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Khinda V, Rao D, Sodhi SPS. Nitrous Oxide Inhalation Sedation Rapid Analgesia in Dentistry: An Overview of Technique, Objectives, Indications, Advantages, Monitoring, and Safety Profile. Int J Clin Pediatr Dent 2023; 16:131-138. [PMID: 37020786 PMCID: PMC10067981 DOI: 10.5005/jp-journals-10005-1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Nitrous oxide inhalation sedation (NOIS) has been the backbone of anxiety alleviation in dentistry for a long time. Advantages of nitrous oxide (N2O) include anxiolysis, mild analgesia, and amnesia. It also has the ability to raise the patient pain threshold, providing rapid analgesia (RA), thus enhancing the action of any local anesthesia used. This paper describes the technique of NOIS in detail and highlights its objectives, advantages, indications, monitoring, and safety profile. Other than the specialty of pediatric dentistry, this paper also highlights the applications and merits of NOIS in adult, geriatric, and special healthcare needs dentistry. Away from dentistry, it also brings to light the multidisciplinary applications of NOIS in other medical streams. This review could be a valuable interpretation on the present position of N2O sedation in dentistry and a valuable starting point for future perspectives. How to cite this article Khinda V, Rao D, Singh Sodhi SP. Nitrous Oxide Inhalation Sedation Rapid Analgesia in Dentistry: An Overview of Technique, Objectives, Indications, Advantages, Monitoring, and Safety Profile. Int J Clin Pediatr Dent 2023;16(1):131-138.
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Affiliation(s)
- Vineet Khinda
- Department of Pediatric Dentistry, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; Pacific Academy of Higher Education and Research University, Udaipur, Rajasthan, India
| | - Dinesh Rao
- Department of Pediatric Dentistry, Pacific Dental College and Hospital, Pacific Academy of Higher Education and Research University, Udaipur, Rajasthan, India
| | - Surender Pal Singh Sodhi
- Department of Oral and Maxillofacial Surgery, Dasmesh Institute of Dental Sciences and Research, Faridkot, Punjab, India
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Qanadli SD, Gudmundsson L, Gullo G, Ponti A, Saltiel S, Jouannic AM, Faouzi M, Rotzinger DC. Virtually Augmented Self-Hypnosis applied to endovascular interventions (VA-HYPO): Randomized Controlled Trial Protocol. PLoS One 2022; 17:e0263002. [PMID: 35196310 PMCID: PMC8865664 DOI: 10.1371/journal.pone.0263002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
Endovascular interventions (EVI) are increasingly performed as minimally-invasive alternatives to surgery and have many advantages, including a decreased need for general anesthesia. However, EVI can be stressful for patients and often lead to anxiety and pain related to the procedure. The use of local anesthetics, anxiolytics, and analgesic drugs can help avoid general anesthesia. Nevertheless, these drugs have potential side effects. Alternative nonpharmacological therapies can improve patients’ experience during conscious interventions and reduce the need for additional medications. The added value of virtually augmented self-hypnosis (VA-HYPO) and its potential to reduce pain and anxiety during peripheral and visceral arterial and venous EVI is unknown. This is a prospective two-arm trial designed to randomize 100 patients in two groups according to the use or not of VA-HYPO during peripheral EVI as a complementary nonpharmacological technique to improve patient comfort. The main objective is to compare per-procedural anxiety, and the secondary aim is to compare the rated per-procedural pain in both groups. The potential significance is that VA-HYPO may improve patients’ experience during peripheral and visceral arterial and venous EVI and other minimally invasive interventions performed under local anesthesia. Trial registration: Our study is registered on clinicaltrials.gov, with trial registration number: NCT04561596.
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Affiliation(s)
- Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- * E-mail: (DCR); (SDQ)
| | - Louis Gudmundsson
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giuseppe Gullo
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Ponti
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sarah Saltiel
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Marie Jouannic
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mohamed Faouzi
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- * E-mail: (DCR); (SDQ)
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Ji T, Li X, Chen J, Ren X, Mei L, Qiu Y, Zhang J, Wang S, Xu Z, Li H, Zheng L, Peng Y, Liu Y, Ni X, Tai J, Liu J. Brain function in children with obstructive sleep apnea: a resting-state fMRI study. Sleep 2021; 44:6155746. [PMID: 33675225 DOI: 10.1093/sleep/zsab047] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/16/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore the neural difference between children with obstructive sleep apnea (OSA) and healthy controls, together with the relation between this difference and cognitive dysfunction of children with OSA. METHODS Twenty children with OSA (7.2 ± 3.1 years, apnea hypopnea index (AHI): 16.5 ± 16.6 events/h) and 29 healthy controls (7.7 ± 2.8 years, AHI: 1.7 ± 1.2 events/h) were recruited and matched with age, gender, and handedness. All children underwent resting-state fMRI (rs-fMRI) and T1-wighted imaging. Some children were sedated for MRI scanning. We compared amplitude of low frequency fluctuation (ALFF) and regional homogeneity (ReHo) of children with OSA with those of healthy controls. During resting-state, the former reflects the intensity of the spontaneous neural activities, whereas the latter reflects temporal similarity of the spontaneous neural activities within a local brain region. Pearson correlation analysis was performed between these features of rs-fMRI and cognitive scores among children with OSA. RESULTS Compared with controls, children with OSA showed decreased ALFF in the left angular gyrus but increased ALFF in the right insula, and decreased ReHo in the left medial superior frontal gyrus, right lingual gyrus, and left precuneus. Additionally, among children with OSA, the ReHo value in the right lingual gyrus was negatively correlated with FIQ and VIQ, whereas that in the left medial superior frontal gyrus was positively correlated with VIQ. CONCLUSIONS Children with OSA presented abnormal neural activities in some brain regions and impaired cognitive functions with the former possibly being the neural mechanism of the latter.
