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The World Journal of Biological... 2016Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in... (Review)
Review
BACKGROUND
Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions.
METHODS
An expert task force iteratively developed consensus using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new, re-worded or re-rated items.
RESULTS
Out of 2175 papers assessing psychomotor agitation, 124 were included in the review. Each component was assigned a level of evidence. Integrating the evidence and the experience of the task force members, a consensus was reached on 22 statements on this topic.
CONCLUSIONS
Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause. For its management, experts agreed in considering verbal de-escalation and environmental modification techniques as first choice, considering physical restraint as a last resort strategy. Regarding pharmacological treatment, the "ideal" medication should calm without over-sedate. Generally, oral or inhaled formulations should be preferred over i.m. routes in mildly agitated patients. Intravenous treatments should be avoided.
Topics: Antipsychotic Agents; Benzodiazepines; Consensus; Disease Management; Emergency Medical Services; Humans; Meta-Analysis as Topic; Olanzapine; Practice Guidelines as Topic; Psychiatric Status Rating Scales; Psychiatry; Psychomotor Agitation; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 26912127
DOI: 10.3109/15622975.2015.1132007 -
Pediatric Dentistry 2006The purpose of this review was to describe the potential influence of childhood obesity on pharmacosedation in pediatric dentistry and provide specific recommendations... (Review)
Review
The purpose of this review was to describe the potential influence of childhood obesity on pharmacosedation in pediatric dentistry and provide specific recommendations for managing obese patients. Increasingly common in the United States, childhood obesity poses specific challenges to the dentist. The greatest of these involve the increased potential for respiratory complications because of fat-induced restrictive lung disease and obstructive sleep apnea. Cardiovascular complications associated with obesity alone are rare in the pediatric patient, although hypertension is more likely. Gastrointestinal problems include increased likelihood for aspiration, necessitating strict fasting requirements. Sedative drugs dosed on total body weight may oversedate obese patients; dosages based on lean body mass may undersedate and usually produce a decreased duration of effect. Extra precautions regarding drug selection (such as avoiding opioids) and proper patient positioning can help minimize the incidence of complications.
Topics: Anesthesia, Dental; Child; Conscious Sedation; Heart Diseases; Humans; Hypnotics and Sedatives; Obesity; Respiration Disorders
PubMed: 17249428
DOI: No ID Found -
Singapore Medical Journal Dec 1996Iontophoretic anaesthesia involves the active transport of lignocaine into underlying tissues, by means of an electric field, for anaesthesia. Its use in urology in...
Iontophoretic anaesthesia involves the active transport of lignocaine into underlying tissues, by means of an electric field, for anaesthesia. Its use in urology in transurethral operations on the bladder and prostate have been well documented. We present a preliminary experience of its use in the following cases: a transurethral resection of a bladder tumour, a transurethral resection of bladder cysts and incision of the bladder neck and a transurethral resection of the prostate. In the few cases that we did, we found that patient selection and patient preparation is of utmost importance as unlike a complete anaesthesia, the patients can feel deep pressure and heat if diathermy is prolonged. It is also important not to oversedate the patients with midazolam as an uncooperative patient may render any procedure impossible. The greatest drawback of this procedure is that the degree of anaesthesia tends to vary from person to person. As such, it is difficult to predict who would or would not respond to this from of anaesthesia. However, with improvements in protocols, current delivery systems and different anaesthetic agents used, one may see a proliferation of this form of anaesthesia in urology in the not too distant future.
Topics: Adult; Aged; Anesthesia, Local; Cysts; Female; Humans; Iontophoresis; Male; Middle Aged; Prostatectomy; Urinary Bladder; Urinary Bladder Diseases; Urinary Bladder Neoplasms
PubMed: 9104067
DOI: No ID Found -
Anaesthesia Mar 2005Effect-site concentration is a mathematical term related to the clinical effect of a drug. We have designed a patient-maintained sedation system for delivering propofol...
Effect-site concentration is a mathematical term related to the clinical effect of a drug. We have designed a patient-maintained sedation system for delivering propofol to the predicted effect-site concentration rather than plasma concentration. To assess its efficacy and safety, 20 healthy volunteers deliberately attempted to over-sedate themselves using the system. The new effect-site concentration driven system delivered sedation successfully, and more rapidly than its predecessor. Fifteen volunteers ended the study when the system automatically reduced the effect-site concentration after 6 min of no button presses despite verbal contact and maintenance of arterial oxygen saturation (at effect-site concentration 1.8-3.8 microg x ml(-1)). Four out of 20 volunteers ended with minor arterial desaturation (lowest 88% at effect-site concentration 2.6-3.4 microg x ml(-1)). One volunteer ended after loss of verbal contact at effect-site concentration 3.4 microg x ml(-1). Further modification of the system's design is necessary before it can be recommended for routine practice.
Topics: Adult; Awareness; Conscious Sedation; Drug Administration Schedule; Equipment Design; Female; Humans; Hypnotics and Sedatives; Male; Oxygen; Propofol; Self Administration
PubMed: 15710007
DOI: 10.1111/j.1365-2044.2004.04071.x