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Inhaled volatile anesthetics in the intensive care unit

World Journal of Critical Care Medicine 2024年第1期13卷 28-39页

作者： Erin D Wieruszewski Mariam ElSaban Patrick M Wieruszewski Nathan J Smischney Department of Pharmacy Mayo ClinicRochesterMN 55905United States Anesthesiology and Perioperative Medicine Mayo ClinicRochesterMN 55905United States Department of Anesthesiology&Perioperative Medicine Mayo ClinicRochesterMN 55905United States

The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century.Recently,a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres,finding diverse applications in intensive care settings.In the dynamic landscape of intensive care,volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements,managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus,conditions of high sedative requirements including burns,high opioid or alcohol use and neurological conditions such as status epilepticus.Volatile anesthetics can be administered through either inhaled route via anesthetic machines/devices or through extracorporeal membrane oxygenation circuitry,providing intensivists with multiple options to tailor therapy.Furthermore,their unique pharmacokinetic profiles render them titratable and empower clinicians to individualize management with heightened accuracy,mitigating risks associated with conventional sedation modalities.Despite the amounting enthusiasm for the use of these therapies,barriers to widespread utilization include expanding equipment availability,staff familiarity and training of safe use.This article delves into the realm of applying inhaled volatile anesthetics in the intensive care unit through discussing their pharmacology,administration considerations in intensive care settings,complication considerations,and listing indications and evidence of the use of volatile anesthetics in the critically ill patient population.

关键词： Anesthesia Critical care Mechanical ventilation sedation Volatile anesthetics Sedative

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Magnetic imaging-assisted colonoscopy vs conventional colonoscopy: A randomized controlled trial

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World Journal of Gastroenterology 2014年第36期20卷 13178-13184页

作者： Christopher W Teshima Sergio Zepeda-Gómez Suliman H AlShankiti Gurpal S Sandha Division of Gastroenterology University of Alberta Edmonton Alberta T6G 2X8 Canada

AIM: To compare magnetic imaging-assisted colonoscopy(MIC) with conventional colonoscopy(CC).METHODS: Magnetic imaging technology provides a computer-generated image of the shape and position of the colonoscope onto a monitor to give visual guidance to the endoscopist. It is designed to improve colonoscopy performance and tolerability for patients by enabling visualization of loop formation and endoscope position. Recently, a new version of MIC technology was developed for which there are limited data.To evaluate this latest generation of MIC among experienced rather than inexperienced or trainee endoscopists, a prospective randomized trial was performed using only gastroenterologists with therapeutic endoscopy training. Consecutive patients undergoing elective outpatient colonoscopy were randomized to MIC or CC, with patients blinded to their group assignment. Endoscopic procedural metrics and quantities of conscious sedation medications were recorded during the procedures. The procedure was classified as "usual" or "difficult" by the endoscopist at the conclusion of each case based on the need for adjunctive maneuvers to facilitate endoscope advancement. After more than one hour post-procedure, patients completed a 10 cm visual analogue pain scale to reflect the degree of discomfort experienced during their colonoscopy. The primary outcome was patient comfort expressed by the visual analogue pain score. Secondary outcomes consisted of endoscopic procedural metrics as well as a sedation score derived from standardized dose increments of the conscious sedation medications.RESULTS: Two hundred fifty-three patients were randomized and underwent MIC or CC between September 2011 and October 2012. The groups were similar in terms of the indications for colonoscopy and patient characteristics. There were no differences in cecal intubation rates(100% vs 99%), insertion distance-tocecum(82 cm vs 83 cm), time-to-cecum(6.5 min vs 7.2 min), or polyp detection rate(47% vs 52%) between the MIC and CC groups. The primary outco

关键词： Colonoscopy Conscious sedation Magnetic endoscope

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Continuous infusion of midazolam and fentanyl during cryoballoon ablation compared with during radiofrequency catheter ablation of atrial fibrillation:Results from a retrospective study

Continuous infusion of midazolam and fentanyl during cryobal...

