Decreasing Pain and Anxiety Associated with Patient‐Activated Atrial Shock: A Placebo‐Controlled Study of Adjunctive Sedation with Oral Triazolam

Fabian, Tanya J.; Schwartzman, David; Ujhelyi, Michael R.; Corey, Sharon E.; Bigos, Kristin L.; Pollock, Bruce G.; Kroboth, Patricia D.

doi:10.1111/j.1540-8167.2006.00416.x

Cited by 7 publications

(6 citation statements)

References 14 publications

(19 reference statements)

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“…16,37 The efficacy of this therapy has been high and the tolerability has been surprisingly high. 38 This is especially the case when patient-activated therapy has been used with a sedative 39,40 or when the shocks were preferentially administered at night. 41 There have been few reports of the efficacy of atrial shock therapies in patients with CRT-D devices.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation Therapy in Patients with a CRT Defibrillator with Wireless Telemetry

Crossley

Aonuma

Haffajee

et al. 2008

Pacing Clinical Electrophis

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation Therapy in Patients with a CRT Defibrillator with Wireless Telemetry

Crossley

Aonuma

Haffajee

et al. 2008

Pacing Clinical Electrophis

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“…As correctly described by Dr. Mitchell, we delivered atrial shocks to patients in a clinical research hospital setting after an intravenous catheter had been placed; patients were in normal sinus rhythm. While being in a hospital may influence anxiety levels, there were no significant differences in self‐reported state anxiety across time or between treatments 1 . Further, self‐reported state anxiety scores in the inpatient study were not significantly different than those previously reported by the same patients in an ambulatory cardiology clinic setting (data not presented).…”

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confidence: 61%

Response to the Editor:

Fabian¹,

Schwartman²,

Ujhelyi³

et al. 2006

Cardiovasc electrophysiol

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Response to the Editor: We thank Dr. Mitchell for expressing interest in our article and welcome the opportunity to address the issues that he raised. As correctly described by Dr. Mitchell, we delivered atrial shocks to patients in a clinical research hospital setting after an intravenous catheter had been placed; patients were in normal sinus rhythm. While being in a hospital may influence anxiety levels, there were no significant differences in self-reported state anxiety across time or between treatments. 1 Further, self-reported state anxiety scores in the inpatient study were not significantly different than those previously reported by the same patients in an ambulatory cardiology clinic setting (data not presented). The intense assessments during the study, including serial blood sample collections for analysis of plasma concentrations of triazolam and stress hormones, made it necessary to conduct this randomized, placebo-controlled trial in an inpatient setting. We agree that a follow-up study should be conducted in a more naturalistic setting to confirm the findings.We acknowledge the very important contributions that Dr. Mitchell and his colleagues have made to the literature with both the Atrial Defibrillator Sedation Assessment Studies, ADSAS and ADSAS-2. 2,3 In these studies, oral midazolam was administered prior to patient-activated atrial shock delivery in a community setting. We should have stated that "Our study was the first randomized, double blind, placebo-

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“…Previous use of Triazolam decreased anxiety, discomfort, pain and caused amnesia in some patients compared to placebo. 27 The usual doses used orally are 0.125-0.25 mg for adults, 0.06-0.125 mg for the elderly, and, for children, it is not recommended; this medication would be ideal for use in the elderly due to its rapid onset and short duration of action, but it is not commercially available in Brazil. 10…”

Section: Literature Review Benzodiazepinesmentioning

confidence: 99%

“…The peak effect is reached in approximately 1 hour, and its effects are sedation, amnesia and reduced anxiety 25. Due to its potential to anterograde amnesia, the faster onset of action and a shorter plasma halflife, from 1.5 to 5.5 hours, Triazolam was chosen in a study byFabian et al (2006) as sedative administrated orally prior cardioversion in patients with atrial fibrillation. Cardioversion is a method to restore normal sinus rhythm, but the disadvantage Sedation with oral benzodiazepines in dental practice in cardiac patients: a literature review 6 • Clin Lab Res Den 2019: 1-8…”

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confidence: 99%

Sedation with oral benzodiazepines in dental practice in cardiac patients

et al. 2019

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| There are different types of sedation used for performing medical and dental procedures. The medications most commonly used for this purpose are benzodiazepines, which are considered safe and effective in the hospital or outpatient dental practice. However, in dental clinical practice, they are underutilized, especially in patients with cardiovascular disease. The aim of this study was to address the use of benzodiazepines as oral sedatives, their indications, contraindications, and peculiarities, as well as their correlation with cardiac patients, through a literature review. Sedation or minimum anxiolysis is a drug-induced state during which patients respond normally to verbal commands and airway reflexes, while respiratory and cardiovascular functions are unaffected. The beneficial effects of benzodiazepines include reduced anxiety, sleep induction and maintenance, muscle relaxation, and treatment and prevention of epileptic seizures. Benzodiazepines are indicated for patients with anxiety but should be used with caution in patients with serious illnesses, pregnancy or using other central nervous system depressants. Its use in cardiac patients is safe and effective because it reduces the hemodynamic function. It is important for the dentist to know and use this class of medications, improving the quality of care for the cardiac patient. KEYWORDS | Benzodiazepines; Heart Disease; Dentistry.RESUMO | Sedação com benzodiazepínicos orais na prática odontológica em pacientes cardíacos: uma revisão de literatura • Existem diferentes tipos de sedação utilizados para a realização de procedimentos médicos e odontológicos. As medicações mais comumente usadas para este fim são os benzodiazepínicos, considerados seguros e efetivos na prática odontológica hospitalar ou ambulatorial. No entanto, na prática clínica odontológica, eles são subutilizados, especialmente em pacientes com doenças cardiovasculares. O objetivo deste estudo foi abordar o uso de benzodiazepínicos como sedativos orais, suas indicações, contraindicações e peculiaridades, bem como sua correlação com pacientes cardíacos, através de uma revisão da literatura. Sedação, ou ansiólise mínima, é um estado induzido por medicamentos, durante o qual os pacientes respondem normalmente a comandos verbais e reflexos das vias aéreas, enquanto a função respiratória e cardiovascular não é afetada. Os efeitos benéficos de benzodiazepínicos incluem redução da ansiedade, indução e manutenção do sono, relaxamento muscular e tratamento e prevenção de convulsões epiléticas. Benzodiazepínicos são indicados para pacientes com ansiedade, mas devem ser usados com cautela em pacientes com doenças graves, gravidez ou que utilizem outros depressores do sistema nervoso central. É importante que o dentista conheça e use esta classe de medicamentos, melhorando a qualidade de atendimento para o paciente cardíaco.

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Decreasing Pain and Anxiety Associated with Patient‐Activated Atrial Shock: A Placebo‐Controlled Study of Adjunctive Sedation with Oral Triazolam

Cited by 7 publications

References 14 publications

Atrial Fibrillation Therapy in Patients with a CRT Defibrillator with Wireless Telemetry

Atrial Fibrillation Therapy in Patients with a CRT Defibrillator with Wireless Telemetry

Response to the Editor:

Sedation with oral benzodiazepines in dental practice in cardiac patients

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