Intranasal dexmedetomidine and midazolam are equally effective in decreasing anxiety upon separation from parents; however, midazolam is superior in providing satisfactory conditions during mask induction.
Pediatric patients undergoing cardiac catheterization usually need deep sedation. In this study, 60 children were randomly allocated to receive sedation with either a ketamine-propofol combination (KP group, n = 30) or a ketamine-propofol-dexmedetomidine combination (KPD group, n = 30). Both groups received 1 mg/kg of ketamine and 1 mg/kg of propofol for induction of sedation, and the KPD group received an additional 1 μg/kg of dexmedetomidine infusion during 5 min for induction of sedation and a maintenance infusion of 0.5 μg/kg/h. In both groups, 0.2 mg/kg of propofol was administered as a bolus to maintain a Ramsey sedation score (RSS) greater than 4 throughout the procedure. None of the patients in either group required intubation. In the KP group, one patient required mask ventilation. The chin-lift maneuver needed to be performed for eight patients in the KP group and one patient in the KPD group (p < 0.05). Adding dexmedetomidine to the ketamine-propofol combination decreased movement during the procedures. The heart rate in the KPD group was significantly lower after induction of sedation and throughout the procedure (p < 0.05). No significant differences in systolic blood pressure, diastolic blood pressure, or respiration rates were found between the two groups (p > 0.05). The mean recovery time was longer in the KP group (5.86 vs 3.13 min; p < 0.05). Adding dexmedetomidine to a ketamine-propofol combination led to a reduced need for airway intervention and to decreased movement during local anesthetic infiltration and throughout the procedure. The recovery time was shorter and hemodynamic stability good in the KPD group.
Astımlı hastaların çoğunda atak kontrolü kolayca elde edilir. Ancak, küçük bir kısmında astım ölümcül olabilir. Ancak, solunum yetmezliği gelişen astımlı hastalarda noninvaziv veya invaziv ventilasyon genellikle gerekli olabilmektedir. Astımlı hastada invaziv mekanik ventilasyon yoğun bakım ekibine zorluklar yaşatabilmekte ve sıklıkla permisif hiperkapni, derin sedasyon ve nöromüsküler blokaja gereklilik göstermektedir. Bu koruyucu yaklaşımlara rağmen, mekanik ventilasyon astımlı hastalarda yüksek komplikasyonlara neden olmaktadır. Bu nedenle astımlı hastalarda invaziv mekanik ventilasyon tercihi son çare olmalıdır. Astımlı hastalarda noninvaziv mekanik ventilasyon (NIV) kullanımı orotrakeal entübasyon ve mekanik ventilasyon ile ilişkili komplikasyonları azaltabilir. Birkaç çalışma astım ataklarında NIV kullanımını araştırmıştır. Ancak, sınırlı miktardaki verilere göre NIV akut astımda yararlı olabileceğini düşündürmektedir. Bu derlemede, astımda solunum yetmezliği mekanizmalarını ve önerilere göre astımda mekanik ventilasyon için tavsiyeleri değerlendirdik.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.