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Injuries in Children
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
If the child becomes uncooperative, the assistance of a play therapist can be extremely helpful. Using distraction therapy and guided imagery, such as asking a child to imagine being on holiday, may well gain the child’s trust and cooperation again. The use of conscious sedation should be considered in selected patients.
Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
There is a high incidence of life-threatening respiratory depression when used for conscious sedation [177]. Rapid development of μ-receptor tolerance occurs after infusion during anaesthesia, resulting in increased postoperative pain and morphine consumption [178]. The inhibitory neurotransmitter glycine is the carrier for remifentanil and the formulation is not used spinally or epidurally [179]. Thoracic rigidity is reported after rapid intravenous injection [179].
Stents in the Gastrointestinal Tract in Palliative Care
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
The procedure can be performed under conscious sedation. SEMSs are usually placed using the over-the-wire (OTW) placement procedure with or without endoscopic assistance. A guidewire is passed through the endoscope across the stricture. Then, a delivery system is introduced along the guidewire to the stenotic lesion. The stent is gradually deployed with position adjustment under fluoroscopic control. Finally, the endoscope is then reinserted to confirm correct stent positioning (Figure 13.1).
A retrospective cohort study of factors influencing long procedure times in colorectal endoscopic submucosal dissection
Published in Scandinavian Journal of Gastroenterology, 2021
Kazuya Miyaguchi, Tomoaki Tashima, Rie Terada, Ryuhei Jinushi, Yuya Nakano, Hiromune Katsuda, Tomoya Ogawa, Akashi Fujita, Yuki Tanisaka, Masafumi Mizuide, Yumi Mashimo, Hidetomo Nakamoto, Tomonori Kawasaki, Hiroyuki Imaeda, Shomei Ryozawa
MoviPrep (EA Pharma Co., Tokyo, Japan) was used as the pretreatment agent. Either scopolamine butylbromide (10 mg) or glucagon (0.5 mg) and midazolam (1–4 mg) were used for conscious sedation. ESDs were performed using therapeutic single-channel colonoscopes (PCF 260 J, and 290ZI; Olympus Co., Tokyo, Japan) with a transparent attachment cap (D-201-13404; Olympus) and a high-frequency generator (VIO300D; EndoCut I, effect 2, duration 4, interval 1; Erbe Elektromedizin, Tübingen, Germany) with carbon dioxide insufflation. Subsequently, after a local injection of sodium hyaluronate solution, an initial mucosal incision and submucosal dissection were performed using a Dual Knife J 1.5 mm (KD655-L; Olympus). Hemostasis for procedural bleeding was attempted using hemostatic forceps (FD-410LR; Olympus, Tokyo, Japan) in the soft coagulation mode (effect 4, 70 W). The S–O clip was used as the traction device (Zeon Medical, Tokyo, Japan) (Figure 3) [8]. The timing of traction use was after a full circumferential incision in all cases. The S–O clip was used for cases of fibrosis or large lesions, and when the knife was perpendicular to the muscle layer.
Restraint in paediatric dentistry: a qualitative study to explore perspectives among public, non-specialist dentists in Norway
Published in Acta Odontologica Scandinavica, 2021
Regina Skavhellen Aarvik, Maren Lillehaug Agdal, Edel Jannecke Svendsen
The results showed that physical restraint is often combined with and legitimised by conscious sedation when the dental treatment is considered necessary and the child opposes treatment. Strøm et al. [26] reported in 2015 that 18% of the asked dentists in the PDS in Norway use conscious sedation at the local clinic to provide dental care to anxious children. In this study, the dentists disagreed on the amnestic effects of sedatives and debated their contributions to the development of dental anxiety. Although the study was published in 1998, Jensen et al.’s findings have been referenced in several discussions on conscious sedation. They identified that 85% of pre-school children experienced the amnestic effect of rectal sedation when extracting a tooth [27]. The children that remembered the extraction when sedated showed less acceptance of future treatment compared with the ones that did not [27]. Because several children do not remember, dentists may conclude that the conscious sedation and restraint combined do not result in anxious children. Additionally, the large number of successful treatments, based on the amnestic effect, may influence and ease the justification of the use of restraint in combination with sedation by dentists.
Endovascular arteriovenous fistulas— are they the answer we haven’t been looking for?
Published in Expert Review of Medical Devices, 2021
Bynvant Sandhu, Charlie Hill, Mohammad Ayaz Hossain
Endovascular AVF creation may be performed by interventional radiologists, interventional nephrologists, and surgeons. The procedure is performed on an outpatient basis in the radiology suite, therefore reducing the burden on operating theater usage. To date, conscious sedation combined with local or regional anesthesia has been used. The use of regional anesthesia requires anesthetic input and therefore impacts on resource utilization. Trials in surgical AVF have demonstrated higher primary short-term patency using regional blockade compared to local anesthesia as the former induces greater vasodilation and increases short-term blood flow [25]. Regional anesthesia also improves long-term patency and cost-effectiveness in surgical AVF [26]. The impact of anesthesia has not yet been investigated in endovascular AVF.