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Affiliation(s)
- Tingting Ji
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jun Chen
- Beijing Engineering Research Center of Pediatric Surgery, Engineering and Translational Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuemin Ren
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medical Science and Engineering, Beihang University, Beijing, China.,Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the, People's Republic of China, Beijing, China
| | - Lin Mei
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yue Qiu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhifei Xu
- Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Department of Sleep Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hongbin Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Li Zheng
- Department of Sleep Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yun Peng
- Department of Radiology, Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yue Liu
- Department of Radiology, Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jun Tai
- Department of Otorhinolaryngology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Jiangang Liu
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medical Science and Engineering, Beihang University, Beijing, China.,Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the, People's Republic of China, Beijing, China
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4
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Martinez-Dolz L, Pajares A, López-Cantero M, Osca J, Díez JL, Paniagua P, Argente P, Arana E, Alonso C, Rodriguez T, Vicente R, Anguita M, Alvarez J. Consensus document for anaesthesiologist-assisted sedation in interventional cardiology procedures. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:309-337. [PMID: 34147407 DOI: 10.1016/j.redare.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Affiliation(s)
- L Martinez-Dolz
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, IIS La Fe, CIBERCV, Valencia, Spain.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - M López-Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - J Osca
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - J L Díez
- Unidad de Hemodinámica, Servicio de Cardiología del Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - P Paniagua
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - P Argente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - E Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, Spain
| | - C Alonso
- Unidad de Arritmias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - T Rodriguez
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain
| | - R Vicente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - M Anguita
- Servicio de Cardiología, Hospital Reina Sofía de Córdoba, Córdoba, Spain
| | - J Alvarez
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario de Santiago, Universidad de Santiago, Santiago de Compostela, Spain
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Martinez-Dolz L, Pajares A, López-Cantero M, Osca J, Díez JL, Paniagua P, Argente P, Arana E, Alonso C, Rodriguez T, Vicente R, Anguita M, Alvarez J. Consensus document for anaesthesiologist-assisted sedation in interventional cardiology procedures. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:309-337. [PMID: 33931263 DOI: 10.1016/j.redar.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Affiliation(s)
- L Martinez-Dolz
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe. IIS La Fe. CIBERCV, Valencia, España.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - M López-Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - J Osca
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - J L Díez
- Unidad de Hemodinámica, Servicio de Cardiología del Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - P Paniagua
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - P Argente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - E Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, España
| | - C Alonso
- Unidad de Arritmias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - T Rodriguez
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, España
| | - R Vicente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - M Anguita
- Servicio de Cardiología, Hospital Reina Sofía de Córdoba., Córdoba, España
| | - J Alvarez
- Servicio Anestesia y Reanimación. Complejo Hospitalario Universitario de Santiago. Universidad de Santiago, Santiago de Compostela, España
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Sahyoun C, Cantais A, Gervaix A, Bressan S, Löllgen R, Krauss B. Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice. Eur J Pediatr 2021; 180:1799-1813. [PMID: 33511466 PMCID: PMC8105204 DOI: 10.1007/s00431-021-03930-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 12/27/2022]
Abstract
Procedural sedation and analgesia outside the operating theater have become standard care in managing pain and anxiety in children undergoing diagnostic and therapeutic procedures. The objectives of this study are to describe the current pediatric procedural sedation and analgesia practice patterns in European emergency departments, to perform a needs assessment-like analysis, and to identify barriers to implementation. A survey study of European emergency departments treating children was conducted. Through a lead research coordinator identified through the Research in European Pediatric Emergency Medicine (REPEM) network for each of the participating countries, a 30-question questionnaire was sent, targeting senior physicians at each site. Descriptive statistics were performed. One hundred and seventy-one sites participated, treating approximately 5 million children/year and representing 19 countries, with a response rate of 89%. Of the procedural sedation and analgesia medications, midazolam (100%) and ketamine (91%) were available to most children, whereas propofol (67%), nitrous oxide (56%), intranasal fentanyl (47%), and chloral hydrate (42%) were less frequent. Children were sedated by general pediatricians in 82% of cases. Safety and monitoring guidelines were common (74%), but pre-procedural checklists (51%) and capnography (46%) less available. In 37% of the sites, the entire staff performing procedural sedation and analgesia were certified in pediatric advanced life support. Pediatric emergency medicine was a board-certified specialty in 3/19 countries. Physician (73%) and nursing (72%) shortages and lack of physical space (69%) were commonly reported as barriers to procedural sedation and analgesia. Nurse-directed triage protocols were in place in 52% of the sites, mostly for paracetamol (99%) and ibuprofen (91%). Tissue adhesive for laceration repair was available to 91% of children, while topical anesthetics for intravenous catheterization was available to 55%. Access to child life specialists (13%) and hypnosis (12%) was rare.Conclusion: Procedural sedation and analgesia are prevalent in European emergency departments, but some sedation agents and topical anesthetics are not widely available. Guidelines are common but further safety nets, nurse-directed triage analgesia, and nonpharmacologic support to procedural sedation and analgesia are lacking. Barriers to implementation include availability of sedation agents, staff shortage, and lack of space. What is Known: • Effective and prompt analgesia, anxiolysis, and sedation (PSA) outside the operating theatre have become standard in managing pain and anxiety in children undergoing painful or anxiogenic diagnostic and therapeutic procedures. • We searched PubMed up to September 15, 2020, without any date limits or language restrictions, using different combinations of the MeSH terms "pediatrics," "hypnotics and sedatives," "conscious sedation," and "ambulatory surgical procedures" and the non-MeSH term "procedural sedation" and found no reports describing the current practice of pediatric PSA in Europe. What is New: • This study is, to the best of our knowledge, the first to shed light on the pediatric PSA practice in European EDs and uncovers important gaps in several domains, notably availability of sedation medications and topical anesthetics, safety aspects such as PSA provider training, availability of nonpharmacologic support to PSA, and high impact interventions such as nurse-directed triage analgesia. • Other identified barriers to PSA implementation include staff shortage, control of sedation medications by specialists outside the emergency department, and lack of space.
