Procedural (Conscious) Sedation and Analgesia in Emergency Setting: How to Choose Agents? DOI
Mustafa Ayan, Orhan Özsoy, Sedat Özbay

et al.

Current Pharmaceutical Design, Journal Year: 2023, Volume and Issue: 29(28), P. 2229 - 2238

Published: Aug. 1, 2023

Abstract: Pain has long been defined as an unpleasant sensory and emotional experience originating from any region of the body in presence or absence tissue injury. Physicians involved acute medicine commonly undertake a variety invasive painful procedures that prompt procedural sedation analgesia (PSA), which is condition sparing protective airway reflexes while depressing patient’s awareness external stimuli. This state achieved following obtaining informed consent, necessary point-ofcare monitoring, complete recording procedures. The most employed combination for PSA mostly comprises short-acting benzodiazepine (midazolam) potent opioid, such fentanyl. biggest advantage opioids despite all powerful effects, upper are preserved often do not require intervention. Choices analgesic sedative agents should be strictly individualized determined specific condition. objective this review article was to underline characteristics, effectiveness, adverse pitfalls relevant drugs adults facilitate emergency

Language: Английский

Dexmedetomidine improves clinical outcomes in sepsis-induced myocardial injury: a retrospective cohort study DOI Creative Commons
Yuan Liu, J. Ouyang, Cuicui Zhang

et al.

Frontiers in Pharmacology, Journal Year: 2025, Volume and Issue: 15

Published: Jan. 15, 2025

The efficacy of dexmedetomidine (DEX) in treating sepsis-induced myocardial injury (SIMI) remains unclear. In this study, we explored the relationship between DEX use and clinical outcomes patients with SIMI, focusing on dosage treatment duration. retrospective cohort analysis, identified SIMI from Medical Information Mart for Intensive Care IV (MIMIC-IV) database categorized them into non-DEX groups based intensive care unit treatment. baseline bias was reduced through propensity score matching (PSM). primary outcome 28-day mortality, whereas secondary were in-hospital mortality rates at 7 days, 90 1 year. association assessed using Kaplan-Meier analysis Cox proportional hazards models. After PSM, 373 group matched 579 to achieve a balanced distribution covariates. regression model demonstrated significant reduction associated use, yielding hazard ratio (HR) 0.61 (95% confidence interval [CI]: 0.47-0.78, P < 0.001). In-hospital also significantly decreased (HR = 0.43, 95% CI: 0.33-0.57, Lower observed doses >0.4 μg/kg/h, particularly range 0.400-0.612 total >3.113 mg during hospitalization, durations exceeding 72 h improved risk all intervals. Regarding 28 our subgroup analyses indicated interaction Sequential Organ Failure Assessment invasive mechanical ventilation. administration year SIMI. These findings require validation future studies.

Language: Английский

Citations

0
Development and Validation of a Neuro-Intensive Care Protocol for Traumatic Brain Injury Management DOI Open Access

Sindu K Mathew,

S Aruna,

Ramesh C Vasudevan

et al.

Cureus, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 24, 2025

Introduction Traumatic brain injury (TBI) is a global public health concern with high mortality and disability rates, particularly among younger populations. Structured treatment protocols might improve outcomes reduce mortality. This study aims to develop validate the Neuro-Intensive Care Protocol for TBI (NICP-TBI) using Medical Research Council framework designing evaluating complex interventions. Methods The protocol was developed systematic literature review, expert consensus, validation. A 15-member multidisciplinary consensus group used Delphi method refine protocol, achieving threshold of 80%. Validation involved seven-member protocol's relevance, clarity, comprehensiveness, appropriateness five-point Likert scale. Content Validity Index (CVI) calculated. Results NICP-TBI incorporated interventions from clinical practice guidelines evidence-based protocols. It established clear goals each parameter concerned such as airway, ventilation, systemic cerebral perfusion, intracranial pressure (ICP), sedation, seizure prophylaxis, fluid management, nutrition, infection temperature venous thromboembolism (VTE), blood glucose positioning, tapering family involvement in care. tiered structure adaptable resource-limited settings. process reached 99.2% final after five rounds, CVI determined be 1, confirming validity. Conclusions provides structured, managing moderate severe TBI. consensus-driven development, approach validation ensure its applicability across diverse settings, including environments. highlights importance developing effective critical care

Language: Английский

Citations

0
Isoflurane vs. Propofol Sedation in Patients with Severe Stroke: A Clinical Proof-of-Concept-Study DOI Open Access
André Worm, Christian Claudi, Stephan A. Braun

et al.

