CI), rating the experience with the preparation positively (OR=7.34) (3.15-17.09, 95% CI), not reporting pain or discomfort during the procedure (OR=3.71) (1.03-13.40, 95% CI) (P=.006) and being examined in a tertiary hospital (OR=2.81) (1.17-6.72; 95% CI) (P=.020). DISCUSSION The mGHAA-9 questionnaire adapted to Spanish is useful to evaluate patient experience factors. There are aspects to improve in terms of waiting time, colon cleansing, satisfaction with preparation and post-colonoscopy problems. Interventions should be implemented to enhance patient experience and colonoscopy quality.
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Cabadas Avion R, Ojea Cendón M, Leal Ruiloba MS, Baluja González MA, Sobrino Ramallo J, Álvarez Escudero J. Prospective analysis of the complications, efficacy, and satisfaction level on the sedation performed by anaesthetists in gastrointestinal endoscopy. ACTA ACUST UNITED AC 2018; 65:504-513. [PMID: 30055768 DOI: 10.1016/j.redar.2018.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/13/2018] [Accepted: 06/25/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the anaesthesia/sedation complications during gastrointestinal endoscopy, as well as comparing scheduled procedures versus urgent procedures. METHODS A protocol was developed to define the anaesthesia/sedation in gastrointestinal endoscopy, where the anaesthetist should always be present. These include ASA 3 and 4 patients, complex tests such as polypectomies, endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound, deep sedation, or patients with probable difficult airway management. An analysis was made of the safety based on the complications recorded from the data directly collected automatically from the monitors, both during the sedation and in the recovery unit. An analysis was also performed on the risk factors associated with cardiorespiratory complications, the effectiveness based on the completed tests and the overall level of satisfaction through an interview using a satisfaction scale. RESULTS The study included a total of 3746 patients over a 7 year-period. The incidence of major complications was low, especially haemodynamic and respiratory complications. An incidence of hypoxaemia of 3% was found in scheduled endoscopy versus 5.7% in urgent endoscopy (P<.05). The rate of hypotension was also low, with significant differences between scheduled and urgent endoscopy (6.4% vs. 18.8%, P<.001). In present study, no test had to be suspended due to poor patient tolerance, and the satisfaction was high in more than 99% of cases. CONCLUSION The participation of the anaesthetist in sedation for gastrointestinal endoscopy has shown excellent results in this study, in terms of safety and efficacy, mainly in the most serious patients and complex tests, as well as a high level of satisfaction.
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Affiliation(s)
| | - M Ojea Cendón
- Servicio de Anestesiología, Hospital Povisa, Vigo, España
| | | | - M A Baluja González
- Servicio de Anestesiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, España
| | | | - J Álvarez Escudero
- Servicio de Anestesiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, España
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García García de Paredes A, Mateos Muñoz B, Albillos A. [Gastrointestinal endoscopy in patients of advanced age]. Rev Esp Geriatr Gerontol 2018; 53:293-298. [PMID: 29598971 DOI: 10.1016/j.regg.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 11/17/2022]
Abstract
The dramatic increase in life expectancy is leading to a significant increase in the use of gastrointestinal endoscopy in the elderly. Taking into account these demographic changes, the use of gastrointestinal endoscopy in this age group is of great importance. Although these procedures are generally safe and well tolerated even in very elderly patients, the onset of physiological changes associated with aging and the increased prevalence of cardiovascular and pulmonary comorbidities raise the risk of sedation related complications in these patients. Age alone is not a contraindication for performing any endoscopic procedure. However, elderly patients have their own peculiarities that require a detailed review of the characteristics, risks and benefits of endoscopic procedures in this specific context.
