The Use of Oral Midazolam to Facilitate the Ophthalmic Examination of Children with Autism and Developmental Disorders.

Ophthalmic examinations of developmentally delayed/autistic children are challenging. Oral midazolam may be a viable alternative to general anaesthesia for this indication. Single-centre retrospective cohort study (January 2018-March 2020). Oral midazolam (0.5 mg/kg, max 15 mg). Metrics included: patient demographics, examination completion rate, duration of stay and adverse events. 50 oral midazolam examinations were performed (45 patients). Mean age was 79.12 months. All had developmental delay (66.67% autism). Time to ophthalmic examination was 60.31 minutes. Eye examination was successfully completed in 98%. No adverse events were reported. Mean stay was 3.35 hours. Oral midazolam (0.5 mg/kg, max 15 mg) is associated with safe, successful completion of ophthalmic examinations in children previously unexaminable in clinic.

Lack of recall after sedation for cataract surgery and its effect on the validity of measuring patient satisfaction.

BACKGROUND: We evaluated the validity of assessing patient satisfaction with the sedation regimen among patients being discharged 45 min after receiving midazolam. If most patients do not have recall, then the sedation cannot be considered complete at the time of evaluation. METHODS: In this prospective cohort study, 20 patients underwent cataract surgery with nurse-administered midazolam and fentanyl. The 11-item Iowa Satisfaction with Anesthesia Scale was administered  30 min after sedation in the recovery room. Recalled items were evaluated the next morning. RESULTS: Eleven patients recalled 0 themes, 4 recalled 1, 4 recalled 2, and 1 recalled 3 themes. Thus, 15/20 patients (75%) recalled 0 or 1 of the 11 themes (P = 0.021 versus half the patients). The 95% one-sided lower confidence limit for 0, 1, or 2 themes was 80% of patients (P < 0.001 versus half). Patients who received less midazolam recalled more themes (Kendall's τb = 0.43, P = 0.039). CONCLUSIONS: Evaluating patient satisfaction with sedation shortly after admission to the post-anesthesia care unit is invalid because of a lack of recall; the sedation/amnesia is ongoing. Patient comfort may be assessed, but comfort is not synonymous with satisfaction; 'satisfaction' implies presence of recall. Because we studied sedation with low doses of midazolam and fentanyl, the same conclusion reliably would apply to larger doses of anxiolytics administered intraoperatively. The results match previous findings that when patients receive preoperative midazolam prior to meeting the anesthesiologist, even if the patient fully answers questions, they may have negligible recall of having met the anesthesiologist.

Physicians' perceptions of palliative sedation for existential suffering: a systematic review.

BACKGROUND: Palliative sedation for existential suffering (PS-ES) is a controversial clinical intervention. Empirical studies about physicians' perceptions do not converge in a clear position and current clinical practice guidelines do not agree either regarding this kind of intervention. AIM: To gain deeper insight into physicians' perceptions of PS-ES, the factors influencing it, the conditions for implementing it and the alternatives to it. DESIGN: Systematic review of qualitative, quantitative and mixed-methods studies following the Peer Review Electronic Search Strategies and Preferred Reporting Items for Systematic Reviews and Meta-analyses protocols; quality appraisal and thematic synthesis methodology. DATA SOURCES: Seven electronic databases (PubMed, CINAHL, Embase, Scopus, Web of Science, PsycINFO, PsycARTICLES) were exhaustively searched from inception through March 2019. Two reviewers screened paper titles, abstracts and full texts. We included only peer-reviewed journal articles published in English, French, German, Dutch, Spanish, Italian or Portuguese that focused on physicians' perceptions of PS-ES. RESULTS: The search yielded 17 publications published between 2002 and 2017. Physicians do not hold clear views or agree if and when PS-ES is appropriate. Case-related and individual-related factors that influenced physicians' perceptions were identified. There is still no consensus regarding criteria to distinguish between necessary and sufficient conditions for invoking PS-ES. Some alternatives to PS-ES were identified. CONCLUSIONS: To date, there is still no consensus on physicians' perceptions of PS-ES. Further research is necessary to understand factors that influence physicians' perceptions and philosophical-ethical presuppositions underlying this perceptions.

Analgesia, sedation, and delirium in pediatric surgical critical care.