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Affiliation(s)
- Cyril Sahyoun
- Division of Pediatric Emergency Medicine, Children’s Hospital of Geneva, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, 4, 1205 Geneva, Switzerland
| | - Aymeric Cantais
- Division of Pediatric Emergency Medicine, Children’s Hospital of Geneva, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, 4, 1205 Geneva, Switzerland
| | - Alain Gervaix
- Division of Pediatric Emergency Medicine, Children’s Hospital of Geneva, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, 4, 1205 Geneva, Switzerland
| | - Silvia Bressan
- Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - Ruth Löllgen
- Pediatric Emergency Department, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Baruch Krauss
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
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Kuga S, Maeda T, Ihara K. Pediatric procedural sedation in Japan: A single-facility study of 1,436 cases. Pediatr Int 2020; 62:1346-1350. [PMID: 32501599 DOI: 10.1111/ped.14331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric procedural sedation (PPS) has been established worldwide as standard practice for several decades. However, there are no comprehensive guidelines or multi-facility databases of PPS in Japan, and the current status of PPS and PPS-related adverse events is unclear. The objectives of this study were to investigate the status of PPS in Japan and clarify the adverse events and risk factors. METHODS This study was a single-facility, database survey performed at Oita University Hospital from September 2016 to March 2019. Children under 18 years of age who had been kept sedated for medical procedures with intravenous sedatives were enrolled in this study. Adverse events were recorded and defined according to the Quebec Guideline. RESULTS During the study period, PPS was performed for 1,436 consecutive cases. The majority (94%) of the sedatives used were thiamylal alone or thiamylal combined with ketamine. There were a total of 253 adverse events in 233 cases (16.2%), including oxygen desaturation, airway hypersensitivity, and vomiting. Patients recovered from respiratory-related adverse events immediately with simple intervention. No patient required endotracheal intubation and no severe adverse event occurred. Four risk factors (a higher American Society of Anesthesiologists classification, longer procedure time, non-compliance of nil per os status, and no Pediatric Advanced Life Support certification for sedation personnel) were associated with the occurrence of adverse events. CONCLUSIONS Adverse events occurred in 16.2% of all PPS cases. Further studies are needed to analyze the serious adverse events and risk factors for PPS in Japan.
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Affiliation(s)
- Shuji Kuga
- Department of Pediatrics, Faculty of Medicine, Oita University, Yufu, Japan
| | - Tomoki Maeda
- Department of Pediatrics, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kenji Ihara
- Department of Pediatrics, Faculty of Medicine, Oita University, Yufu, Japan
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Azizkhani R, Heydari F, Ghazavi M, Riahinezhad M, Habibzadeh M, Bigdeli A, Golshani K, Majidinejad S, Mohammadbeigi A. Comparing Sedative Effect of Dexmedetomidine versus Midazolam for Sedation of Children While Undergoing Computerized Tomography Imaging. J Pediatr Neurosci 2020; 15:245-251. [PMID: 33531939 PMCID: PMC7847110 DOI: 10.4103/jpn.jpn_107_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/04/2019] [Accepted: 05/24/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Pediatric anxiety and restlessness may create issues and difficulties in performing accurate diagnostic studies even noninvasive ones, such as radiological imaging. There are some agents that will help to get this goal. This study aimed to compare the intranasal effect of dexmedetomidine (DEX) and midazolam (MID) for sedation parameters of children undergoing computerized tomography (CT) imaging. Materials and Methods: A double-blind clinical trial was conducted on 162 eligible children who underwent CT imaging. These patients were divided into two groups including MID (n = 81) with dose of 0.3 mg.kg and DEX (n = 81) with dose of 3 μg.kg, which was consumed intranasally. The mean blood pressure (MBP), respiratory rate (RR), heart rate (HR), and oxygen saturation (O2Sat) in children were recorded. Then, time of initiation, level of sedation, and duration effect of medication were measured at 0, 10, 20, and 30 min. Parents and clinician satisfaction score was asked. All data were analyzed using the Statistical Package for the Social Sciences (SPSS) software by t test and chi-square test. Results: Decreasing in MBP and HR was higher in DEX group than MID group (P < 0.001), whereas decrease of O2Sat in MID group was higher than DEX group (0.009). Starting time of sedation (22.72 ± 11.64 vs. 33.38 ± 10.17, P = 0.001) was lower in DEX group. Parents (P < 0.001) and physician (P < 0.001) satisfaction score was higher in DEX group than the MID group. Conclusion: Using 3 μg/kg intranasal DEX for sedation of 1–6-year-old children was a suitable method to undergo noninvasive studies such as CT imaging. Intranasal DEX is superior to MID due to higher sedation satisfactory, faster starting effect of sedation, and lower side effects and complications. Nevertheless, in children with hemodynamic instability DEX is not an appropriate choice.
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Affiliation(s)
- Reza Azizkhani
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farhad Heydari
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Maryam Riahinezhad
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ali Bigdeli
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keihan Golshani
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Majidinejad
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abolfazl Mohammadbeigi
- Neuroscience Research Center, Department of Epidemiology and Biostatistics, Qom University of Medical Sciences, Qom, Iran
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Romagnoli S, Fanelli F, Barbani F, Uberoi R, Esteban E, Lee MJ, Nielsen PT, Mahnken AH, Morgan R. CIRSE Standards of Practice on Analgesia and Sedation for Interventional Radiology in Adults. Cardiovasc Intervent Radiol 2020; 43:1251-1260. [PMID: 32556610 DOI: 10.1007/s00270-020-02536-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/25/2020] [Indexed: 11/24/2022]
Abstract
This CIRSE Standards of Practice document provides best practices for the safe administration of procedural sedation and analgesia for interventional radiology procedures in adults. The document is aimed at health professionals involved in the provision of sedation and analgesia during interventional radiology procedures. The document has been developed by a writing group consisting of physicians with internationally recognised expertise in interventional radiology, and analgesia and sedation.