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Affiliation(s)
- Ana García García de Paredes
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
| | - Beatriz Mateos Muñoz
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - Agustín Albillos
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
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Terada Y, Inoue S, Konda M, Egawa J, Ueda J, Kirita T, Kawaguchi M. Effects of deep sedation under mechanical ventilation on cognitive outcome in patients undergoing surgery for oral and maxillofacial cancer and microvascular reconstruction. Med Intensiva 2017; 43:3-9. [PMID: 29258778 DOI: 10.1016/j.medin.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/10/2017] [Accepted: 11/13/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Cognitive impairment after intensive care unit (ICU) admission is becoming increasingly recognized. High-dose deep sedation has been suggested to play an important role in the development of cognitive impairment. However, the impact of heavy sedation as a single cause in the development of cognitive impairment in ICU patients remains unclear. In this study we investigated whether a three-day deep sedation protocol could reduce cognitive function in mechanically ventilated non-critical patients. DESIGN A prospective observational study was carried out. PATIENTS A total of 17 surgical patients were studied. INTERVENTION None. VARIABLES OF INTEREST Cognitive function before and after ICU admission. RESULTS Thirty-one patients requiring three days of sedation after microvascular reconstruction were initially enrolled in the study. Sedation in the ICU was maintained with propofol and dexmedetomidine combined with fentanyl. Cognitive function was assessed using a battery of 6 neuropsychological tests two days before surgery and three weeks after surgery. Finally, a total of 17 patients were included in the analysis. Cognitive impairment (defined as a decline of >20% from the pre-admission cognitive evaluation scores in at least two of 6 tests) was observed in 5 of the 17 patients (29%). However, there were no significant differences between the pre- and post-admission cognitive evaluations in 6 tests. CONCLUSIONS Middle-term cognitive function can be impaired in some patients subjected to deep sedation during several days following maxillary-mandibular oral surgery with microvascular reconstruction.
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Affiliation(s)
- Y Terada
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, Japan
| | - S Inoue
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, Japan.
| | - M Konda
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, Japan
| | - J Egawa
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, Japan
| | - J Ueda
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara 634-8522, Japan
| | - T Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara 634-8522, Japan
| | - M Kawaguchi
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, Japan
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Arnal Velasco D, Romero García E, Martínez Palli G, Muñoz Corsini L, Rey Martínez M, Postigo Morales S. [Patient safety recommendations for out of operating room procedure sedation]. Rev Calid Asist 2017; 32:155-165. [PMID: 27641104 DOI: 10.1016/j.cali.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/18/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. METHOD We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. RESULTS The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. CONCLUSION We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare.
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Affiliation(s)
- D Arnal Velasco
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - E Romero García
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario La Fe, Valencia, España
| | - G Martínez Palli
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Clínic y Centro de Investigaciones IDIBAPS, Barcelona, España
| | - L Muñoz Corsini
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario de Guadalajara, Guadalajara, España
| | - M Rey Martínez
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Povisa, Vigo, Pontevedra, España
| | - S Postigo Morales
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital de Galdakao, Usansolo, Bizkaia, España
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Arnal Velasco D, Romero García E, Martínez Palli G, Muñoz Corsini L, Rey Martínez M, Postigo Morales S. Patient safety recommendations for out of operating room procedure sedation. Rev Esp Anestesiol Reanim 2016; 63:577-587. [PMID: 27545841 DOI: 10.1016/j.redar.2016.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. METHOD We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. RESULTS The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. CONCLUSION We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare.
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Affiliation(s)
- D Arnal Velasco
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - E Romero García
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario La Fe, Valencia, España
| | - G Martínez Palli
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Clínic y Centro de Investigaciones IDIBAPS, Barcelona, España
| | - L Muñoz Corsini
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario de Guadalajara, Guadalajara, España
| | - M Rey Martínez
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Povisa, Vigo, Pontevedra, España
| | - S Postigo Morales
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital de Galdakao, Usansolo, Bizkaia, España
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Cuadrado García AM, Hernández Antolín RA, Almería Valera C, López Timoneda F. Anaesthetic management of percutaneous aortic valve implants: Results of 100 cases. ACTA ACUST UNITED AC 2016; 63:451-8. [PMID: 26907801 DOI: 10.1016/j.redar.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Transfemoral transcatheter aortic-valve implantation represents a therapeutic alternative for patients with severe aortic stenosis who cannot undergo surgery due to high surgical risk. OBJECTIVE The aim of this study is to describe the anaesthetic procedure for transfemoral transcatheter aortic-valve implantation and the results on 100 patients with symptomatic severe aortic stenosis. MATERIAL AND METHODS A series of cases are presented with prospective data collected on 100 consecutive patients. The anaesthetic procedure consisted of continuous remifentanil and propofol infusions, for sedation or general anaesthetic. RESULTS Almost two-thirds (65%) of the cases ended on sedation, and 35% on general anaesthetic (19% out of this total were elective and 16% were due to complications during the procedure). Complications occurred in 34% of the cases, with both vascular and complete atrioventricular block being the most frequent. Mortality within the first 24h was 5%. CONCLUSIONS Implantation of transfemoral aortic prosthesis under remifentanil-propofol sedation can be considered a valid therapeutic alternative for patients with severe symptomatic aortic stenosis, and with a high surgical risk, and therefore not considered for conventional surgery.