The alleviation of discomfort and distress is an essential component of the management of critically ill surgical patients. Pain and anxiety have multifocal etiologies that may be related to an underlying disease or surgical procedure, ongoing medical therapy, invasive monitors, an unfamiliar, complex and chaotic environment, as well as fear. Pharmacologic and non-pharmacologic therapies have complex risk benefit profiles. A fundamental understanding of analgesia, sedation, and delirium is essential for optimizing important outcomes in critically ill pediatric surgical patients. There has been a recent emphasis on goal directed, evidence based, and patient-centered management of the physical and psychological needs of these children. The purpose of this article is to review and summarize recent advances and describe current practice of these important subjects in the pediatric surgical intensive care environment.

Promoting a nursing team's ability to notice intent to communicate in lightly sedated mechanically ventilated patients in an intensive care unit: An action research study.

OBJECTIVES: This study aimed to examine changes in the practice of nurses who received an intervention designed to increase their awareness of endotracheally intubated, lightly sedated mechanically ventilated patients' intent to communicate. RESEARCH METHODOLOGY: Action research was applied. Specifically, three interventions promoting awareness of patients' intent to communicate were administered and pre- and post-intervention, observations of patient-nurse interactions, unstructured interviews with nurses and a patients' satisfaction survey were conducted. The pre- and post-intervention patient-nurse interactions and patients' survey results were then compared and a content analysis of the interviews and field notes was performed. SETTING: The intensive care unit of a university hospital. MAIN OUTCOME MEASURE: Nurses' awareness of lightly sedated mechanically ventilated patients' intent to communicate. FINDINGS: After the intervention, the incidence-rate ratios for nurses noticing of patients' intent to communicate were 1.53; there was no change in the frequency of patients' intent to communicate. Further, nurses became more aware of and reflected on their own practices, showed increased interest in co-workers' practices and considered their actions from patients' perspectives. Patients' satisfaction with nurses' respect for their wishes and dignity also increased. CONCLUSIONS: Action research can induce a change in intensive-care-unit-based nursing practice towards patient-centred care.

Anxiety and Salivary Cortisol Levels in Children Undergoing Esophago-Gastro-Duodenoscopy Under Sedation.

OBJECTIVES: Esophagogastroduodenoscopy (EGD) can cause fear and anxiety in children. Cortisol, which is the most important glucocorticoid hormone in humans, can increase under physiological stress. The purpose of this study was to measure the salivary cortisol level (SCL) and anxiety level in patients undergoing EGD and evaluate their effects on the procedure. METHODS: Children undergoing EGD under sedoanalgesia with propofol for various reasons were included. Their basal SCLs were compared with those of healthy age- and sex-matched controls. Moreover, SCL of the patient group at 30 minutes before EGD and 2 hours after the procedure were measured. Their anxiety scores were calculated using the modified Yale Preoperative Anxiety Scale before EGD. Duration of endoscopy, sedation, and recovery and total propofol doses were recorded. RESULTS: Demographic properties of the patient group (n = 119; 10.9 ±â€Š3.2 years; 43.7% boys) and control group (n = 85; 11.8 ±â€Š2.8 years; 45.1% boys) were not significantly different. Basal SCLs of both groups were similar (16.9 ±â€Š0.7 vs 19.7 ±â€Š1.8 ng/mL, P = 0.16). SCL before EGD in the patient group was significantly higher than basal and post-EGD values (P < 0.001 for each). Pre-EGD SCL was positively correlated with anxiety level, propofol dose, and duration of sedation, procedure, and recovery. Anxiety levels of patients were positively correlated with propofol dose and duration of sedation and recovery, and negatively correlated with age. CONCLUSIONS: Childhood EGD is a significant stress factor, which was reflected by the pre-procedural SCL in this study. Increased anxiety resulted in increased propofol doses and sedoanalgesia-related procedural durations, which may cause potential complications.

A first contribution to the validation of the Italian version of the Behavioral Pain Scale in sedated, intubated, and mechanically ventilated paediatric patients.

