Two patient controlled sedation techniques compared using Graseby PCA pump

Abstract no. 17published_or_final_versio

Tuberculosis in UK cities: workload and effectiveness of tuberculosis control programmes

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB) has increased within the UK and, in response, targets for TB control have been set and interventions recommended. The question was whether these had been implemented and, if so, had they been effective in reducing TB cases.</p> <p>Methods</p> <p>Epidemiological data were obtained from enhanced surveillance and clinics. Primary care trusts or TB clinics with an average of > 100 TB cases per year were identified and provided reflections on the reasons for any change in their local incidence, which was compared to an audit against the national TB plan.</p> <p>Results</p> <p>Access to data for planning varied (0-22 months). Sputum smear status was usually well recorded within the clinics. All cities had TB networks, a key worker for each case, free treatment and arrangements to treat HIV co-infection. Achievement of targets in the national plan correlated well with change in workload figures for the commissioning organizations (Spearman's rank correlation R = 0.8, P < 0.01) but not with clinic numbers. Four cities had not achieved the target of one nurse per 40 notifications (Birmingham, Bradford, Manchester and Sheffield). Compared to other cities, their loss to follow-up during treatment was usually > 6% (χ²= 4.2, P < 0.05), there was less TB detected by screening and less outreach. Manchester was most poorly resourced and showed the highest rate of increase of TB. Direct referral from radiology, sputum from primary care and outreach workers were cited as important in TB control.</p> <p>Conclusion</p> <p>TB control programmes depend on adequate numbers of specialist TB nurses for early detection and case-holding.</p> <p>Please see related article: <url>http://www.biomedcentral.com/1741-7015/9/127</url></p

Anaesthetist-controlled versus patient-maintained effect-site targeted propofol sedation during elective primary lower-limb arthroplasty performed under spinal anaesthesia (ACCEPTS): study protocol for a parallel-group randomised comparison trial

Background: The clinical efficacy of effect-site targeted patient-maintained propofol sedation (PMPS) compared to anaesthetist-controlled propofol sedation (ACPS) for patients undergoing awake joint replacement surgery is currently unknown. There is no commercially available medical device capable of delivering PMPS so we have designed and built such a device. We plan a clinical trial to compare PMPS to ACPS and to collect data relating to the safety of our prototype device in delivering sedation. Methods: The trial is an open-label, randomised, controlled superiority trial recruiting adults who are undergoing elective primary lower-limb arthroplasty with sedation by propofol infusion by effect-site targeting into two equal-sized parallel arms: PMPS and ACPS. The primary research objective is to compare the body-weight-normalised rate of propofol consumption when sedation for surgery on adults undergoing elective primary lower-limb arthroplasty under spinal anaesthesia is patient-maintained versus when it is anaesthetist-controlled. The study primary null hypothesis is that there is no difference in the rate of propofol consumption when sedation is patient-maintained versus anaesthetist-controlled. Discussion: This is the first trial to test the superiority of effect-site-targeted patient-maintained propofol sedation versus anaesthetist-controlled propofol sedation in terms of total propofol consumption during the sedation period. The results of this trial will help inform clinicians and device manufacturers of the clinical efficacy and safety of patient-maintained propofol sedation applied to a common operative setting. Trial registration: International Standard Randomised Controlled Trial Number Registry, ISRCTN29129799. Prospectively registered on 12 June 2018

Comparison of two techniques of patient controlled sedation with midazolam

Objective: To compare patient-controlled sedation with 1-mg increments of midazolam at 1-min intervals with 0.1-mg increments of midazolam without a lock-out interval. Design: Randomized cross over study.Subjects : 32 patients aged 17–35 years having third molars removed. Results: Doses of midazolam obtained, degree of sedation and operating conditions were similar in the two groups. The demands far exceeded the increments actually received by patients obtaining 0.1-mg increments. Some were extremely sedated with both techniques. Conclusions: In this age group, there were no significant advantages or disadvantages of one technique over the other. Patients obtained the degree of sedation they required to undergo the operation by pressing the button independently of the dose or incremental interval. So-called ‘true’ patient-controlled sedation is a misnomer. The cut-off interval proved to be an extremely important safety feature

Oral midazolam sedation in third molar surgery

A double-blind randomised study was designed to assess the value of oral midazolam in patients undergoing minor oral surgery. 30 young healthy Hong Kong Chinese with bilateral symmetrical impaction of lower third molars to be surgically removed in 2 visits, were included in the study. Randomly selected, a powdered midazolam tablet or placebo was given on the 1st visit and the alternative on the 2nd visit. 45 min were given for the drug to act. Surgical removal of the teeth was carried out by a single operator, randomly, one side being done at one visit. The majority who had midazolam were relaxed during the operation. Nearly 75% had partial to complete amnesia. Midazolam sedation lasted about 45 min, produced good operating conditions and stable vital signs with adequate verbal response. The main adverse effects were drowsiness and dizziness on the same day. The majority had never heard of oral sedation being available to supplement local anaesthesia. The majority preferred midazolam to placebo and preferred to have local anaesthesia supplemented with oral sedation for minor oral surgery in the future.link_to_subscribed_fulltex

Asystole and bradycardia during maxillofacial surgery: Campbell R, Rodrigo C, Cheung L. Anesth Progr 41:13, 1994

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Paracetamol and diflunisal for pain relief following third molar surgery in Hong Kong Chinese

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A randomised crossover comparison of patient-controlled sedation and patient-maintained sedation using propofol

This randomised, crossover study compared patient-controlled sedation using boluses of propofol and patient-maintained sedation using a target-controlled infusion of propofol. Twenty-three patients aged 18-35 years having surgical removal of bilateral third molar teeth under local anaesthesia during two separate visits were studied. In the majority of patients, both techniques provided moderate sedation, good operating conditions, stable physiological parameters and a high degree of patient satisfaction. Two patients became over-sedated during patient-controlled sedation. The time taken for titration to adequate sedation was longer with patient-maintained sedation than with patient-controlled sedation [mean (SD) = 8.6 (3.7) min vs. 5.7 (3.1) min, p < 0.005]. The mean overall propofol consumption was similar with both techniques. The majority of patients preferred patient-maintained sedation to patient-controlled sedation, p < 0.05.link_to_subscribed_fulltex