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Affiliation(s)
- Stefano Romagnoli
- Health Science Department, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy.,Department of Anesthesia and Critical Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Fabrizio Fanelli
- Vascular and Interventional Radiology Department, "Careggi" University Hospital, Florence, Italy.
| | - Francesco Barbani
- Department of Anesthesia and Critical Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Raman Uberoi
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Enrique Esteban
- Vascular and Interventional Radiology Department, Hospital Universitario de la Ribera, Alzira, Valencia, Spain
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont, Ireland
| | - Peter Thomas Nielsen
- Department of Anaesthesia and Critical Care, Hull and East Yorkshire Hospitals NHS Trust, Kingston Upon Hull, UK
| | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Marburg, Germany
| | - Robert Morgan
- Department of Interventional Radiology, St George's University of London, London, UK
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Sauer H, Lobenhofer M, Abdul-Khaliq H. Analgosedation for diagnostic and interventional procedures: a countrywide survey of pediatric centers in Germany. Ital J Pediatr 2020; 46:14. [PMID: 32014023 PMCID: PMC6998146 DOI: 10.1186/s13052-020-0783-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background As more and more diagnostic and interventional options are becoming available for use in pediatric patients, techniques of procedural sedation analgesia (PSA) are being administered in considerably growing numbers as well. Aims The objective of this research effort was to conduct the first countrywide survey on the status quo of sedation analgesia as delivered to children and adolescents in Germany. Methods We dispatched letters to all pediatric hospital settings in Germany (n = 305), including a questionnaire that had been developed with existing guidelines taken into account. Its items were designed to elucidate the current practice of PSA throughout these pediatric centers regarding (a) organizational structures and (b) standards of medication and staffing. Results A total of 138 centers returned the questionnaire, hence the response rate was 45.2%. Numerous centers had implemented adequate structures and staffing standards. Deficits were nevertheless identified, most notably in terms of on-location equipment and staff provided to deliver sedations. Essential items of equipment were not provided in up to 26.8% of centers. Adequate staffing was not provided in up to 44.2% of centers, depending on the diagnostic or interventional procedures for which the PSA was delivered. The most widely used sedative agents were midazolam, ketamine/esketamine, and propofol. Conclusions Adequate care structures for the management of procedural sedation analgesia have been implemented by many pediatric centers in Germany. On the downside, these findings also reveal deficits that will take efforts to be eliminated.
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Affiliation(s)
- Harald Sauer
- Department of Pediatric Cardiology, University Hospital of Saarland, Kirrberger Strasse, Building 9, 66421, Homburg (Saar), Germany.
| | - Marie Lobenhofer
- Department of Gynecology, St. Theresa Hospital Nuremberg, Nuremberg, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, University Hospital of Saarland, Kirrberger Strasse, Building 9, 66421, Homburg (Saar), Germany
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Poonai N, Spohn J, Vandermeer B, Ali S, Bhatt M, Hendrikx S, Trottier ED, Sabhaney V, Shah A, Joubert G, Hartling L. Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review. Pediatrics 2020; 145:peds.2019-1623. [PMID: 31862730 DOI: 10.1542/peds.2019-1623] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children. OBJECTIVE To explore the effectiveness of IND for procedural distress in children. DATA SOURCES We performed electronic searches of Medline (1946-2019), Embase (1980-2019), Google Scholar (2019), Cumulative Index to Nursing and Allied Health Literature (1981-2019), and Cochrane Central Register. STUDY SELECTION We included randomized trials of IND for procedures in children. DATA EXTRACTION Methodologic quality of evidence was evaluated by using the Cochrane Collaboration's risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. The primary outcome was the proportion of participants with adequate sedation. RESULTS Among 19 trials (N = 2137), IND was superior to oral chloral hydrate (3 trials), oral midazolam (1 trial), intranasal midazolam (1 trial), and oral dexmedetomidine (1 trial). IND was equivalent to oral chloral hydrate (2 trials), intranasal midazolam (2 trials), and intranasal ketamine (3 trials). IND was inferior to oral ketamine and a combination of IND plus oral ketamine (1 trial). Higher doses of IND were superior to lower doses (4 trials). Adverse effects were reported in 67 of 727 (9.2%) participants in the IND versus 98 of 591 (16.6%) in the comparator group. There were no reports of adverse events requiring resuscitative measures. LIMITATIONS The adequacy of sedation was subjective, which possibly led to biased outcome reporting. CONCLUSIONS Given the methodologic limitations of included trials, IND is likely more effective at sedating children compared to oral chloral hydrate and oral midazolam. However, this must be weighed against the potential for adverse cardiovascular effects.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; .,Division of Emergency Medicine and.,Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | | | - Ben Vandermeer
- Department of Pediatrics and Alberta Research Centre for Health Evidence
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, and.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Evelyne D Trottier
- Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montréal, Québec, Canada; and
| | - Vikram Sabhaney
- BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,Division of Emergency Medicine and
| | - Lisa Hartling
- Department of Pediatrics and Alberta Research Centre for Health Evidence
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Morel B, Andersson F, Samalbide M, Binninger G, Carpentier E, Sirinelli D, Cottier JP. Impact on child and parent anxiety level of a teddy bear-scale mock magnetic resonance scanner. Pediatr Radiol 2020; 50:116-120. [PMID: 31501961 DOI: 10.1007/s00247-019-04514-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/26/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pediatric magnetic resonance imaging (MRI) can be stressful. Mock MR scanners have been proven to be effective in avoiding the use of general anesthesia. OBJECTIVES We prospectively evaluated the impact of a teddy bear-scale model of a mock MR scanner on the anxiety experienced by parents and their children during MRI without general anesthesia . MATERIALS AND METHODS A 1-year prospective study before and after the installation of a mock scanner in a Pediatric Radiology Department of a university hospital. Anxiety levels were self-estimated by children ages 4 to 16 years and by the parents with a visual analogue scale (from 0, completely relaxed, to 100, extremely stressed) at three moments: in the waiting room, in the preparation room after an explanation by the MRI technologists, and at the issue of the MR acquisition images. Two groups were tested: one with a mock MR scanner, the other without. Analysis of variance (ANOVA) and Fisher exact tests were performed. Motion artifacts were studied. RESULTS Ninety-one children and their parents were included. The median age was 8 years (standard deviation [SD]=2). In the post mock period, the ambiance of the preparation room was considered by children as significantly more relaxing in 50% vs. 20% (P=0.004) and the anxiety level of children was significantly lower after the explanation, particularly in girls, but unchanged for their parents. The anxiety levels at the end of the examination were significantly lower for parents. The motion artifacts rate was lower (1.7% vs. 4.7%, P=0.04). CONCLUSION A mock scanner was an efficient tool to improve efficiency of the explanation and to decrease anxiety in children and motion artifacts in pediatric MRI.