BACKGROUND AND AIM OF THE WORK: Numerous negative outcomes of inadequate pain management among children have been cited in the literature. Inadequate pain management may be particularly detrimental to children and adolescents facing life-threatening injury or illness on a Paediatric Intensive Care Unit (PICU). It is therefore absolutely necessary that professionals utilize effective and efficient tools in order to evaluate a person's sensations of pain in the most objective way possible. The COMFORT-B scale is recognised as the gold standard in such patients. However, the use of this instrument in the clinical PICU setting is disputed. It requires long periods of observation to ensure an adequate utilization. Boerlage et al. noted that nurses are often impatient and do not always observe the patient for the recommended 2 minutes period. The Behavioral Pain Scale (BPS), instead, is considered to be the gold standard for pain assessment in deeply sedated, mechanically ventilated adult patients. This observational pain scale requires shorter observation time compared to the COMFORT-B. Moreover, BPS three subscales are included in other observational pain scales for paediatric patients. Therefore, the objective of this study was to assess the applicability of the BPS for use with paediatric patients. METHODS: Firstly, a questionnaire was administered to physicians and nursing staff that work in the units where the study was conducted in order to investigate the actual use of observational pain scales in their units. A second questionnaire was administered to a group of experts regarding the BPS, to assess both face validity and content validity, and to gain opinions on the relative appropriateness of each item. A descriptive, comparative design was used. A convenience sample of non-verbal, sedated and mechanically ventilated critical care paediatric patients was included. 39 observations were collected from 9 patients, all in their first year of age. Patient pain was assessed concurrently with the three observational scales, before, during and after routine procedures that are considered painful and non-painful. RESULTS: The data collected through questionnaires for professionals gave a useful insight into pain assessment in the investigated units: only 46% of respondents stated that they assessed patients' pain levels, with an average of 2.8 times per shift; 60% of respondents declared to be unhappy with the observational scales that they utilise. Regarding the observations, internal consistency was α = .865. Correlations between BPS and the other instruments were high, demonstrating a good concurrent validity of the test. T test and ROC curves demonstrated a good discriminant validity as well. CONCLUSIONS: Although the current study is based on a small sample of participants, these first results encourage us to continue working in the validation of the BPS in paediatric patients.

Parental awareness, knowledge, and attitude toward conscious sedation in North Indian children population: A questionnaire-based study.

AIM: The purpose of this study is to find the opinion, attitude, beliefs, and the existing knowledge of parents of Himachal Pradesh suburban city about conscious sedation. OBJECTIVE: To know the effect of education of parent and prior sedation experience of the child on opinion, attitude, and knowledge of parent about conscious sedation. METHODOLOGY: A questionnaire in Hindi/English was provided to parents who accompanied their child for the treatment in the Paedodontics Department of HPGDC College Shimla. Information regarding demography, existing knowledge gained through television, the internet, opinion about the safety of the procedure, knowledge of nothing by mouth guidelines, restraints usage, and knowing their preferences of staying with the child during treatment was explored. Questions were straight yes or no type and multiple choice type. Some questions were statements and wanted the respondents to strongly agree, agree, disagree, or strongly disagree. RESULTS AND CONCLUSION: A total of 350 questionnaires were collected. Parents feel sedation is safe in the dental office as an adjunct to dental treatment. Education played a role in existing knowledge about sedation and perception about the safety of conscious sedation.

[Palliative Sedation: Comments on a controversial topic]. / Palliative Sedierung: Anmerkungen zu einem strittigen Thema.

Palliative Sedation: Comments on a controversial topic Abstract. Palliative sedation (PS) is an accepted medical practice for terminally ill patients. It intends the alleviation of unbearable suffering by intentionally lowering the level of consciousness. In contrast to physician assisted suicide and euthanasia, palliative sedation aims to relieve burdensome symptoms with no intention of hastening death. PC can be applied as "intermittent palliative sedation" or "continuous (deep) sedation until death". Most ethical controversies are related to the latter form of PS: 1: Is existential or psychosocial suffering a possible indication for PS? 2: What is the earliest possible time point to start PS? 3: The withdrawal or withholding of artificial nutrition and hydration during PS. A critical reflection of these ethical controversial aspects within the treatment team is highly desirable. However, the patient's well-being and the respect for the patient's decisions that are based on experiences which are made only by him or her, must remain the guiding principle for medical actions.

Immunizations under sedation at a paediatric hospital in Melbourne, Australia from 2012-2016.

BACKGROUND: Sedation for immunizations is of particular importance in a subset of paediatric patients with anxiety disorders, needle phobia, developmental or behavioural disorders. The Royal Children's Hospital (RCH) Melbourne offers a unique immunization under sedation service for these patients. We aimed to evaluate the number and types of patients using inpatient sedation for immunizations, distraction and sedation techniques used, and outcomes of these procedures. METHODS: A medical record review was conducted on all patients who had immunization under sedation between January 2012 to December 2016 in the RCH Day Medical Unit (DMU). RESULTS: A total of 139 children and adolescents had 213 vaccination encounters. More than half of the vaccination encounters involved multiple vaccines. A total of 400 vaccines were administered. One third of patients (32.3%) had multiple DMU admissions for vaccinations. The median age of patients was 13 years. There were only 10 (4.7%) failed attempts at vaccination; all due to patient non-compliance with prescribed sedation. The majority of patients (58.9%) had a diagnosis of needle phobia. Sedation was most commonly adequately achieved with inhaled nitrous oxide (54.7% sole agent). Midazolam was often used as an adjunct therapy (42.8%). Local anaesthetic cream or play therapy, were used in only 5.9% and 3.9% of patients respectively, although this may reflect poor documentation rather than actual practice. CONCLUSIONS: For a subset of paediatric patients for which standard immunization procedures have failed, distraction techniques and conscious sedation enable immunizations to be given safely and effectively. Future research will develop protocols to streamline immunization procedures under sedation.