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(5), P. 1594 - 1594

Published: Feb. 26, 2025

Background: Severe strokes often require deep sedation, yet the optimal sedation regimen remains unclear. This comparative study compared efficacy of achieving target depth using inhaled (isoflurane) versus intravenous (propofol) sedation. Methods: prospective, observational, proof-of-concept was conducted between July 2022 and June 2023 at two University Hospitals with dedicated neurological intensive care units. We included conservatively treated patients severe space-occupying (ischemic or haemorrhagic) requiring Patients received either Sedation targets were defined in morning rounds Richmond-Agitation-Sedation-Scale assessed subsequent time points (7 p.m. 7 a.m.) during hospital stay. The primary outcome number days where predefined achieved both points, comparing regimens. Secondary safety outcomes incidence delirium, pneumonia, functional outcomes, mortality, vasopressor doses. Results: Seventy-nine (age 71 [63–81] years, 31 female) included. sedated isoflurane significantly more often, 182/444 (41%) to 80/497 (16%) assessments propofol (RR 1.4; 95%-CI: 1.3–1.6). effect consistent across all stages, specifically 1.5; 1.2–1.9) no-sedation 5.1; 2.8–9.4). revealed no significant differences. Conclusions: Isoflurane offers a benefit for invasively ventilated stroke respect targets. Specifically, facilitates faster awakening when transitioning from awakening. These data encourage further confirmatory studies specific stroke-patient groups.

Language: Английский

Citations

0
Pharmacological mechanism and clinical application of ciprofol DOI Creative Commons
Jie Zhou, Lifeng Wang, Zhihui Zhong

et al.

Frontiers in Pharmacology, Journal Year: 2025, Volume and Issue: 16

Published: March 25, 2025

Propofol has become one of the most commonly used anesthetic agents because its good sedative effects, rapid onset, and fast metabolism. However, associated respiratory circulatory depression injection pain make it difficult for patients to tolerate. Ciprofol, which is structurally similar propofol but an additional cyclopropyl group, less likely impact function cause pain, highlighting potential clinical application. Currently, as research on Ciprofol still in exploratory stage, application limited underlying mechanisms are not yet fully understood. The aim this article review pharmacological propofol, hypothesize primary effects adverse reactions summarize current status, with goal providing a reference future use.

Language: Английский

Citations

0
Assessment of sedation by automated pupillometry in critically ill patients: a prospective observational study DOI
Lin Shi,

Danni Jin,

Xia-Jing Cao

et al.

British Journal of Anaesthesia, Journal Year: 2024, Volume and Issue: 132(5), P. 877 - 885

Published: Feb. 29, 2024

Language: Английский

Citations

3
Procedural Sedation in Emergency Department: A Narrative Review DOI Creative Commons
Iacopo Cappellini, Gaia Bavestrello Piccini,

Lorenzo Campagnola

et al.

Emergency Care and Medicine, Journal Year: 2024, Volume and Issue: 1(2), P. 103 - 136

Published: April 26, 2024

Procedural sedation and analgesia (PSA) in the emergency department (ED) presents a crucial aspect of medicine, enabling execution painful or distressing procedures with minimal patient discomfort. This narrative review delineates pharmacological framework, methodologies, clinical considerations integral to optimizing PSA, particular focus on pediatric geriatric populations. Through comprehensive analysis current practices, this work evaluates pharmacokinetics pharmacodynamics widely utilized sedatives analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, remimazolam. Special attention is dedicated selection criteria based patient-specific risk factors, procedural requirements, management potential adverse effects. The manuscript also explores innovative techniques integration new agents, emphasizing evidence-based approaches enhance safety outcome. results underscore significance tailored strategies, especially for vulnerable groups such as patients, highlighting need meticulous pre-procedural assessment monitoring mitigate risks. conclusions drawn advocate nuanced application guided by evidence guidelines, improve quality care settings. research reinforces imperative ongoing education, skill development, adaptation into practice advance ED.