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Frade-Mera MJ, Regueiro-Díaz N, Díaz-Castellano L, Torres-Valverde L, Alonso-Pérez L, Landívar-Redondo MM, Muñoz-Pasín R, Terceros-Almanza LJ, Temprano-Vázquez S, Sánchez-Izquierdo-Riera JÁ. [A first step towards safer sedation and analgesia: A systematic evaluation of outcomes and level of sedation and analgesia in the mechanically ventilated critically ill patient]. Enferm Intensiva 2016; 27:155-167. [PMID: 26803376 DOI: 10.1016/j.enfi.2015.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Safe analgesia and sedation strategies are necessary in order to avoid under or over sedation, as well as improving the comfort and safety of critical care patients. OBJECTIVES To compare and contrast a multidisciplinary protocol of systematic evaluation and management of analgesia and sedation in a group of critical care patients on mechanical ventilation with the usual procedures. MATERIALS AND METHODS A cohort study with contemporary series was conducted in a tertiary care medical-surgical ICU February to November during 2013 and 2014. The inclusion criteria were mechanical ventilation ≥ 24h and use of sedation by continuous infusion. Sedation was monitored using the Richmond agitation-sedation scale or bispectral index, and analgesia were measured using the numeric rating scale, or behavioural indicators of pain scale. The study variables included; mechanical ventilation time, weaning time, ventilation support time, artificial airway time, continuous sedative infusion time, daily dose and frequency of analgesic and sedative drug use, hospital stay, and ICU and hospital mortality, Richmond agitation-sedation scale, bispectral index, numeric rating scale, and behavioural indicators of pain scale measurements. Kruskal Wallis and Chi2, and a significance of p<.05 were used. RESULTS The study included 153 admissions, 75 pre-intervention and 78 post-intervention, with a mean age of 55.7±13 years old, and 67% men. Both groups showed similarities in age, reason for admission, and APACHE. There were non-significant decreases in mechanical ventilation time 4 (1.4-9.2) and 3.2 (1.4-8.1) days, respectively; p= 0.7, continuous sedative infusion time 6 (3-11) and 5 (3-11) days; p= 0.9, length of hospital stay 29 (18-52); 25 (14-41) days; p= 0.1, ICU mortality (8 vs. 5%; p= 0.4), and hospital mortality (10.6 vs. 9.4%: p= 0.8). Daily doses of midazolam and remifentanil decreased 347 (227-479) mg/day; 261 (159-358) mg/day; p= 0.02 and 2175 (1427-3285) mcg/day; 1500 (715-2740) mcg/day; p= 0.02, respectively. There were increases in the use of remifentanil (32% vs. 51%; p= 0.01), dexmedetomidine (0 vs.6%; p= 0.02), dexketoprofen (60 vs. 76%; p= 0.03), and haloperidol (15 vs.28%; p= 0.04). The use of morphine decreased (71 vs. 54%; p= 0.03). There was an increase in the number of measurements and Richmond agitation-sedation scale scores 6 (3-17); 21 (9-39); p< 0.0001, behavioural indicators of pain scale 6 (3-18); 19(8-33); p< 0.001 and numeric rating scale 4 (2-6); 8 (6-17); p< 0.0001. CONCLUSIONS The implementation of a multidisciplinary protocol of systematic evaluation of analgesia and sedation management achieved an improvement in monitoring and adequacy of dose to patient needs, leading to improved outcomes.
