Patient satisfaction with procedural sedation in the emergency department

Johnson, Olivia Grover; Taylor, David; Lee, Marina; Ding, Juen-Li; Ashok, Aadith; Johnson, Damian; Peck, Daniel; Knott, Jonathan; Weinberg, Laurence

doi:10.1111/1742-6723.12762

Cited by 7 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The degree of sedation during certain procedures has been associated with a greater degree of satisfaction. 22 In the present study, satisfaction was significantly higher in the MF group, in which patients experienced a higher degree of sedation, compared with the M group. Administration of 1.5 μg/kg of fentanyl enhances the sedative effects of midazolam, with high-quality sedation reducing IONV and increasing patient satisfaction with surgery.…”

Section: Discussionsupporting

confidence: 43%

Effect of fentanyl on nausea and vomiting in cesarean section under spinal anesthesia: a randomized controlled study

et al. 2019

View full text Add to dashboard Cite

ObjectiveAlthough opioids may induce nausea and vomiting, they possess sedative effects and can reduce intraoperative nausea and vomiting (IONV). This study assessed the effect of adding fentanyl to midazolam on sedation levels and IONV during cesarean section under spinal anesthesia.MethodsEighty parturients scheduled for elective cesarean section were enrolled in the study. Following fetal delivery, patients were administered 0.05 mg/kg of midazolam plus 0.03 mL/kg of normal saline (M group) or 0.05 mg/kg of midazolam plus 1.5 μg/kg of fentanyl (MF group). The primary outcome was the incidence of IONV. The secondary outcomes were incidence of postoperative nausea and vomiting (PONV), intraoperative sedation level, and five-point patient satisfaction score (PSS).ResultsThe IONV incidence was significantly lower in the MF group compared with the M group (5% [2/40] vs. 25% [10/40]). The PONV incidence did not differ significantly between the groups. The intraoperative sedation level tended to be deeper in the MF group. The 5-point PSS was significantly higher in the MF group. There was a strong correlation between the sedation level and IONV incidence.ConclusionsAdding fentanyl to midazolam is effective for sedation and to prevent IONV in women who are undergoing cesarean section under spinal anesthesia.

show abstract

Section: Discussionsupporting

confidence: 43%

Effect of fentanyl on nausea and vomiting in cesarean section under spinal anesthesia: a randomized controlled study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…14 Therefore, maintaining a balance between patient preference and expectations for comfort, and the necessary requirements for patient safety, may ultimately improve the overall patient experience. Once the patient has received procedural sedation, pain and discomfort can then be measured using a more sensitive indicator such as observer-rated assessment of facial grimacing associated with discomfort 4,16,17 or patient behaviors such as vocalization and movement, which typify discomfort. The addition of patient preferences to the treatment plan would help guide management and increase patient centeredness of care during the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…1,3 Pain and discomfort are long-standing patient satisfaction indicators, yet the patient perspective of procedural pain is not fully assessed within current standardized survey instruments. Several tools for assessing patient experience and patient satisfaction with sedation have been developed in the areas of emergency services, 4 endoscopy, 2,5,6 and interventional radiology, 7 yet these tools are not commonly used in invasive cardiology. A paucity of information exists in the literature describing the patient experience during cardiac catheterization and how the modification of periprocedural factors may affect pain and discomfort.…”

Section: Introductionmentioning

confidence: 99%

Understanding the patient experience of pain and discomfort during cardiac catheterization

