Background: Pneumatic Balloon Dilation (PBD) as an achalasia treatment is painful procedure because of tearing the lower esophageal sphincter (LES) muscle fibres. Recently, two sedation methods including the Moderate sedation and deep sedation are used for increasing the convenience of the patients and gastroenterologist. Methods: To compare the efficacy of Moderate and deep sedation in PBD in treatment of Idiopathic Achalasia (IA). Results: We prospectively assessed 200 IA patients. The first 100 patients (group A) underwent PBD by the Moderate sedation using diazepam or midazolam and meperidine injections. The patients in the group B (100 patients) received midazolam, fentanyl and propofol as a deep sedation.  The pulse rate (PR), systolic and diastolic blood pressure (SBP, DBP), respiratory rate (RR), and oxygen saturation were monitored before, during and after PBD and achalasia symptom scores (ASS) were collected before and 1.5 months after treatment. The mean PR during and after procedures in the group B were significantly lower compared to the group A (p 0.001, 0.028). The patients in group B revealed less SBP and DBP after PBD versus group A (p 0.004, 0.002). The mean psi for 30 mm and 35 mm balloon dilators were significantly increased in group B compared to group (p 0.0001, 0.002). Conclusion: We concluded that the deep sedation of achalasia patients in the PBD process can improved the efficacy of PBD and decreased the complications (transient chest pain) of the procedures. The patients with the deep sedation revealed less tachycardia and blood pressure rising and tolerated more pressure in balloon dilators.

Background: Intravenous (IV) sedation is often used to relieve anxiety or stress during surgery under regional anesthesia. Subarachnoid block is a widely followed regional anaesthesia technique, especially in lower abdominal and lower limb surgeries. Intense sensory and motor block, continuous supine position and the inability to move the body also brings a feeling of discomfort and phobia in many patients. sedation has been shown to increase patient satisfaction during regional anaesthesia. Dexmedetomidine is well suited for conscious sedation as patient can be quickly aroused and oriented on demand. Aim of this study was to compare infusion doses of 0.3μg/kg/hr and 0.5μg/kg/hr, after loading dose of 1μg/kg of injection (inj).dexmedetomidine in order to obtain a better regimen for patients undergoing procedures under spinal anaesthesia in terms of sedation and hemodynamic stability. Objective: To compare efficacy of dexmedetomidine for intraoperative sedation and hemodynamic stability at doses of 0.3μg/kg/hr and 0.5μg/kg/hr after loading dose of 1 μg/kg in patients operated under spinal anaesthesia. Methods: Adult 80 Patients were randomly divided into two groups, (Group D-0.3) and (Group D-0.5). They were given spinal anaesthesia with 0.5% hyperbaric bupivacaine and initial dose of inj.dexmedetomidine 1 μg/kg was infused over 10 minutes. Group D-0.3 received maintenance dose of inj.dexmedetomidine of 0.3μg/kg/hr and Group D-0.5 received maintenance dose of 0.5μg/kg/hr.  Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), respiratory rate (RR), spO2 and sedation using observer’s assessment of alertness/sedation (OASS) were recorded at baseline, after loading dose, before spinal anesthesia, after spinal anesthesia at every 5 minutes upto 30 minutes, followed by every 15 minutes till the end of surgery and every 5 minutes upto 15 minutes after surgery. Data were compared using chi-square and unpaired t test.   Results: The mean age for Group D-0.3 is 43.9+11 and for Group D-0.5 is 35.3+20. There is no statistically significant difference in demographic profile between two groups. It was also observed that there is no statistically significant difference in HR, SBP, DBP, MAP, RR and SpO2 in all point of time (p>0.05). According to sedation score in group D-0.3 72% patients were sleeping comfortably but easily arousable and 8% patients were in deep sleep, while in group D-0.5 70% were sleeping comfortably but easily arousable and 15% in deep sleep. Conclusion: After a loading dose of 1 μg/kg intravenously, an iv infusion of dexmedetomidine at a lower rate, i.e. 0.3μg/kg/hr is equally effective in providing sedation for patients undergoing surgeries under spinal anesthesia as 0.5μg/kg/hr.

Background: One of the factors that affect the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the level of sedation. Objectives: Therefore, we aimed to compare dexmedetomidine (DEX) as Moderate sedation (MS) versus general anesthesia (GA) on the diagnostic yield of EBUS-TBNA. Methods: This randomized open-label controlled trial was carried out on 70 patients older than 18 years of age, classified as American Society of Anesthesiologists (ASA) II or III, and scheduled for EBUS-TBNA. Patients were randomly allocated into two equal groups. Group D received 1 μg/kg fentanyl 2 minutes before induction with a 1 μg/kg infusion of DEX for 10 minutes, then maintenance with 0.5 - 1 μg/kg/h aiming for a Ramsey sedation Scale of 4 - 5 while preserving hemodynamics. Group GA received 1 μg/kg fentanyl, 2 mg/kg propofol, and 0.5 mg/kg atracurium (then 0.1 mg/kg every 20 minutes). Results: Group D had a significantly higher rate of recalling the procedure (P = 0.005) and a lower rate of shortness of breath compared to group GA (P = 0.038). Intraoperative heart rate measurements at baseline were not significantly different between groups but were significantly lower at 5 min, 10 min, 15 min, 20 min, and at the end of surgery in group D compared to group GA (P < 0.05). Intraoperative mean arterial blood pressure measurements at baseline, 5 min, 10 min, 15 min, 20 min, and at the end of surgery were not significantly different between groups. Recovery time was significantly shorter in group D compared to group GA (P < 0.001). Conclusions: Compared to GA, MS with DEX showed a comparable diagnostic yield with faster recovery time and better patient satisfaction, as evidenced by a willingness to repeat procedures when needed and less shortness of breath in EBUS-TBNA.