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2015年中国药学大会暨第十五届中国药师周

作者： Xu Liu Xiao-gang Guo Gong-bu Zhou Jian-du Yang Qi Sun Keping Chen Jian Ma Shu Zhang Arrhythmias Center State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College

Aims Cryoballoon ablation（CBA） or radiofrequency catheter ablation（RFCA） of atrial fibrillation（AF） can be performed under sedation/analgesic. We sought to investigate the feasibility, safety with continuous infusion of midazolam and fentanyl for CBA and RFCA.Methods and Results One hundred and sixty paroxysmal atrial fibrillation patients were enrolled into two groups by ablation technique used（CBA or RFCA, 80 patients for each group）. We recorded patient characteristics and perioperative data including peripheral oxygen saturation, heart rate, and noninvasive blood pressure. Dosage of midazolam was not significantly different between the two groups（13.7 ± 1.6 mg in CBA vs. 13.7 ± 1.8 mg in RFCA, P=0.11）. However, dosage of fentanyl was significantly less in CBA group（199.0 ± 26.5 μg vs. 278.5 ± 31.8 μg, P＜0.001）. Frequency of applied oropharyngeal airway due to upper airway obstruction or desaturation（SpO2＜90%） was significantly lower in CBA group（30 vs. 44, P=0.03）, while the incidence of restlessness was similar between the two groups. There were 3 patients in RFCA group who left atrial geometry required remapping because restlessness influenced the reference patch. The Ramsay sedation score（RSS） was similar between groups, while operator satisfaction score was significantly higher in CBA group（3.1 ± 0.5 vs. 2.8 ± 0.7, P=0.01）. Conclusion Continuous infusion of midazolam and fentanyl by cardiologists wasfeasible and safe for CBA and mostly RFCA of atrial fibrillation. A higher operator satisfaction level was obtained for CBA of atrial fibrillation.

关键词： sedation Midazolam Fentanyl Cryoballoon ablation Radiofrequency catheter ablation Atrial fibrillation

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Dexmedetomidine in gastrointestinal endoscopic procedures

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World Journal of Anesthesiology 2016年第1期5卷 1-14页

作者： Somchai Amornyotin Department of Anesthesiology and Siriraj Gastrointestinal Endoscopy Center Faculty of Medicine Siriraj HospitalMahidol University

Gastrointestinal endoscopy is the gold standard in the examination and the treatment of the diseases of gastrointestinal system, but the disadvantage of being painful process. At this point the sedative and analgesic agents may be important. Dexmedetomidine is a new sedoanalgesic agent which is alternative to benzodiazepines and opioids. It has analgesia, amnesia, sedative and anxiolytic properties. The use of dexmedetomidine as the sole anesthetic agent and as the adjuvant analgesic agent has been published but has not been approved because of the inconsistency of efficacy and safety. The author has been collected the published papers in the literature. This article is aimed to describe the use of dexmedetomidine in various gastrointestinal endoscopic procedures.

关键词： Complication Safety Dexmedetomidine Gastrointestinal endoscopy sedation

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Respiratory Volume Monitoring to Assess the Effect of Airway Maneuvers on Ventilation during Upper Endoscopy

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Open Journal of Anesthesiology 2014年第11期4卷 281-290页

作者： Katherine Holley Donald Mathews Diane Ladd Lisa Campana Howard Schapiro Department of Anesthesiology Fletcher Allen Health Care University of Vermont College of Medicine Burlington USA School of Nursing West Virginia University Morgantown USA Respiratory Motion Inc. Waltham USA

Introduction: Propofol use during endoscopic procedures has become increasingly popular and assessing and maintaining airway patency is a significant challenge. Anesthesiologists often use airway maneuvers to maintain airway patency and ventilation during procedural sedation. A novel, non-invasive, Respiratory Volume Monitor (RVM) that provided continuous, real-time measurements of minute ventilation (MV), tidal volume (TV) and respiratory rate (RR) was used to monitor respiratory performance before, during, and after endoscopic procedures, quantify MV changes before and after airway maneuvers, and to quantify propofol-induced respiratory depression. Methods: RVM traces were obtained from 25 patients undergoing sedation for endoscopic procedures. Airway maneuvers were performed in 19/25 patients. All 25 patients received propofol as the primary sedative. Results: Forty-five airway maneuvers were performed. During these maneuvers, all respiratory parameters increased relative to pre-maneuver levels. On average, MV increased by 24% ± 5% (mean ± SEM), TV 14% ± 5% and RR: 17% ± 6%. The cohort average MVBASELINE was 9.5 ± 0.7 L/min (TV = 670 ± 60 ml, RR = 15 ± 0.7). Following propofol MV decreased transiently, reaching nadir five minutes after the last dose of propofol at 82% ± 10% of baseline (MV = 7.5 ± 1.0 L/min). The reduction in MV was driven by reduction in TV, not RR. Conclusions: Data demonstrated that RVM was able to track changes in ventilation and was able to quantify respiratory changes following airway maneuvers. All patients had a significant reduction in ventilatory volumes after propofol. Five minutes after the last dose of propofol, MV and TV were significantly reduced while RR was not, suggesting that monitoring respiratory rate alone was not a sufficient indicator of respiratory status.