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Affiliation(s)
- Baptiste Morel
- Pediatric Radiology Department, Clocheville University Hospital, 49 Boulevard Beranger, 37000, Tours, France. .,Faculty of Medicine, Francois Rabelais University, Tours, France. .,UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.
| | | | - Muriel Samalbide
- Pediatric Radiology Department, Clocheville University Hospital, 49 Boulevard Beranger, 37000, Tours, France
| | - Gauthier Binninger
- Pediatric Radiology Department, Clocheville University Hospital, 49 Boulevard Beranger, 37000, Tours, France
| | - Elodie Carpentier
- Pediatric Radiology Department, Clocheville University Hospital, 49 Boulevard Beranger, 37000, Tours, France
| | - Dominique Sirinelli
- Pediatric Radiology Department, Clocheville University Hospital, 49 Boulevard Beranger, 37000, Tours, France.,Faculty of Medicine, Francois Rabelais University, Tours, France
| | - Jean-Philippe Cottier
- Faculty of Medicine, Francois Rabelais University, Tours, France.,UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,Neuroradiology Department, Bretonneau Hospital, Tours, France
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Park BS, Yoo YM, Noh OK, Park MS, Lee JH. Adverse Events and Risk Factors Associated with Chloral Hydrate Sedation for Brain Magnetic Resonance Imaging in the Neonatal Intensive Care Unit. Neonatal Med 2019. [DOI: 10.5385/nm.2019.26.2.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
This retrospective study investigated the application of the sedation-agitation scale (SAS) in pediatric bronchoscopy by observing its effects on sedative dosages and adverse reactions.Children who underwent sedation before bronchoscopy, during the period from January 2014 to June 2017, were divided into control and SAS groups. Patients in the control group were administered a single dose of 0.1 to 0.3 mg/kg midazolam, based on physicians' clinical experience. The initial dose of midazolam in the SAS group was 0.1 mg/kg, and was adjusted based on the SAS score, as evaluated by physicians. Between-group comparisons were made of midazolam dose; adverse reactions of midazolam, such as agitation, delirium, excessive sedation, and respiratory depression; operating time of bronchoscopy; and number of participants.No statistically significant differences in gender, age distribution, weight, or disease composition were observed between the groups. The midazolam dose, operating time, and number of participants at different ages were all lower in the SAS group than in the control group. Fewer adverse drug reactions, such as intraoperative agitation and delirium, were noted in the SAS group. Moreover, the overall number of participants was reduced, and the overall operating time was less than that in the control group.Application of SAS for assessment of sedation during pediatric bronchoscopy can guide individualized administration of midazolam, reduce midazolam dose while achieving an ideal sedative effect, reduce adverse reactions, and improve operator experience. Hence, its use should be promoted for pediatric patients undergoing bronchoscopy under local anesthesia and conscious sedation.
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Affiliation(s)
- Lin Zhong
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Kun Shen
- Department of Orthopedics, Nuclear Industry 416 Hospital
- The Second Affiliated Hospital of Chengdu Medical college, Chengdu, Sichuan, China
| | - Songhui Zhai
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Ting Chen
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Qingfen Tao
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University
| | - Lina Chen
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Yuhong Tao
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Li Qiu
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
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Míguez Navarro C, Oikonomopoulou N, Rivas García A, Mora Capín A, Guerrero Márquez G, Míguez Navarro C, Oikonomopoulou N, Rivas García A, Mora Capín A, Guerrero Márquez G, Lorente AIF, de Gracia Calvo PS, Ruiz EB, Gracia ES, Ayestarán OS, Muñoz CP, Castro CC, García SM, López CM, Arrieta NC, García JÁ, Cubero I, Arribas JLF, Millán AB, Olmo JAC, Cervera JLC, Bel CGV, Celís MJC, Linde MJC, Salas MTA. Efficacy, safety and satisfaction of sedation-analgesia in Spanish emergency departments. Anales de Pediatría (English Edition) 2019; 90:32-41. [DOI: 10.1016/j.anpede.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
BACKGROUND This is the second update of a Cochrane Review (Issue 4, 2006). Pain and distress from needle-related procedures are common during childhood and can be reduced through use of psychological interventions (cognitive or behavioral strategies, or both). Our first review update (Issue 10, 2013) showed efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents. OBJECTIVES To assess the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents. SEARCH METHODS We searched six electronic databases for relevant trials: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; PsycINFO; Embase; Web of Science (ISI Web of Knowledge); and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We sent requests for additional studies to pediatric pain and child health electronic listservs. We also searched registries for relevant completed trials: clinicaltrials.gov; and World Health Organization International Clinical Trials Registry Platform (www.who.int.trialsearch). We conducted searches up to September 2017 to identify records published since the last review update in 2013. SELECTION CRITERIA We included peer-reviewed published randomized controlled trials (RCTs) with at least five participants per study arm, comparing a psychological intervention with a control or comparison group. Trials involved children aged two to 19 years undergoing any needle-related medical procedure. DATA COLLECTION AND ANALYSIS Two review authors extracted data and assessed risks of bias using the Cochrane 'Risk of bias' tool. We examined pain and distress assessed by child self-report, observer global report, and behavioral measurement (primary outcomes). We also examined