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Moderate Sedation (moderate + sedation)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Review article: moderate sedation for endoscopy: sedation regimens for non-anaesthesiologists

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2006
D. K. REX
Summary Background Moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands with or without light tactile stimulation. Moderate sedation is typically accepted in the anaesthesia community as an appropriate target for sedation by non-anaesthesiologists. Aim To describe drug regimens that can be successfully and safely targeted to moderate sedation for endoscopy by non-anaesthesiologists. Results Moderate sedation can be achieved using narcotics and benzodiazepines. There is interest in some countries in propofol for endoscopy, which is often viewed as an agent for deep sedation. Indeed, propofol cannot be targeted to moderate sedation for endoscopy as a single agent because of coughing during upper endoscopy and pain withdrawal responses during colonoscopy. Pre-treatment with low doses of narcotic and/or benzodiazepine blocks these effects, allowing propofol to be targeted to moderate sedation. Fospropofol, a prodrug of propofol in clinical development, can also be targeted to moderate sedation if co-administered with narcotic. Conclusion Moderate sedation provides a safety margin when compared with deep sedation and general anaesthesia. Development of protocols that target agents such as propofol to moderate sedation will expand the sedation agents available to non-anaesthesiologists and help ensure that this expansion occurs safely. [source]

Pain and Anatomical Locations of Radiofrequency Ablation as Predictors of Esophageal Temperature Rise During Pulmonary Vein Isolation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2008
ARASH ARYANA M.D.
Introduction: Esophageal temperature rise (ETR) during ablation inside left atrium has been reported as a marker for esophageal thermal injury. We sought to investigate the possible relationships between chest pain and ETR during radiofrequency (RF) ablation, and ETR and locations of RF application, in patients undergoing pulmonary vein (PV) isolation under moderate sedation. Methods and Results: We analyzed anatomical locations of each RF application and its association with esophageal temperature and presence/absence of pain. Data from 40 consecutive patients (mean age: 56 ± 10 years) were analyzed. There were a total of 4,071 RF applications resulting in 291 episodes of pain (7.1%) and 223 ETRs (5.5%). Thirty-five patients (87.5%) experienced at least one pain episode and 32 (80.0%) had at least one ETR. While 77.4% of posterior wall applications that caused pain also corresponded to an ETR (P < 0.0001), only 0.8% of pain-free posterior wall applications were associated with ETRs (P < 0.0001). The sensitivity and specificity of pain during ablation for ETR were 94% and 98%, respectively. No ETRs were observed during anterior wall applications. ETRs occurred more frequently during ablation on the left (86.1%) versus the right (13.9%), and in inferior (70.4%) versus superior (29.6%) segments. Conclusion: In patients undergoing PV isolation, ETR was encountered when ablating in the posterior left atrium with the distribution left > right and inferior > superior. Pain during ablation was associated with ETR, and lack of pain was strongly associated with absence of ETR. Pain during RF ablation may thus serve as a predictor of esophageal heating and potential injury. [source]

Clinical trial: a dose,response study of fospropofol disodium for moderate sedation during colonoscopy

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2008
L. 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]