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Affiliation(s)
- M J Frade-Mera
- UCI Polivalente, Hospital Universitario 12 de Octubre, Madrid, España.
| | - N Regueiro-Díaz
- UCI Polivalente, Hospital Universitario 12 de Octubre, Madrid, España
| | - L Díaz-Castellano
- UCI Polivalente, Hospital Universitario 12 de Octubre, Madrid, España
| | - L Torres-Valverde
- UCI Polivalente, Hospital Universitario 12 de Octubre, Madrid, España
| | - L Alonso-Pérez
- UCI Polivalente, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - R Muñoz-Pasín
- UCI Polivalente, Hospital Universitario 12 de Octubre, Madrid, España
| | - L J Terceros-Almanza
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - S Temprano-Vázquez
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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González Balenciaga M, Ballestero Y, Udaondo J, García S, Mintegi S, Benito J. [Impact of a quality of care improvement team on the use of sedatives during wound repair in young children]. Emergencias 2016; 28:375-380. [PMID: 29106081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To analyze the impact of actions organized by a quality of care improvement team on the use of sedatives when treating wounds in children under the age of 5 years. MATERIAL AND METHODS Quasiexperimental pre/post study enrolling children under the age of 5 years brought to a pediatric emergency department with wounds requiring surgical repair with suturing. A team to promote the use of sedation in such minor procedures in these children was established. The team organized the following interventions: training workshops, development and circulation of a sedation protocol, and establishment of a computerized alert. The first analysis of results was done at 2 months and the second at 9 months. The quality of care indicators, the use of sedatives while wounds were treated in children, was analized in 2 age groups: (under the age of 2 years and between 2 and 5 years) and results were compared with the preintervention phase. RESULTS A total of 22 958 emergencies were registered in children under 5 years old; 548 (2.4%) involved uncomplicated wounds. Of the 548 patients, 350 (63.8%) required surgical repair, 75 of them (21.4%) in children under the age of 2 years. Ten percent of these children had received a sedative in the period before the team's intervention; 22% had been sedated at the 2-month analysis and 31.4% at 9 months (P<.01). For children between 2 and 5 years old, the percentages were 4.4% (pre-intervention), 10% (2 months), and 25% (9 months) (P<.01). Eighty-two percent of the families and 69% of the physicians thought that anxiety was adequately controlled. CONCLUSION Actions designed by a multidisciplinary quality of care team are effective for increasing the use of sedatives while wounds are treated in children under the age of 5 years.
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Affiliation(s)
| | - Yolanda Ballestero
- Servicio Urgencias Pediatría, Hospital Universitario Cruces, Barakaldo, Bizkaia, España
| | - June Udaondo
- Servicio Pediatría, Hospital Universitario Cruces, Barakaldo, Bizkaia, España
| | - Silvia García
- Servicio Urgencias Pediatría, Hospital Universitario Cruces, Barakaldo, Bizkaia, España
| | - Santiago Mintegi
- Servicio Urgencias Pediatría, Hospital Universitario Cruces, Barakaldo, Bizkaia, España
| | - Javier Benito
- Servicio Urgencias Pediatría, Hospital Universitario Cruces, Barakaldo, Bizkaia, España
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Avila-Alvarez A, Carbajal R, Courtois E, Pertega-Diaz S, Anand KJS, Muñiz-Garcia J. [Clinical assessment of pain in Spanish Neonatal Intensive Care Units]. An Pediatr (Barc) 2015; 85:181-188. [PMID: 26553356 DOI: 10.1016/j.anpedi.2015.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 09/21/2015] [Accepted: 09/27/2015] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Clinical scales are currently the best method to assess pain in the neonate, given the impossibility of self-report in this age group. A study is designed with the aim of determining the current practices as regards the clinical assessment of pain in Spanish Neonatal Units and the factors associated with the use of clinical scales. METHODS A prospective longitudinal observational study was conducted. A total of 30 Units participated and 468 neonates were included. RESULTS Only 13 Units (43.3%) had pain assessment protocols. Pain was evaluated with a scale in 78 neonates (16.7%, 95% CI; 13.1-20.1) and the mean number of pain assessments per patient and per day was 2.3 (Standard Deviation; 4.8), with a median of 0.75. Of the total number of 7,189 patient-days studied, there was at least one pain assessment in 654 (9.1%). No pain assessment was performed with a clinical scale on any patient in 20 (66.7%) Units. Among those that did, a wide variation was observed in the percentage of patients in whom pain was assessed, as well as in the scales used. The CRIES (C-Crying; R-Requires increased oxygen administration; I-Increased vital signs; E-Expression; S-Sleeplessness) scale was that used in most Units. In the multivariate analysis, only invasive mechanical ventilation was associated with receiving a pain assessment with a scale (OR 1.46, P=.042). DISCUSSION The majority of neonates admitted into Intensive Care in Spain do not receive a pain assessment. Many units still do not routinely use clinical scales, and there is a wide variation between those that do use them. These results could serve as a basis for preparing national guidelines as regards pain in the neonate.