Language: Английский

Citations

3
Knowledge, attitudes, and perceived barriers regarding pain assessment and management among Thai critical care nurses: A cross-sectional study DOI

Nongnapat Chaleewong,

Suchira Chaiviboontham, Martin Christensen

et al.

Intensive and Critical Care Nursing, Journal Year: 2024, Volume and Issue: 84, P. 103764 - 103764

Published: July 21, 2024

Language: Английский

Citations

3
Disturbed laterality of non-rapid eye movement sleep oscillations in post-stroke human sleep: a pilot study DOI Creative Commons

Benjamin K. Simpson,

Rohit Rangwani, Aamir Abbasi

et al.

Frontiers in Neurology, Journal Year: 2023, Volume and Issue: 14

Published: Nov. 30, 2023

Sleep is known to promote recovery post-stroke. However, there a paucity of data profiling sleep oscillations in the post-stroke human brain. Recent rodent work showed that resurgence physiologic spindles coupled slow (SOs) and concomitant decrease pathological delta (

Language: Английский

Citations

3
Procedural Sedation in Emergency Department: A Narrative Review DOI Open Access
Iacopo Cappellini, Gaia Bavestrello Piccini,

Lorenzo Campagnola

et al.

Published: March 24, 2024

Procedural Sedation and Analgesia (PSA) in the Emergency Department (ED) presents a crucial aspect of emergency medicine, enabling execution painful or distressing procedures with minimal patient discomfort. This narrative review delineates pharmacological framework, methodologies, clinical considerations integral to optimizing PSA, particular focus on pediatric geriatric populations. Through comprehensive analysis current practices, this work evaluates pharmacokinetics pharmacodynamics widely utilized sedatives analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, remimazolam. Special attention is dedicated selection criteria based patient-specific risk factors, procedural requirements, management potential adverse effects. The manuscript also explores innovative sedation techniques integration new agents, emphasizing evidence-based approaches enhance safety outcome. Results underscore significance tailored strategies, especially for vulnerable groups such as patients, highlighting need meticulous pre-procedural assessment monitoring mitigate risks. Conclusions drawn advocate nuanced application guided by evidence guidelines, improve quality care settings. research reinforces imperative ongoing education, skill development, adaptation into practice advance analgesia ED.

Language: Английский

Citations

0
Mecanismos de estabilização do paciente neurocrítico DOI Open Access

Débora Elem Cruz Monteiro,

Paula Izabelle Pantoja Veloso,

Suzan Letícia Barboza Menezes

et al.

Brazilian Journal of Health Review, Journal Year: 2024, Volume and Issue: 7(2), P. e68397 - e68397

Published: March 27, 2024

O paciente neurocrítico é aquele que apresenta comprometimento de diversos sistemas, principalmente o sistema nervoso, consequentemente, manifestando disfunção neurológica. Uma das principais características esse demonstra a alteração da pressão intracraniana, sendo imprescindível uso ventilação mecânica com finalidade neuro proteção, uma vez ajuda na estabilidade desse enfermo. Analisar impacto medidas estabilização no desfecho do neurocrítico. Trata-se um estudo revisão sistemática base busca pela estratégia PICO, nas bases dados PubMed, Scielo e Cochrane através dos descritores DECs MeSH, publicados entre 2019 2023. Foram encontrados 33 estudos, 27 excluídos por não apresentarem perfil abordagem adequado acordo os critérios inclusão, totalizando 6 estudos selecionados para pesquisa. A protetora, solução hiper osmolar hipertônica, bem como sedação bloqueadores neuromusculares são suma importância crítico, pois mecanismo garantir hemodinâmica diminuir riscos mortalidade.

Citations

0