A mini-review of procedural sedation and analgesia in the emergency department.

Procedural sedation and analgesia (PSA) is performed for a variety of indications in emergency departments (EDs). Although the practice of PSA in the ED is somewhat unique from other clinical areas, there is currently no guideline for this practice in Japan. Policy statements and guidelines for PSA have been published in Europe and North America. These guidelines suggest first evaluating patients carefully before performing PSA, and then deciding on target sedative level and choice of medications. Patient evaluation requires a combination of continuous visual observation by trained medical staff to assess the depth of sedation and respiration with noninvasive measurements of blood pressure, continuous electrocardiography monitoring, and pulse oximetry. Sedative selection should be based on its characteristics, peak time, effectiveness, and risks. It is important to administer sedatives and analgesics in small, incremental doses while keeping a close eye on the patient's reaction to avoid adverse events (AEs) until the planned sedation level is reached. Further, additional attention is needed for special populations such as pediatric and elderly patients. PSA is a key element for patient-centered care in emergency medicine. In this manuscript, we review the available evidence for PSA in the EDs, including guidelines for evaluation, monitoring, pharmacology, AEs, and special populations such as pediatric and elderly patients.

[Application of sintered Ti powder to dental prostheses].

PURPOSE: Powder metallurgy is a metal processing technology. Porous titanium produced from powder is widely used. The method is applied to titanium, which is not easy to cast as it sinters under melting point. In prosthetic dentistry, powder metallurgy can be applied to high fusing metal that is biocompatible. In this study, we examined the mechanical characteristics of the Ti sheet produced by sintering and discussed its application to dental prosthesis manufacturing. METHODS: Ti sheets of 1-mm thickness, in which a binder was added to spherical Ti powder, were produced with the Doctor Blade Method. The sintering was carried out between 900-1150 degrees C at 6 temperatures. The sintered compact was evaluated by dimensional change rate, hardness test, bending strength, tensile strength and SEM observation. Another compact was sintered on the refractory cast. RESULTS: Mechanical strength significantly increased with sintering temperature. In addition, excellent mechanical strength was acquired by adding crushed powder and performing the de-binder process. In the sintering on the refractory cast, pre-baking for more than 100 minutes and sintering at over 1050 degrees C was needed for practical application. CONCLUSIONS: It thus seems possible to apply sintered titanium to dental prostheses. However, it will be necessary to examine the control of the shrinkage of the sintered compact in the future too.

Conversion of atrial fibrillation to sinus rhythm during landiolol infusion.

A 71-year-old woman with a history of persistent atrial fibrillation underwent clipping of a ruptured cerebral artery aneurysm. During the surgery her cardiac rhythm was atrial fibrillation and the ventricular rate increased to 130 beats.min(-1). Administration of landiolol was started with 1-min loading infusion at 0.125 mg.kg(-1).min(-1) and continuous infusion at 0.04 mg.kg(-1).min(-1), which was effective in controlling the ventricular rate without causing hypotension. Approximately 120 min after the landiolol infusion was started, the atrial fibrillation was converted to sinus rhythm. Her sinus rhythm was maintained until she left the operating room, even after discontinuation of landiolol.