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Observer's Assessment (observer + assessment)
Selected AbstractsDoes propofol and alfentanil-induced sedation cause periodic apnoea in chronic renal failure patients?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2010S. M. Lee Summary Aims:, There is evidence suggesting that the respiratory response to sedation is different in patients with sleep apnoea, which is common in patients with chronic renal failure (CRF). This study examined the respiratory response of sedation with propofol and alfentanil, whose pharmacokinetics are not affected by the renal function, in CRF patients. Methods:, Chronic renal failure patients who underwent arteriovenous-fistular surgery (CRF group) and patients who underwent chemoport insertion (control group) were enrolled in this study. Sedation was induced by infusing propofol 1.5 ,/ml and alfentanil 0.2 ,/kg/min continuously in both groups. In the desaturation study, the respiratory rate and peripheral oxygen saturation in room air were checked. In the apnoea,hypopnoea study, the patient's sedation (Observer's Assessment of Alertness/Sedation) score, apnoea,hypopnoea index (AHI) was recorded using a portable ventilation effort recorder (microMesam) while applying 5 l/min of oxygen through a facial mask. Results:, The desaturation event was more common (21.5/h vs. 2/h, p = 0.001) in the CRF patients. Apnoea and hypopnoea (AHI: 13.0 vs. 1.6, p = 0.012, per cent of patients with an AHI > 5: 53.3% vs. 7.1%, p = 0.014) occurred more frequently in the CRF patients but the sedation score was not different. Conclusion:, Chronic renal failure patients have a higher risk of developing apnoea and hypopnoea during sedation, which highlights the need for careful monitoring and management in these patients. [source] Clinical trial: a dose,response study of fospropofol disodium for moderate sedation during colonoscopyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2008L. B. COHEN Summary Background, An effective agent is needed that provides rapid onset of sedation and quick recovery for patients undergoing colonoscopy. Aim, To assess the efficacy and safety of fospropofol disodium in providing sedation in patients undergoing colonoscopy. Methods, A randomized, double-blind, multicentre trial evaluated 127 adult patients who received fospropofol (2, 5, 6.5 or 8 mg/kg) or midazolam 0.02 mg/kg following pre-treatment with fentanyl. Supplemental doses of study medication were allowed to reach a Modified Observer's Assessment of Alertness/Sedation scale score ,4. Efficacy end points included sedation success, measures of clinical benefit, sedation, and recovery as well as patient- and doctor-rated satisfaction. Results, Fospropofol produced a significant dose-dependent increase in sedation success from 24% (2 mg/kg), 35% (5 mg/kg) and 69% (6.5 mg/kg) to 96% (8 mg/kg; P < 0.001). There were also dose-dependent trends for time to sedation, requirements for alternative sedative medication, supplemental doses of sedative and fentanyl, time to ready for discharge and doctor-rated satisfaction scores. Fospropofol was well tolerated, with most adverse events mild-to-moderate in severity. Conclusion, The 6.5 mg/kg dose of fospropofol provides the ideal balance of efficacy and safety for patients undergoing colonoscopy and has been selected for phase 3 clinical development. [source] Effect of midazolam on memory: a study of process dissociation procedure and functional magnetic resonance imagingANAESTHESIA, Issue 6 2010S. Y. Tian Summary To assess the effects of midazolam on explicit and implicit memories, 12 volunteers were randomly divided into the two groups: one with an Observer's Assessment of Alertness/Sedation score of 3 (mild sedation) and one with a score of 1 (deep sedation). Blood oxygen-level-dependent functional magnetic resonance imaging was measured before and during an auditory stimulus, then with midazolam sedation, and then during a second auditory stimulus with continuous midazolam sedation. After 4 h, explicit and implicit memories were assessed. There was no evidence of explicit memory at the two levels of midazolam sedation. Implicit memory was retained at a mild level of midazolam sedation but absent at a deep level of midazolam sedation. At a mild level of midazolam sedation, activation of all brain areas by auditory stimulus (as measured by functional magnetic resonance imaging) was uninhibited. However, a deep level of midazolam sedation depressed activation of the superior temporal gyrus by auditory stimulus. We conclude that midazolam does not abolish implicit memory at a mild sedation level, but can abolish both explicit and implicit memories at a deep sedation level. The superior temporal gyrus may be one of the target areas. [source] Effect of epidural dexmedetomidine on intraoperative awareness and post-operative pain after one-lung ventilationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2010M. ELHAKIM Background: During combined general and regional anaesthesia, it is difficult to use autonomic signs to assess whether wakefulness is suppressed adequately. We compared the effects of a dexmedetomidine,bupivacaine mixture with plain bupivacaine for thoracic epidural anaesthesia on intraoperative awareness and analgesic benefits, when combined with superficial isoflurane anaesthesia (<0.05 maximum alveolar concentration) in patients undergoing thoracic surgery with one-lung ventilation (OLV). Methods: Fifty adult male patients were randomly assigned to receive either epidural dexmedetomidine 1 ,g/kg with bupivacaine 0.5% (group D) or bupivacaine 0.5% alone (group B) after induction of general anaesthesia. Gasometric, haemodynamic and bispectral index values were recorded. Post-operative verbal rating score for pain and observer's assessment of alertness/sedation scale were determined by a blinded observer. Results: Dexmedetomidine reduced the use of supplementary fentanyl during surgery. Patients in group B consumed more analgesics and had higher pain scores after operation than patients of group D. The level of sedation was similar between the two groups in the ICU. Two patients (8%) in group B reported possible intraoperative awareness. There was a limited decrease in PaO2 at OLV in group D compared with group B (P<0.05). Conclusion: In thoracic surgery with OLV, the use of epidural dexmedetomidine decreases the anaesthetic requirements significantly, prevents awareness during anaesthesia and improves intraoperative oxygenation and post-operative analgesia. [source] Do Participants and Observers Assess Intentions Differently During Bargaining and Conflict?AMERICAN JOURNAL OF POLITICAL SCIENCE, Issue 4 2009Eric S. Dickson Political actors in conflict settings are often uncertain about their counterparts' intentions. This article explores the psychology of how intentions are assessed using a novel experimental design that randomly assigns subjects to one of three roles,"proposer,""recipient," or "observer." Recipients and observers are given identical noisy information about proposers' actions, and make postplay assessments of proposers' intentions that are rewarded based on accuracy. A first experiment explores a context of ambiguity, while a second experiment explores a context of uncertainty. The results suggest that actors' perceptions can sometimes be directly affected by the set of strategic alternatives they possess. When signals about proposer behavior appear "negative," recipients' assessments of proposers' intentions are more negative than observers' assessments if recipients have the ability to respond to the proposer's action,but not if recipients lack this ability. The ability to respond to proposer behavior appears to cause recipients to make more negative inferences about the proposer than circumstances warrant. Interestingly, recipients' and observers' assessments are indistinguishable when signals about proposer behavior instead appear "positive." [source] | ||||||||||