关键词： Non-Invasive Respiratory Volume Monitoring Minute Ventilation Airway Maneuvers Procedural sedation Endoscopy

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Unrecognised, undertreated, pain in ICU—Causes, effects, and how to do better

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Open Journal of Nursing 2013年第1期3卷 108-113页

作者： S. M. Alderson S. R. McKechnie John Radcliffe Hospital Oxford UK

Methods: a literature review from 1990 to August 2012. Introduction: pain and its recognition can be a particular problem for patients in intensive care units (ICUs). Studies have suggested that around 70% of ICU patients have unrecognised or undertreated pain. Pain has serious physical and psychological effects, and can impair patient recovery and discharge. Pain relief is also an ethical and professional responsibility of doctors and nurses—and we may be failing in this. Causes: pain may be due to medical and nursing procedures, and the ICU environment. Pain can be under-recognised because ICU patients are often impaired in their ability to communicate (e.g. secondary to confusion from acute illness, endotracheal intubation, or reduced conscious level from sedative agents). Tools for pain assessment: in patients able to communicate verbally, the numerical rating scale (NRS) can be used to rate pain severity. In non-verbal, conscious, patients, the visual analogue scale (VAS) can be used as a visual alternative. Both are well-established. For unconscious/sedated patients, the behavioural pain scale (BPS) and critical care pain observation tool (CPOT) have been developed and validated. Changes in practice: where possible, sedation practice can be changed to allow better recognition of pain. Constant deep sedation can be interrupted with daily “sedation holds” to allow pain assessment. “Analgo-sedation” may also be used, with drug regimes which prioritise analgesia over sedation. “No-sedation” approaches may also be considered, but further research is required.

关键词： Pain Pain Assessment Pain Recognition Pain Management ICU ITU Intensive Care sedation An-algo-sedation

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Gastrointestinal endoscopy in cirrhotic patient:Issues on the table

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World Journal of Gastrointestinal Endoscopy 2021年第7期13卷 210-220页

作者： Giuseppe Grassi Ilaria Lenci Alessandro Signorello Martina Milana Leonardo Baiocchi Hepatology Unit University of Tor VergataRome 00100Italy

Patients with liver cirrhosis are fragile and present specific clinical hallmarks.When undergoing to gastrointestinal(GI)endoscopy,these subjects require an individual pre evaluation,taking into account:Level of haemostasis impairment,the individual risk of infection,the impact of sedation on hepatic encephalopathy and other factors.The overall assessment of liver function,employing common scoring systems,should be also assessed in the preprocedural phase.Beside some common general problems,regarding GI endoscopy in cirrhotic subjects,also specific issues are present for some frequent indications or procedures.For instance,despite an increased incidence of adenomas in cirrhosis,colon cancer screening remains suboptimal in subjects with this disease.Several studies in fact demonstrated liver cirrhosis as a negative factor for an adequate colon cleansing before colonoscopy.On the other hand,also the routine assessment of gastroesophageal varices during upper GI endoscopy presents some concern,since important inter-observer variability or incomplete description of endoscopic findings has been reported in some studies.In this review we discussed in details the most relevant issues that may be considered while performing general GI endoscopic practice,in patient with cirrhosis.For most of these issues there are no guidelines or clear indications.Moreover until now,few studies focused on these aspects.We believe that targeting these issues with corrective measures may be helpful to develop a tailored endoscopic approach for cirrhosis,in the future.

关键词： Gastrointestinal endoscopy Cirrhosis sedation Infection Gastroesophageal varices Colonoscopy Bowel cleansing Liver transplantation

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Being in limbo: The experience of critical illness in intensive care and beyond

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Open Journal of Nursing 2012年第3期2卷 270-276页

作者： Agness C. Tembo Vicki Parker Isabel Higgins University of New England Armidale Australia University of Newcastle Newcastle Australia

Critical illness is a sudden traumatising lived experience that affects the sufferer and their family throwing them into a crisis situation [1,2]. It is disruptive and alienating. Critically ill patients emerging from unconsciousness often suffer from confusion that could be momentary or lasting. There is an increasing number of critical illness survivors in intensive care units (ICU)1 with numerous life changing ongoing physiological and psychological sequelae from critical illness and ICU hospitalization, with inadequate ongoing treatment for ICU survivors. Medicalised accounts of critical illness fail to recognise the significant impact on the person, their embodied sense of self and their ability to move on with their life after they leave hospital. The main purpose of this study was to explore the experience of critically ill patients in ICU and beyond. This phenomenological study describes what it was like for twelve people to experience critical illness in ICU and in the months after discharge. The finding was that critical illness is an acute life threatening event with long lasting effects which translate into temporal and biographical disruption, imprisonment by the ICU and its therapies and being trapped in an alien body that is plagued by uncertainty and long lasting conditions arising from the critical illness and the ICU therapies. Critical illness survivors are left in a state of limbo characterised by a struggle to reclaim their precritical illness ICU identity and uncertainty about their future. Hence an overarching theme of being in limbo under which three major themes of 1) disrupttion, 2) imprisonment and 3) being trapped were generated from the study.