any reported physiological outcomes and adverse events (secondary outcomes). We used meta-analysis to assess the efficacy of identified psychological interventions relative to a comparator (i.e. no treatment, other active treatment, treatment as usual, or waitlist) for each outcome separately. We used Review Manager 5 software to compute standardized mean differences (SMDs) with 95% confidence intervals (CIs), and GRADE to assess the quality of the evidence. MAIN RESULTS We included 59 trials (20 new for this update) with 5550 participants. Needle procedures primarily included venipuncture, intravenous insertion, and vaccine injections. Studies included children aged two to 19 years, with few trials focused on adolescents. The most common psychological interventions were distraction (n = 32), combined cognitive behavioral therapy (CBT; n = 18), and hypnosis (n = 8). Preparation/information (n = 4), breathing (n = 4), suggestion (n = 3), and memory alteration (n = 1) were also included. Control groups were often 'standard care', which varied across studies. Across all studies, 'Risk of bias' scores indicated several domains at high or unclear risk, most notably allocation concealment, blinding of participants and outcome assessment, and selective reporting. We downgraded the quality of evidence largely due to serious study limitations, inconsistency, and imprecision.Very low- to low-quality evidence supported the efficacy of distraction for self-reported pain (n = 30, 2802 participants; SMD -0.56, 95% CI -0.78 to -0.33) and distress (n = 4, 426 participants; SMD -0.82, 95% CI -1.45 to -0.18), observer-reported pain (n = 11, 1512 participants; SMD -0.62, 95% CI -1.00 to -0.23) and distress (n = 5, 1067 participants; SMD -0.72, 95% CI -1.41 to -0.03), and behavioral distress (n = 7, 500 participants; SMD -0.44, 95% CI -0.84 to -0.04). Distraction was not efficacious for behavioral pain (n = 4, 309 participants; SMD -0.33, 95% CI -0.69 to 0.03). Very low-quality evidence indicated hypnosis was efficacious for reducing self-reported pain (n = 5, 176 participants; SMD -1.40, 95% CI -2.32 to -0.48) and distress (n = 5, 176 participants; SMD -2.53, 95% CI -3.93 to -1.12), and behavioral distress (n = 6, 193 participants; SMD -1.15, 95% CI -1.76 to -0.53), but not behavioral pain (n = 2, 69 participants; SMD -0.38, 95% CI -1.57 to 0.81). No studies assessed hypnosis for observer-reported pain and only one study assessed observer-reported distress. Very low- to low-quality evidence supported the efficacy of combined CBT for observer-reported pain (n = 4, 385 participants; SMD -0.52, 95% CI -0.73 to -0.30) and behavioral distress (n = 11, 1105 participants; SMD -0.40, 95% CI -0.67 to -0.14), but not self-reported pain (n = 14, 1359 participants; SMD -0.27, 95% CI -0.58 to 0.03), self-reported distress (n = 6, 234 participants; SMD -0.26, 95% CI -0.56 to 0.04), observer-reported distress (n = 6, 765 participants; SMD 0.08, 95% CI -0.34 to 0.50), or behavioral pain (n = 2, 95 participants; SMD -0.65, 95% CI -2.36 to 1.06). Very low-quality evidence showed efficacy of breathing interventions for self-reported pain (n = 4, 298 participants; SMD -1.04, 95% CI -1.86 to -0.22), but there were too few studies for meta-analysis of other outcomes. Very low-quality evidence revealed no effect for preparation/information (n = 4, 313 participants) or suggestion (n = 3, 218 participants) for any pain or distress outcome. Given only a single trial, we could draw no conclusions about memory alteration. Adverse events of respiratory difficulties were only reported in one breathing intervention. AUTHORS' CONCLUSIONS We identified evidence supporting the efficacy of distraction, hypnosis, combined CBT, and breathing interventions for reducing children's needle-related pain or distress, or both. Support for the efficacy of combined CBT and breathing interventions is new from our last review update due to the availability of new evidence. The quality of trials and overall evidence remains low to very low, underscoring the need for improved methodological rigor and trial reporting. Despite low-quality evidence, the potential benefits of reduced pain or distress or both support the evidence in favor of using these interventions in clinical practice.
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Affiliation(s)
- Kathryn A Birnie
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Ucisik-Keser FE, Chi TL, Hamid Y, Dinh A, Chang E, Ferson DZ. Impact of airway management strategies on magnetic resonance image quality. Br J Anaesth 2018; 117 Suppl 1:i97-i102. [PMID: 27566792 DOI: 10.1093/bja/aew210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Use of general anaesthesia or deep sedation during magnetic resonance imaging (MRI) studies leads to pharyngeal muscle relaxation, often resulting in snoring and subsequent vibrations with head micromotion. Given that MRI is very susceptible to motion, this causes artifacts and image quality degradation. The purpose of our study was to determine the effectiveness of different airway management techniques in overcoming micromotion-induced MRI artifacts. METHODS After obtaining institutional review board approval, we conducted a retrospective study on the image quality of central nervous system MRI studies in nine patients who had serial MRIs under general anaesthesia. All data were obtained from electronic records. We evaluated the following airway techniques: use of no airway device (NAD); oral, nasal, or supraglottic airway (SGA); or tracheal tube. To assess MRI quality, we developed a scoring system with a combined score ranging from 6 to 30. We used the linear mixed model to account for patient-dependent confounders. RESULTS We assessed 85 MRI studies from nine patients: 48 NAD, 27 SGA, four oral, four nasal, and two tracheal tube. Arithmetical mean combined scores were 21.6, 27.6, 20.3, 15.3, and 29.5, respectively. The estimated mean combined scores for the NAD and SGA cohorts were 22.0 and 27.3, respectively, showing that SGA use improved the combined score by 5.3 (P<0.0001). CONCLUSIONS The use of an SGA during MRI studies under general anaesthesia or deep sedation significantly improves image quality.
