Intravenous sedation

To conceal a potential demarcation line, before the administration of intravenous sedation a... 

Adams F. Emergency intravenous sedation of the delirious, medically ill patient. J Clin Psychiatry 1988 49(suppl 12) 22-27. 

The BDZs of choice for intravenous sedation remain midazolam, diazepam (as an emulsion) and, in some European countries, flunitrazepam. These vary very little in their phamacological effects but it should be remembered that midazolam is twice as potent as diazepam and must be titrated slowly according to the patient s response. 

In New York City, five of 50 000 deaths over a 5-year period were associated with tumescent liposuction all had received hdocaine in doses of 10-40 mg/kg in association with general anesthesia and/or intravenous sedation and analgesia (49). Three patients died as a result of severe acute intraoperative hypotension and bradycardia with no identified cause, one died of fluid overload, and another died of pulmonary embolism. The authors speculated that hdocaine toxicity or lidocaine-related drug interactions could have contributed to some of the deaths, but other causes could not be ruled out. 

Most patients can easily tolerate this treatment without nerve block anesthesia if the peel is done slowly, cosmetic unit by cosmetic unit. More squeamish patients may prefer to have intravenous sedation, along with nerve blocks. 

Fintsi recommended simple intravenous sedation without FNB he used promethazine and morphine sulfate (5-15 mg) and titrated the doses until the burning sensation subsided. According to him, nerve block anesthesia is not essential with this procedure, but, without the FNB, the patient is in pain during the peel and this makes it uncomfortable for both the patient and the doctor. The patient only has a vague memory of the pain. Asken reported on a study by Litton showing an accelerated heartbeat slowing down when deep sedation is combined with nerve block anesthesia. 

Epstein SK Decision to extubate. Intens Care Med 2002 28(5) 535-546. [PMiD 12029399] (Risk factors tor taiied extubation inciude advanced age, ionger duration of intubation, and use of continuous intravenous sedation.)... 

Yaster M, Nichols DG, Deshpande JK, Wetzel RC. Midazolam-fentanyl intravenous sedation in children case report of respiratory arrest. Pediatrics (1991) 86, 463-6. 

If spasm of the ovarian vein occurs during selective catheterization then forceful injection of 5 cc of normal saline followed by a wait of 4-5 min is usually sufficient to allow resolution. The use of injectable vasodilators such as nitroglycerin has not been successful in the author s hands. If resolution of spasm is not possible, the procedure can be attempted on another occasion and at that instance the patient provided with sublingual nifedipine and intravenous sedation prior to the procedure. 

Grose DJ. Cigarette burn after tumescent anesthesia and intravenous sedation a case report. Dermatol Surg 2003 29(4) 433-5. 

Intravenous sedation and analgesia are used during the procedure. At our institution, a combination of Midazolam (1-3 mg) and Fentanyl (50-300 mg) is used in most patients. Patients are monitored with pulse oximetry, pulse, and blood pressure measurement throughout the procedure (Oran et al. 2000 Trotteur et al. 2000). 

The procedural mortality for metallic stent insertion is very low (0%-1.4%) (Acunas et al. 1996 Cwikiel et al. 1998 Song et al. 1994 Laasch et al. 1998 Saxon et al. 1995 Morgan et al. 1996). Procedural mortality is mainly due to comorbidity rather than trauma sustained as a result of the stent insertion procedure itself. It can be minimized by careful patient selection, optimization of patients before the procedure (e.g., by correction of electrolyte imbalances and treatment of chest infections with appropriate antibiotics and chest physiotherapy), and careful use of intravenous sedation. If possible, the use of sedation should be kept to a minimum. Stents can be inserted without... 

The procedure can be performed under CT or MRI guidance. Only local anesthesia and intravenous sedation are usually sufficient. For analgesia and sedation, piritramid (Dipidolor, Janssen Cilaq, Ger-... 

Local anesthetic and intravenous sedation are used in almost all cases for placement of a nephrostomy catheter. The patient is placed either in a prone or prone-oblique position. An entry site is selected on the flank using anatomic landmarks alone or with imaging. With ultrasound, an entry site is selected beneath the costal margin in approximately the mid-scapular line. The puncture site selected should allow for puncture into a middle or lower pole calyx. If a percutaneous surgical procedure is planned, it is usually best to enter the renal pelvis via a middle pole calyx. However, the best entry site depends on the procedure to be performed. 

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