Mall

Girton

Yardley

et al. 2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives Patient centeredness is an essential component of high‐quality care, yet little is known regarding the patient experience during procedures performed in the cardiac catheterization lab. Background Available literature focuses on the safe delivery of sedation, but does not address patient‐reported satisfaction or comfort. Further delineation of how procedural factors impact the patient experience is needed. Methods We conducted a retrospective, exploratory analysis of adult cardiac catheterization outpatients (n = 375) receiving physician ordered, nurse administered procedural sedation (benzodiazepine and/or opioids) between April and June, 2017. Data were abstracted from the procedural database, Electronic Health Record, and Press Ganey© surveys. Results The mean age was 63 (SD 12.2), a majority were male (n = 226; 60%), white (n = 271; 73%), and overweight (mean body mass index = 29, SD 6.8). Patient‐reported satisfaction with pain control and perceived staff concern for comfort were >75th percentile (Press Ganey© survey), with no difference in preprocedure and postprocedure pain scores (p = .596). Intraprocedural medication dose range and mean frequency were highly variable: midazolam (0.25–5.5 mg; 1.48); fentanyl (12.5–200 mcg; 1.63); and hydromorphone (0.5–2.5 mg; 1.33). Median time interval between administration of initial sedation and local anesthetic was 6 min. Patients with longer intervals had less frequent dosing (p < .001) and less total procedural sedation (p < .001). Sensitivity analysis revealed that trainee/fellow involvement (p = .001), younger age (p = .002), and shorter time intervals (p < .001) were associated with increased frequency and larger total dose. Conclusions Waiting to gain vascular access following administration of procedural was associated with less frequent subsequent dosing, lower overall administration, and similar patient satisfaction. Optimizing processes for administering periprocedural sedation may allow for less medication without impacting patient experience.

show abstract

“…This tool has been shown useful in monitored anesthesia care associated with anesthetic techniques for several other procedures, including cataract surgery, emergency medical procedures, hernia repair, craniotomy, and transesophageal echocardiography; it has been validated in several languages . Within otolaryngology, it has recently been used in the context of local anesthesia for cochlear implantation and in‐office lateral nasal wall block for office‐based procedures, although the small numbers in these series seem to have precluded further reliability and validity testing and any group comparisons.…”

Section: Discussionmentioning

confidence: 99%

Topical anesthetic techniques in office‐based laryngeal surgery: A comparison of patient preferences

Naunheim

Woo

2019

The Laryngoscope

View full text Add to dashboard Cite

Objectives: Multiple topical anesthesia techniques exist for office-based laryngeal surgery. Our objective was to assess patient and surgeon satisfaction for three different techniques.Study Design: Cohort study. Methods: All consecutive patients presenting to an outpatient laryngology office for awake surgical procedures were enrolled. Patients were anesthetized with local anesthesia (2 cubic centimeters of 4% lidocaine) in one of three ways: 1) nebulizer, 2) flexible cannula through a channeled laryngoscope, or 3) transtracheal instillation. Demographics, procedure times, and surgeon satisfaction were recorded. A validated 11-item patient satisfaction questionnaire (Iowa Satisfaction with Anesthesia Survey) was administered after the procedure to calculate an overall satisfaction score (−3[worst] to 3[best]). Descriptive and correlative statistics were performed.Results: One hundred consecutive patients were included (37 females, 73 males), with relatively equal numbers between groups (32 nebulizer, 35 cannula, 33 transtracheal). Seven procedures were aborted (4 nebulizer, 2 cannula, 1 transtracheal) due to movement, anxiety, or technical issues. Three patients did not adequately complete the survey. Of the 90 remaining patients, patient satisfaction was highest with the transtracheal technique (2.04) versus cannula (1.46) or nebulizer (1.45), and this was statistically significant (P = 0.0167). This difference was driven by decreased pain and nausea scores in the transtracheal group. Surgeon satisfaction was lower with nebulizer and higher with transtracheal injection (P = 0.0081). There was a correlation between surgeon satisfaction and patient satisfaction (P < 0.0001).Conclusion: Transtracheal instillation was favored by both patients and the surgeon. Choice of local anesthetic techniques may impact patient preferences and surgical success. This may serve as a basis for optimizing anesthetic care in office-based laryngeal surgery.

show abstract

Patient satisfaction with procedural sedation in the emergency department

Abstract: Generally, the level of patient satisfaction is high. Greater satisfaction is associated with deeper sedation, sedation with propofol and non-orthopaedic procedures.

Cited by 7 publications

References 20 publications

Effect of fentanyl on nausea and vomiting in cesarean section under spinal anesthesia: a randomized controlled study

Effect of fentanyl on nausea and vomiting in cesarean section under spinal anesthesia: a randomized controlled study

Understanding the patient experience of pain and discomfort during cardiac catheterization

Topical anesthetic techniques in office‐based laryngeal surgery: A comparison of patient preferences

Contact Info

Product

Resources

About