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Gynaecology, Fertility and Family Planning
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Kopal Singhal Agarwal, Chawan Baran, Lauren Laws, Maria Garcia de Frutos, Black Benjamin
All women should be routinely offered pain medication (e.g. non-steroidal anti-inflammatory drugs) NSAIDs) during abortions. General anaesthesia is not recommended routinely for vacuum aspiration abortion or dilatation and evacuation (D&E). Anaesthetic options include local anaesthesia, conscious sedation, deep sedation or general anaesthesia. This will depend on gestation and local expertise. A paracervical block using 20 ml of lidocaine can be performed prior to abortion procedures. Other anaesthetic options include conscious sedation, deep sedation or general anaesthesia. This will depend on gestation and local expertise.
Case 27
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
Risks of sedation include slow breathing, low blood pressure, nausea, vomiting, having an allergic reaction, feeling unsteady or that it might have a temporary effect on your judgement, memory or decision-making
Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Sedation comprises sleep-like states following the administration of medication. These have been defined as conscious sedation, deep sedation and general anaesthesia [14,15], and are adapted here to distinguish deep sedation from general anaesthesia on the basis of a self-maintained airway and airway clearing reflexes (cough) in the former and not in the latter.
Comparison of effectiveness, cost and safety between moderate sedation and deep sedation under esophagogastroduodenoscopy in Chinese population: a quasi-experimental study
Published in Scandinavian Journal of Gastroenterology, 2022
Feng Hu, Long Zou, Hongxia Chang, Lin Tian, Fanrong Liu, Ya Lan, Fangxin Zhang, Xiao Liu
Moderate sedation refers to that patients can respond to verbal orders with or without the requirement for light tactile stimulation [22]. Deep sedation is defined that patients will elicit a response with repeated or painful stimulation [22]; these people have a risk of entering into general anesthesia, making them unconscious and possibly unable to protect their airways. Considering these additional risks, deep sedation needs to be monitored by additional personnel and equipment, which increases the cost [23]. In addition, propofol is a hypnotic agent and is commonly used in deep sedation with or without opioids [24]. Although propofol can immediately induce anaesthesia and is easy to use to maintain an appropriate sedation level, evidence has shown that propofol sedation is costly compared to the potential benefits [8,25,26]. In China, moderate sedation was performed by a nurse specially trained in sedation under the supervision of an endoscopic physician specially trained in sedation, and deep sedation was performed by an anesthesiologist [27]. A meta-analysis demonstrated that the sedation performed by trained nurses was more economical than by anesthesiologists [28]. In our study, expenses of moderate sedation were largely less than that of deep sedation, indicating that moderate sedation superior to deep sedation in cost.
The role of Rezūm ™ team ablation of the prostate in the treatment of patients with acute urinary retention secondary to benign prostatic hyperplasia. A single center, single surgeon case series and literature review
Published in The Aging Male, 2020
The results concluded that Rezūm ™ steam ablation of the prostate is safe, fast and effective in treating patients with AUR secondary to BPH. The sample size was small, and hence further research should be conducted in a multicenter setting, with a larger cohort and a longer follow up period. However, all patients in this study were catheter free and satisfied with the functional outcomes as shown by IPSS, QoL, Qmax and PVR volume. Anatomy such as middle lobes did not affect the patient outcomes and in men who were sexually active no deterioration was reported. All patients stopped any BPH medication. This cohort of patients opted for general anesthesia; however, it can be performed under sedation, spinal and local anesthesia. The only adverse effect reported was a blocked catheter that was managed with a simple bladder washout. In summary, Rezūm ™ is a safe, effective day case procedure for men with AUR secondary to BPH and further studies with a larger sample size is being conducted.
A Prospective Study of the Safety and Effectiveness of Droperidol in Children for Prehospital Acute Behavioral Disturbance
Published in Prehospital Emergency Care, 2019
Colin B. Page, Lachlan E. Parker, Stephen J. Rashford, Katherine Z. Isoardi, Geoffrey K. Isbister
Secondary outcomes (Table 3) are as follows. Median time to sedation was 14 minutes (IQR: 10 to 20 minutes; range: 3–85 minutes). No additional sedation (0/102 [0%]; 95% CI: 0–4%) was required during the ambulance journey to hospital. On arrival to the hospital, additional sedation in the first hour was required by 4 patients (4/102 [4%]; 95% CI: 1–10%). Drugs used for additional sedation in the ED included olanzapine (2), diazepam (1), and midazolam (1). There was one (1/102 [1%]; 95% CI: 0–5%) injury to ambulance staff and no injuries to patients. Failure to sedate occurred in one patient (1/102 [1%]; 95% CI: 0–5%). This patient’s SAT score went from 3 to 2 after 5 mg IM droperidol. The patient did not receive a second dose of droperidol in the ambulance, but settled after arrival at the receiving hospital where he did not require any further sedation and was discharged some hours later. Overall successful sedation was achieved in 89 (87%) patients.