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Affiliation(s)
- Alejandro Avila-Alvarez
- Unidad de Neonatología, Servicio de Pediatría, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade de A Coruña (UDC), A Coruña, España.
| | - Ricardo Carbajal
- Service d'Urgences Pédiatriques. Hôpital d'enfants Armand Trousseau, Inserm UMR 1153 Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Université Pierre et Marie Curie, París, Francia
| | - Emilie Courtois
- Service d'Urgences Pédiatriques. Hôpital d'enfants Armand Trousseau, Inserm UMR 1153 Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Université Pierre et Marie Curie, París, Francia
| | - Sonia Pertega-Diaz
- Grupo de Investigación de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade de A Coruña (UDC), A Coruña, España
| | | | - Javier Muñiz-Garcia
- Instituto Universitario de Ciencias de la Salud e Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España
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Abstract
Pain and fear are still the most common memories that refer patients after ICU admission. Recently an important politician named the UCI as the branch of the hell. It is necessary to carry out profound changes in terms of direct relationships with patients and their relatives, as well as changes in environmental design and work and visit organization, to banish the vision that our society about the UCI. In a step which advocates for early mobilization of critical patients is necessary to improve analgesia and sedation strategies. The ICU is the best place for administering and monitoring analgesic drugs. The correct analgesia should not be a pending matter of the intensivist but a mandatory course.
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Affiliation(s)
- C Chamorro
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España.
| | - M A Romera
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
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Avila-Alvarez A, Carbajal R, Courtois E, Pertega-Diaz S, Muñiz-Garcia J, Anand KJS. [Sedation and analgesia practices among Spanish neonatal intensive care units]. An Pediatr (Barc) 2015; 83:75-84. [PMID: 25979386 DOI: 10.1016/j.anpedi.2015.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. METHOD A multicenter, observational, longitudinal and prospective study. RESULTS Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P<.001; OR=23.79), a CRIB score >3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (P<.001; OR=3.82), and a pain leader (P=.034; OR=2.35). CONCLUSIONS Almost half of the neonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the "state of the art", and could serve as the basis of preparing clinical practice guidelines at a national level.
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Affiliation(s)
- A Avila-Alvarez
- Unidad de Neonatología, Servicio de Pediatría, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España.
| | - R Carbajal
- Service d'Urgences Pédiatriques, Hôpital d'enfants Armand Trousseau, Inserm UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Université Pierre et Marie Curie, París, Francia
| | - E Courtois
- Service d'Urgences Pédiatriques, Hôpital d'enfants Armand Trousseau, Inserm UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Université Pierre et Marie Curie, París, Francia
| | - S Pertega-Diaz
- Grupo de Investigación de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España
| | - J Muñiz-Garcia
- Instituto Universitario de Ciencias de la Salud, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España
| | - K J S Anand
- University of Tennessee Health Science Center, Menphis, Estados Unidos
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Romera Ortega MA, Chamorro Jambrina C, Lipperheide Vallhonrat I, Fernández Simón I. [Indications of dexmedetomidine in the current sedoanalgesia tendencies in critical patients]. Med Intensiva 2013; 38:41-8. [PMID: 23683866 DOI: 10.1016/j.medin.2013.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 11/20/2022]
Abstract
Recently, dexmedetomidine has been marketed in Spain and other European countries. The published experience regarding its use has placed dexmedetomidine on current trends in sedo-analgesic strategies in the adult critically ill patient. Dexmedetomidine has sedative and analgesic properties, without respiratory depressant effects, inducing a degree of depth of sedation in which the patient can open its eyes to verbal stimulation, obey simple commands and cooperate in nursing care. It is therefore a very useful drug in patients who can be maintained on mechanical ventilation with these levels of sedation avoiding the deleterious effects of over or infrasedation. Because of its effects on α2-receptors, it's very useful for the control and prevention of tolerance and withdrawal to other sedatives and psychotropic drugs. The use of dexmedetomidine has been associated with lower incidence of delirium when compared with other sedatives. Moreover, it's a potentially useful drug for sedation of patients in non-invasive ventilation.
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Affiliation(s)
- M A Romera Ortega
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - C Chamorro Jambrina
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | - I Lipperheide Vallhonrat
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - I Fernández Simón
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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