Patient-controlled sedation for col...

Patient-controlled sedation for colonoscopy

Hong Kong Medical Journal April 2004

Patient-controlled sedation (PCS) is rapidly becoming accepted as an alternative sedation regularity for colonoscopy. In this technique, a bolus of the sedative agent is delivered from a syringe cross-examine in response to the pres of a button. The patient self-administers the sedative to the point at which he or she is satisfied with the horizontal of sedation. The purpose of this prospective contemplation was to assess the safety, feasibility, and acceptability of PC in a large cluster of patients undergoing colonoscopy. (1)

Five hundr patients undergoing colonoscopy at a university-affiliated endoscopy center in Hong Kong were recruited for this investigation Sedation was delivered by means of a patient-controlled syringe cross-examine that contained a mixture of propofol and alfentanil. Patients were instructed upon how to use the hand-held button before the practice Vital signs, including pulse rate, oxygen saturation, and kin pressure were monitored and recorded over the procedure and recovery period.

After the patient was completely conscious and oriented, a questionnaire to assess patient satisfaction was administered by dint of the postanesthesia care unit supply with nourishment Additionally, 24 to 48 hours after the management patients were contacted by telephone to determine whether they had experienced any delayed side purports whether they were satisfied with this course of sedation, and whether they would be willing to use PC as their sedation manner for future colonoscopy procedures. Satisfaction was scored onward a 10-cm visual analog scale, with naught indicating "not satisfied" and 10 indicating "very satisfied." Summary statistics, including means, standard deviations, and Chi square exhibitions were used to analyze the variables.

Findings. The mean dose of propofol used was 093 mg/kg Forty-three patients (86%) expanded hypotension during the procedure, five patients required supplemental IV fluid, and sum of two units patients required cessation of PC The remainder had transient hypotension that did not require further treatment. Sixteen patients (32%) make knowned delayed side effects. The mean satisfaction score was high (ie, 72) Approximately 78% of the patients said they would be willing to use PC as their sedation means for future colonoscopy.

Clinical implications. The arises of this study indicate that the use of PC for colonoscopy is safe, feasible, and acceptable to a majority of patients. Perioperative foments should be prepared for PC use to increase and should make sure that the required patient monitoring conducts are performed consistently.

weight of increased inspired oxygen concentration forward surgical site infection

JAMA January 2004

Surgical site infection (SSI), the inferior most frequently reported type of health care-associated infection, continues to be an important public health be of importance to Destruction of bacteria by oxidation (ie, oxidative killing) is a viable proces to manage bacteria that are involved in the increase of SSIs. Oxidative killing hangs on the oxygen tension in contaminated tissue. Increasing the oxygen tension can be achieved on increasing the fraction of inspired oxygen (FI[0.sub.2]) (ie, by way of providing supplemental oxygen to the patient). The design of this double blind, randomized cogitation was to determine the force of routine use of high FI[0.sub.2] during the perioperative period forward the incidence of SSI in a general surgical population. (2)

Patients undergoing major intra-abdominal surgical acts under general anesthesia were assigned randomly to single in kind of two groups. Participants in form into groups I received 80% oxygen (ie, FI[0.sub.2] of 08) and participants in assign places to II received 35% oxygen (ie, FI[0.sub.2] of 035) during surgery and for the first pair hours after surgery. The neighborhood of an SSI in the first 14 days after surgery was noted. Standard statistical techniques, including multivariate regression analysis, were used to distinguish differences between the sum of two units groups.

Findings. Analysis was complet forward data from 160 patients. Overall, 29 patients bring outed SSI for a rate of 181% Twenty patients (25%) in form into groups I developed SSI versus nine patients in dispose II (11.3%). The rate of SSI was significantly higher in cluster I (P = .02). The unmatcheds ratio for the two clusters was 2.63 (95% confidence interval, 11-62) The flows of multivariate logistic regression analysis showed that FI[0.sub.2] was a predictor of SSI.

Clinical implications. This research yielded unexpected results. Administration of FI[0.sub.2] 08 during the perioperative period accrueed in a doubling of the SSI rate in patients undergoing a variety of major abdominal courses Results of this study, therefore, do not support the routine use of a high FI[0.sub.2] to bring into the incidence of SSI in patients undergoing major abdominal surgery Perioperative foments should be aware, however, that supplemental oxygen during the perioperative period may benefit certain patients, and they should be prepared to assist members of the surgical team in implementing the use of supplemental oxygen when necessary.