关键词： Critical Illness Intensive Care Mechanical Ventilation Daily sedation Interruption

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Effects of Terminalia catappa seeds on sexual behaviour and fertility of male rats

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Asian Journal of Andrology 2000年第3期2卷 213-219页

作者： W.D.Ratnasooriya M.G.Dharmasiri Department of Zoology University of Colombo Colombo 3 Sri LankaDepartment of Zoology University of Colombo Colombo 3 Sri Lanka

Aim: To evaluate the aphrodisiac potential of Terminalia catappa Linn. seeds using a suspension of its kernel (SS)in 1% methyl cellulose in rats. Methods: Male rots were orally treated with 1500 mg/kg or 3000 mg/kg SS or ve-hicle, and their sexual behaviour was monitored 3 h later using a receptive female. Another group of rats was orallytreated with either 3000 mg/kg SS or vehicle for 7 consecutive days. Their sexual behaviour and fertility were evaluatedon days 1, 4 and 7 of treatment and day 7 post-treatment by pairing overnight with a pro-oestrous female. Results:The 1500 mg/kg dose, had a marked aphrodisiac action (prolongation of ejaculation latency) but no effect on libido(% mounting, % intromission and % ejaculation), sexual vigour (mounting-and-intromission frequency), or sexualperformance (intercopulatory interval). In contrast, the higher dose (3000 mg/kg) reversibly inhibited all the para?e-ten of sexual behaviour other than mounting-and-intromission frequency and copulatory efficiency. The effects of highdose SS were not due to general toxicity, liver toxicity, haemotoxicity, stress, muscle deficiency, muscle incoordina-fion, analgesia, hypoglycaemia or reduction in blood testosterone level. They were due to marked sedation. Conclu-sion: The kernel of T. catappa seeds has aphrodisiac activity and may be useful in the treatment of certain forms ofsexual inadequacies, such as premature ejaculation.

关键词： Terminalia catappa seeds aphrodisiac male sexual behaviour libido premature ejaculation fertility sedation

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Guidelines for Patients with Bleeding Disorders Undergoing Dentalveolar Surgeries

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Health 2022年第10期14卷 1044-1058页

作者： Mahira Amirova Sabrin Ali Azim Parisa Foroughiasl Lovely Annamma Jumma Alkhabuli Svetlana Nagiyeva Rena Rahimova Department of Biochemistry Azerbaijan Medical University Baku Azerbaijan Dentistry Department City University College of Ajman Ajman UAE Department of Oral and Maxillofacial Surgeon New York USA Faculty Clinical Sciences College of Dentistry Ajman University Ajman UAE QU Health College of Dental Medicine Qatar University Doha Qatar General Practical at Family Medicine Department Azerbaijan Medical University Baku Azerbaijan Biochemistry Department Faculty of Public Health Azerbaijan Medical University Baku Azerbaijan

Dental practitioners must be well informed about the pathology, complications and treatment options associated with bleeding disorders patients. Prolongation of bleeding time can seriously complicate the patient’s condition during and after surgery, especially if there is iron deficiency anemia or any other condition accompanied by a decrease in hematopoiesis. For this reason, the dentist surgeon must be aware about the presence of such diseases in advance, in order to prevent the development of bleeding and its undesirable consequences promptly. Blood loss becomes apparent when blood exits through a natural opening in the body, for instance the nose & mouth. In this article, common medical bleeding situations with the potential to compromise the successful outcome of dental surgical procedures have been presented. Bleeding disorders is a disease group, which can be classified as deficiencies of coagulation factors, platelet disorders, vascular disorders, fibrinolytic defects and so on. Fragile blood vessels can cause bleeding, petechiae, bruising, etc. In most cases, vascular disease does not cause serious blood loss, with the exception of hereditary hemorrhagic telangiectasia. In this paper, we discuss the most common hereditary diseases associated with a deficiency of plasma coagulation factors VIII and IX, the disease of platelet deficiency (Glansman disease), the prophylaxis of bleeding in this kind of patients, and the effect of drugs on coagulation processes as well.

关键词： Coagulation Factors Hemophilia Platelet sedation

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