Background: Providing high-quality care in the intensive care units (ICUs) is a major goal of every medical system. Nurses play a crucial role in achieving this goal. One of the most important responsibilities of nurses is sedation and pain control of patients. The present study tried to assess the effect of nurses’ practice of a sedation protocol on sedation and consciousness levels and the doses of sedatives and analgesics in the ICU patients.Materials and Methods: This clinical trial was conducted on 132 ICU patients on mechanical ventilation. The patients were randomly allocated to two groups. While the control group received the ICU’s routine care, the intervention group was sedated by ICU nurses based on Jacob’s modified sedation protocol. The subjects’ sedation and consciousness levels were evaluated by the Richmond Agitation sedation Scale (RASS) and the Glasgow Coma Scale (GCS), respectively. Doses of administered midazolam and morphine were also recorded.Results: The mean RASS score of the intervention group was closer to the ideal range (-1 to+1), compared to the control group (-0.95±0.3 vs. -1.88±0.4). Consciousness level of the control group was lower than that of the intervention group (8.4±0.4 vs.8.8±0.4). Finally, higher doses of midazolam and morphine were administered in the control group than in the intervention group.Conclusion: As nurses are in constant contact with the ICU patients, their practice of a sedation protocol can result in better sedation and pain control in the patients and reduce the administered doses of sedatives and analgesics.

Background: The use of analgesics and sedatives to provide sedation for Patients in Intensive Care Unit (ICU) is inevitable. The present study aimed to determine the effect of sedation protocol using the Richmond Agitation‑ sedation Scale on sedation level and amount of pharmacological and non‑ pharmacological interventions on patients under mechanical ventilation. Materials and Methods: This randomized clinical trial was conducted on 79 patients under mechanical ventilation in Zanjan. The patients were recruited using the blocking randomized sampling method. In the experiment group, the sedation was provided hourly, using the Richmond sedation Protocol, during the mechanical ventilation period. The level of sedation and pharmacological and nonpharmacological interventions were compared in the two groups using Fisher exact test. Results: Totally, 40 patients in the experiment and 39 patients in the control groups were evaluated. No significant difference was found between the two groups in terms of confounding variables (age, sex, level of consciousness, Acute Physiologic and Chronic Health Evaluation (APACHE) II criterion, underlying disease, and cause of hospitalization). The level of sedation in the experiment group was significantly closer to the ideal score of the Richmond Scale compared to the control group (p < 0. 001). The experimental group received significantly more non‑ pharmacological interventions and fewer pharmacological interventions compared to the control group (P < 0. 001). Conclusions: Using a sedation protocol could provide better sedation levels in patients under mechanical ventilation, and reduce the use of sedative medications, and consequently, the cost of hospitalization. Further research is suggested.

BACKGROUND: The intensivist should be avoided over or under sedation in mechanically ventilated patients. There are controversies in validity of bispectral index (BIS) in the management of intensive care unit (ICU) patients. The aim of this study was to evaluate sedation level in sedated and mechanically ventilated patients in our ICU using BIS and Richmond agitation–sedation scale (RASS, as a valid tool) and to determine the correlation between these two methods of evaluation.METHODS: Following the institutional research committee approval, we prospectively determined the sedation level in 33 patients aged 20-75 years who were mechanically ventilated and sedated routinely using intravenous diazepam (0.05 – 0.1 mg/kg/6 hr) combined with intravenous morphine (0.05 – 0.1 mg/kg/6 hr) in central ICU of Al-Zahra hospital. In each patient, we assessed BIS (0 to 100) values and also RASS (-5 to +4) twice a day, two hours after receiving systemic sedation in the morning and evening during mechanical ventilation period. Appropriate sedation score was considered -2 and -3 on RASS and 70 to 80 in BIS. Lower or greater values were considered as under- or over-sedation, respectively. Data were analyzed using chi-square and spearman's correlation tests.RESULTS: In this study, sedation level was assessed in patients using RASS (201 times) and BIS (201 times) methods. The frequency (percent) of under-sedated, appropriately sedated and over-sedated patients with BIS assessments were 121 (60.2%), 35 (17.4%) and 45 (22.4%), respectively. These values for RASS assessments were 196 (97.5%), zero, and 5 (2.5%), respectively. There was a weak correlation between BIS and RASS for determination of sedation level (P = 0, r = 0.245).CONCLUSIONS: This study showed that most of our ICU patients were under-sedated. BIS was poorly correlated with RASS in assessing the depth of sedation in mechanically ventilated patients.