The role of patient-controlled apparatus for sedation in the emergency department

PubMedID: 16358163Aim: Hand trauma is a fairly common cause of emergency unit admissions. Various analgesic and sedative agents are used to decrease pain and anxiety during minor surgical procedures for hand trauma patients and provide more comfortable conditions for the surgeon. The aim of this study was to investigate the potential role of patient-controlled sedation (PCS) during surgical procedures done under local anesthesia for hand trauma in the emergency department. Materials and methods: Forty ASA I-II (Assignment of the American Society of Anesthesiologists) patients who visited the emergency unit with hand trauma were randomized to 2 groups of 20 patients each. The control group received 1 µg/kg of fentanyl (IV) and 0.028 mg/kg of midazolam (IV). Additional 1 mg doses of midazolam were given by the anesthesiologist to keep the sedation level between 3 and 4. In the PCS group, the midazolam was administered after programming the apparatus. The settings were as follows: loading dose: 0.028 mg/kg, bolus dose 1 mg, lock-out period: 5 min and basal infusion rate: 0. The loading dose was given before local anesthesia. All patients received prilocaine hydrochloride (Citanest 2%, 10 mL) for local anesthesia. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), oxygen saturation (SpO2) and respiration rate (RR) were measured before intervention and at 2, 3, 5, 10, 15, 20 and 30 minutes. Results: There were no differences in the demographic characteristics, operation and discharge times in the two groups (p>0.05). No cardiovascular or respiratory instability was observed in any patient, and SpO2 remained over 95% for all. The SBP, DBP, HR and SpO2 did not differ significantly (p>0.05). Although the sedation levels of all patients were satisfactory, the sedation levels of the control group were significantly lower at 5 and 15 minutes (p<0.05). The total midazolam dose was 4.3+1.1 in the control group and 4.0+0.8 in the PCS group. The patient satisfaction rate was 95% in the PCS group and 80% in the control group (p>0.05). Conclusions: The two regimens did not differ with respect to hemodynamic changes, sedation levels and patient satisfaction. Therefore, PCS may be an acceptable alternative for surgical procedures performed using local anesthesia. © The Mount Sinai Journal of Medicine

Ocular trauma in Turkey: A 2-year prospective study

PubMedID: 16751160This 2-year prospective study was conducted to identify those at risk for ophthalmologic emergencies, to define the risk factors and reasons for eye injuries, to analyze treatment options, and to compare findings with those of previous studies. A total of 203 patients (74% male, mean age 27.3±13.9 y, 51% right eye injuries, 44% left eye injuries, 5% bilateral injuries) with injury to 208 eyes who presented to the emergency department for treatment were included in this study. All patients were evaluated by an ophthalmologist, who completed a formal questionnaire. Information recorded included demographic data, details of the eye injury, whether eye protection was used, and the type, location, and mechanism of injury to the eye. Mechanism of injury was categorized as blunt, sharp, or a combination. The ophthalmologist reported the time that had passed between occurrence of injury and presentation for treatment. Each patient was examined by the ophthalmologist, and findings, diagnosis, and treatment were documented. Of treated patients, 93% were hospitalized, most of whom required surgical treatment. One hundred (48%) injuries were related to blunt trauma and 86 (41%) to sharp device trauma. Only 10 (4%) patients were wearing protective eyewear when injured. Ruptured globe was the most common diagnosis of hospitalized patients and the most frequent cause of this was corneal lesions; subconjunctival hemorrhage was the most common diagnosis among nonhospitalized patients. In this study, the leading cause of eye injury was workplace accidents, probably attributable to growing industrialization in the region. Ocular trauma continues to be an important health problem in Turkey. Investigators believe that with education about and use of proper eye protection, 90% of eye injuries could be prevented. ©2006 Health Communications Inc

Measurement of D0D^0, D+D^+, Ds+D_s^+ and D∗+D^{*+} Production in Fixed Target 920-GeV Proton-Nucleus Collisions.

The inclusive production cross sections of the charmed mesons D^0, D^+, D_s^+ and D^{*+} have been measured in interactions of 920 GeV protons on C, Ti, and W targets with the HERA-B detector at the HERA storage ring. Differential cross sections as a function of transverse momentum and Feynman's x variable are given for the central rapidity region and for transverse momenta up to \pT=3.5 GeV/$c$. The atomic mass number dependence and the leading to non-leading particle production asymmetries are presented as well.Comment: Submitted to EPJ