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Affiliation(s)
- F E Ucisik-Keser
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4000, USA
| | - T L Chi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4000, USA
| | - Y Hamid
- Department of Anaesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0409, Houston, TX 77030-4000, USA
| | - A Dinh
- Department of Anaesthesiology, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0591, USA
| | - E Chang
- William Carey University College of Osteopathic Medicine, 498 Tuscan Avenue, Hattiesburg, MS 39401, USA
| | - D Z Ferson
- Department of Anaesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0409, Houston, TX 77030-4000, USA
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Míguez Navarro C, Oikonomopoulou N, Rivas García A, Mora Capín A, Guerrero Márquez G; en representación del Grupo de Analgesia y Sedación de la Sociedad Española de Urgencias de Pediatría. [Efficacy, safety and satisfaction of sedation-analgesia in Spanish emergency departments]. An Pediatr (Barc) 2019; 90:32-41. [PMID: 29650431 DOI: 10.1016/j.anpedi.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To offer analgesia and sedation should be a priority in paediatric emergency departments. The aim of this study was to determine the effectiveness and safety of the sedation-analgesia procedure, as well as the satisfaction of the doctors, patients and parents. METHODS A multicentre, observational, and prospective analytical study was conducted on the sedation-analgesia procedure performed on children younger than 18 years old in 18 paediatric emergency departments in Spain from February 2015 until January 2016. RESULTS A total of 658 procedures were recorded. The effectiveness was good in 483 cases (76.1%; 95%CI: 72.7-79.4%), partial in 138 (21.7%; 95%CI: 18.5-24.9%), and poor in 14 (2.2%; 95%CI: 1.1-3.4). The effectiveness was better when the doctor in charge was an emergency paediatrician (OR: 3.14; 95%CI: 1.10-8.95), and when a deeper level of sedation was achieved (OR: 2.37; 95%CI: 1.68-3.35). Fifty two children (8.4%) developed adverse drug reactions, more usually gastrointestinal, neurological or respiratory ones (89.9% were resolved in <2h). One patient was intubated. The older child and a deeper level of sedation were found to be independent risk factors for adverse reactions (OR: 1.18; 95%CI: 1.09-1.28 and OR: 1.86; 95%CI: 1.22-2.83, respectively). Thirteen children (5%) developed late adverse drug reactions, more commonly, dizziness and nauseas. A combination of midazolam/ketamine had been used in all the cases (RR: 24.46; 95%CI: 11.78-50.76). The perceived satisfaction level (0-10) was obtained from 604 doctors (mean: 8.54; SD: 1.95), 526 parents (mean: 8.86; SD: 1.49), and 402 children (mean: 8.78; SD: 1.70). CONCLUSIONS The sedation-analgesia procedure performed in paediatric emergency departments by trained paediatricians seems to be useful, effective and safe, as well as satisfactory for all participants.
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Hinkelbein J, Lamperti M, Akeson J, Santos J, Costa J, De Robertis E, Longrois D, Novak-jankovic V, Petrini F, Struys MM, Veyckemans F, Fuchs-buder T, Fitzgerald R. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol 2018; 35:6-24. [DOI: 10.1097/eja.0000000000000683] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Fontaine M, Latarjet J, Payre J, Poupelin JC, Ravat F. Feasibility of monomodal analgesia with IV alfentanil during burn dressing changes at bedside (in spontaneously breathing non-intubated patients). Burns 2017; 43:337-342. [DOI: 10.1016/j.burns.2016.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 01/13/2023]
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Esser M, Gatidis S, Teufel M, Ketelsen I, Nikolaou K, Schäfer JF, Tsiflikas I. Contrast-Enhanced High-Pitch Computed Tomography in Pediatric Patients Without Electrocardiography Triggering and Sedation: Comparison of Cardiac Image Quality With Conventional Multidetector Computed Tomography. J Comput Assist Tomogr 2017; 41:165-71. [DOI: 10.1097/rct.0000000000000482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fencl JL. Guideline Implementation: Moderate Sedation/Analgesia. AORN J 2016; 103:500-11. [DOI: 10.1016/j.aorn.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 01/23/2016] [Accepted: 03/02/2016] [Indexed: 10/21/2022]
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McCarthy C, Brady P, O'Halloran KD, McCreary C. Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia. Anesth Prog 2016; 63:25-30. [PMID: 26866408 DOI: 10.2344/15-00005r1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hyperventilation can be a manifestation of anxiety that involves abnormally fast breathing (tachypnea) and an elevated minute ventilation that exceeds metabolic demand. This report describes a case of hyperventilation-induced hypocapnia resulting in tetany in a 16-year-old girl undergoing orthodontic extractions under intravenous conscious sedation. Pulse oximetry is the gold standard respiratory-related index in conscious sedation. Although the parameter has great utility in determining oxygen desaturation, it provides no additional information on respiratory function, including, for example, respiratory rate. In this case, we found capnography to be a very useful aid to monitor respiration in this patient and also to treat the hypocapnia.
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Affiliation(s)
| | - Paul Brady
- Clinical Fellow Oral Surgery, and Departments of
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Sauer H, Grünzinger L, Pfeifer J, Lieser U, Abdul-khaliq H. Sedation and analgosedation performed by pediatricians—experience made with the implementation of an in-house sedation standard: Sedation and analgosedation—implemantation of an in-house standard. Wien Med Wochenschr 2016; 166:54-61. [DOI: 10.1007/s10354-015-0400-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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Uman LS, Birnie KA, Noel M, Parker JA, Chambers CT, McGrath PJ, Kisely SR. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2013:CD005179. [PMID: 24108531 DOI: 10.1002/14651858.cd005179.pub3] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND This review is an updated version of the original Cochrane review published in Issue 4, 2006. Needle-related procedures are a common source of pain and distress for children. Our previous review on this topic indicated that a number of psychological interventions were efficacious in managing pediatric needle pain, including distraction, hypnosis, and combined cognitive behavioural interventions. Considerable additional research in the area has been published since that time. OBJECTIVES To provide an update to our 2006 review assessing the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents. SEARCH METHODS Searches of the following databases were conducted for relevant randomized controlled trials (RCTs): Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; PsycINFO; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Web of Science. Requests for relevant studies were also posted on various electronic list servers. We ran an updated search in March 2012, and again in March 2013. SELECTION CRITERIA Participants included children and adolescents aged two to 19 years undergoing needle-related procedures. Only RCTs with at least five participants in each study arm comparing a psychological intervention group with a control or comparison group were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors extracted data and assessed trial quality and a third author helped with data extraction and coding for one non-English study. Included studies were coded for quality using the Cochrane Risk of bias tool. Standardized mean differences with 95% confidence intervals were computed for all analyses using Review Manager 5.2 software. MAIN RESULTS Thirty-nine trials with 3394 participants were included. The most commonly studied needle procedures were venipuncture, intravenous (IV) line insertion, and immunization. Studies included children aged two to 19 years, with the most evidence available for children under 12 years of age. Consistent with the original review, the most commonly studied psychological interventions for needle procedures were distraction, hypnosis, and cognitive behavioural therapy (CBT). The majority of included studies (19 of 39) examined distraction only. The additional studies from this review update continued to provide strong evidence for the efficacy of distraction and hypnosis. No evidence was available to support the efficacy of preparation and information, combined CBT (at least two or more cognitive or behavioural strategies combined), parent coaching plus distraction, suggestion, or virtual reality for reducing children's pain and distress. No conclusions could be drawn about interventions of memory alteration, parent positioning plus distraction, blowing out air, or distraction plus suggestion, as evidence was available from single studies only. In addition, the Risk of bias scores indicated several domains with high or unclear bias scores (for example, selection, detection, and performance bias) suggesting that the methodological rigour and reporting of RCTs of psychological interventions continue to have considerable room for improvement. AUTHORS' CONCLUSIONS Overall, there is strong evidence supporting the efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents, with no evidence currently available for preparation and information or both, combined CBT, parent coaching plus distraction, suggestion, or virtual reality. Additional research is needed to further assess interventions that have only been investigated in one RCT to date (that is, memory alteration, parent positioning plus distraction, blowing out air, and distraction plus suggestion). There are continuing issues with the quality of trials examining psychological interventions for needle-related pain and distress.
