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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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Inhalational Anesthetics: Overview01:20

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Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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The most common cardiovascular diagnostic test is an X-ray. It produces images of the heart, blood vessels, and adjacent structures.
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Ketamine/Midazolam versus Fentanyl/Midazolam Sedation for Interventional Radiology Procedures: A Prospective

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Ketamine/midazolam sedation effectively reduced pain during interventional radiology procedures compared to fentanyl/midazolam. IR staff also preferred ketamine/midazolam for patient comfort, with no increase in procedure time or adverse events.

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Area of Science:

  • Medical research
  • Anesthesiology
  • Interventional Radiology

Background:

  • Pain management is crucial in interventional radiology (IR).
  • Current sedation protocols may have limitations in efficacy and patient comfort.
  • Optimizing sedation is key to improving patient experience and procedural outcomes.

Purpose of the Study:

  • To compare the efficacy of ketamine/midazolam versus fentanyl/midazolam for reducing periprocedural pain in IR procedures.
  • To evaluate the impact of ketamine/midazolam on procedure duration and adverse events.
  • To assess interventional radiology staff's perception of sedation quality and patient comfort.

Main Methods:

  • Prospective quality improvement registry data collection for 292 adult IR procedures.
  • Comparison of pain scores (pre-, intra-, post-procedural), procedure duration, and adverse events.
  • Surveys of IR staff on sedation observations before and after implementing ketamine/midazolam.

Main Results:

  • Ketamine/midazolam significantly lowered intra- and post-procedural pain scores compared to fentanyl/midazolam (P ≤ .001 and P ≤ .05).
  • No significant difference in procedure duration (P = .436) or adverse events (P > .999) was observed.
  • Staff reported higher patient comfort with ketamine/midazolam (P ≤ .01), with 82% preferring it.

Conclusions:

  • Ketamine/midazolam sedation is superior to fentanyl/midazolam for reducing patient discomfort and is preferred by IR staff.
  • This sedation regimen can be safely used in IR without anesthesiology support, without increasing procedure time or adverse events.
  • Further investigation is warranted for routine incorporation of ketamine into IR sedation protocols.