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Affiliation(s)
- Lindsay S Uman
- IWK Health Centre & Dalhousie University, Halifax, Nova Scotia, Canada
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Bocskai T, Németh A, Bogár L, Pytel J. Sedation of children for auditory brainstem response using ketamine-midazolam-atropine combination - a retrospective analysis. Springerplus 2013; 2:178. [PMID: 23646294 PMCID: PMC3642359 DOI: 10.1186/2193-1801-2-178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 04/07/2013] [Indexed: 11/10/2022]
Abstract
Authors investigated sedation quality in children for auditory brainstem response testing. Two-hundred and seventy-six sedation procedures were retrospectively analyzed using recorded data focusing on efficacy of sedation and complications. Intramuscular ketamine-midazolam-atropine combination was administered on sedation preceded by narcotic suppository as pre-medication. On using the combination vital parameters remained within normal range, the complication rate was minimal. Pulse rate, arterial blood pressure and pulse oxymetry readings were stable, hypoventilation developed in 4, apnoea in none of the cases, post-sedation agitation occurred in 3 and nausea and/or vomiting in 2 cases. Repeated administration of narcotic agent was necessary in a single case only. Our practice is suitable for the sedation assisting hearing examinations in children. It has no influence on the auditory brainstem testing, the conditions necessary for the test can be met entirely with minimal side-effects. Our practice provides a more lasting sedation time in children during the examination hence there is no need for the repetition of the narcotics.
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Affiliation(s)
- Tímea Bocskai
- Department of Anesthesiology and Intensive Care Medicine, University of Pécs, 13. Ifjúság Street, Pécs, 7624 Hungary
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Abstract
Children comprise approximately one-quarter of all visits to most emergency departments. Children are generally healthier than adults, yet there are similar priorities in assessment and management of pediatric patients. The initial approach to airway, breathing, and circulation still applies and is first and foremost in the evaluation of young infants and children. There are certain anatomic, physiologic, developmental, and social considerations that are unique to this population and must be taken into account during their evaluation and treatment. In this review, we present and discuss an evidence-based approach to high-yield procedures necessary for all emergency physicians taking care of children.
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Affiliation(s)
- Fernando Soto
- Pediatric Emergency Medicine Section, University of Puerto Rico School of Medicine, PO Box 29207, San Juan, PR 00929, USA.
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Bracken J, Heaslip I, Ryan S. Chloral hydrate sedation in radiology: retrospective audit of reduced dose. Pediatr Radiol 2012; 42:349-54. [PMID: 22246409 DOI: 10.1007/s00247-011-2279-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 07/07/2011] [Accepted: 08/01/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chloral hydrate (CH) is safe and effective for sedation of suitable children. OBJECTIVE The purpose of this study was to assess whether adequate sedation is achieved with reduced CH doses. MATERIALS AND METHODS We retrospectively recorded outpatient CH sedations over 1 year. We defined standard doses of CH as 50 mg/kg (infants) and 75 mg/kg (children >1 year). A reduced dose was defined as at least 20% lower than the standard dose. RESULTS In total, 653 children received CH sedation (age, 1 month-3 years 10 months), 42% were given a reduced initial dose. Augmentation dose was required in 10.9% of all children, and in a higher proportion of children >1 year (15.7%) compared to infants (5.7%; P < 0.001). Sedation was successful in 96.7%, and more frequently successful in infants (98.3%) than children >1 year (95.3%; P = 0.03). A reduced initial dose had no negative effect on outcome (P = 0.19) or time to sedation. No significant complications were seen. CONCLUSION We advocate sedation with reduced CH doses (40 mg/kg for infants; 60 mg/kg for children >1 year of age) for outpatient imaging procedures when the child is judged to be quiet or sleepy on arrival.
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Affiliation(s)
- Jennifer Bracken
- Radiology Department, Children's University Hospital, Temple Street, Dublin, Ireland.
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Edwards AD, Arthurs OJ. Paediatric MRI under sedation: is it necessary? What is the evidence for the alternatives? Pediatr Radiol 2011; 41:1353-64. [PMID: 21678113 DOI: 10.1007/s00247-011-2147-7] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 02/28/2011] [Accepted: 03/20/2011] [Indexed: 01/19/2023]
Abstract
To achieve diagnostic images during MRI examinations, small children need to lie still to avoid movement artefact. To reduce patient motion, obviate the need for voluntary immobilisation or breath-holding and therefore obtain high-quality images, MRI of infants is frequently carried out under sedation or general anaesthesia, but this is not without risk and expense. However, many other techniques are available for preparing children for MRI, which have not been fully evaluated. Here, we evaluate the advantages and disadvantage of sedation and anaesthesia for MRI. We then evaluate the alternatives, which include neonatal comforting techniques, sleep manipulation, and appropriate adaptation of the physical environment. We summarize the evidence for their use according to an established hierarchy. Lastly, we discuss several factors that will influence the choice of imaging preparation, including patient factors, imaging factors and service provision. The choice of approach to paediatric MRI is multi-factorial, with limited scientific evidence for many of the current approaches. These considerations may enable others to image children using MRI under different circumstances.
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Lourenço-Matharu L, Roberts GJ. Effectiveness and acceptability of intravenous sedation in child and adolescent dental patients: report of a case series at King's College Hospital, London. Br Dent J 2011; 210:567-72. [DOI: 10.1038/sj.bdj.2011.482] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2011] [Indexed: 11/09/2022]
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