The involvement of cancer patients in the four stages of decision-making preceding continuous sedation until death: A qualitative study.

BACKGROUND: Involving patients in decision-making is considered to be particularly appropriate towards the end of life. Professional guidelines emphasize that the decision to initiate continuous sedation should be made in accordance with the wishes of the dying person and be preceded by their consent. AIM: To describe the decision-making process preceding continuous sedation until death with particular attention to the involvement of the person who is dying. DESIGN: Qualitative case studies using interviews. SETTING/PARTICIPANTS: Interviews with 26 physicians, 30 nurses and 24 relatives caring for 24 patients with cancer who received continuous sedation until death in Belgium, the United Kingdom and the Netherlands. RESULTS: We distinguished four stages of decision-making: initiation, information exchange, deliberation and the decision to start continuous sedation until death. There was wide variation in the role the patient had in the decision-making process. At one end of the spectrum (mostly in the United Kingdom), the physician discussed the possible use of sedation with the patient, but took the decision themselves. At the other end (mostly in Belgium and the Netherlands), the patient initiated the conversation and the physician's role was largely limited to evaluating if and when the medical criteria were met. CONCLUSION: Decision-making about continuous sedation until death goes through four stages and the involvement of the patient in the decision-making varies. Acknowledging the potential sensitivity of raising the issue of end-of-life sedation, we recommend building into clinical practice regular opportunities to discuss the goals and preferences of the person who is dying for their future medical treatment and care.

Conscious sedation in critically ill patients is associated with stressors perception lower than assessed by caregivers.

BACKGROUND: In ICU, the stay is frequently a stressful experience. Caregivers may help to understand patients' perceptions; however, their reliability is uncertain. Despite the recent recommendations of lighter sedation targets, little is known about the impact of "conscious sedation" on ICU patients memories. Purpose of this prospective, observational study is to analyze the stress perception in consciously-sedated ICU-patients, comparing it to caregivers and staff members. METHODS: Twenty-nine high-risk ICU-patients treated with awake/cooperative sedation were enrolled. Before discharge, patients received a validated questionnaire for ICU stressors evaluation, also administered to their main caregiver (N.=29), to caregivers of other ICU patients not enrolled in the study (N.=33) and to staff members (ICU nurses, attending physicians, residents, medical students, N.=56). RESULTS: Total stress score was: patients 141±41, patient relatives 210±63, other relatives: 202±73, ICU staff: 232±44, P<0.001. Among patients, older age (P=0.031), longer ICU-stay (P=0.018) and awake-sedation (P=0.022) were associated with lower stress; sex and illness severity had no effect; mechanical ventilation length (P=0.021) and agitation (P=0.029) were associated with higher stress. Nurses tended to overestimate stressors more than attending physicians and trainees. Within staff members, age (P=0.021) and years of experience (P=0.069) were positively associated with overestimation. CONCLUSIONS: Conscious sedation is associated with stress perception lower than stress assessed by caregivers: relatives and staff members tend to overestimate ICU patient stress, more so with increasing age or expertise. A number of stressors underestimated by staff and families could be target of specific interventions to ameliorate quality of life during ICU stay.

Effect of the midazolam added with propofol-based sedation in esophagogastroduodenoscopy: A randomized trial.

BACKGROUND AND AIM: Although propofol has been widely used for sedation during esophagogastroduodenoscopy (EGD), adverse events including hypoxia and hypotension may be a concern in the propofol-based sedation. We aimed to analyze whether administration of midazolam would improve safety and efficacy of propofol-based sedation in EGD. METHODS: One hundred twenty patients who were scheduled to undergo diagnostic EGD were randomly assigned to either midazolam plus propofol (MP) or propofol alone groups. In the MP group, 2 mg of midazolam and 10 mg of propofol were given initially. In the propofol alone group, 40-60 mg of propofol was given initially. In both groups, 20 mg of propofol was given repeatedly to maintain moderate sedation as needed. Vital signs including oxygen saturation were monitored every 2 min. After the patients fully recovered, satisfaction score was investigated from endoscopists, nurses, and patients, respectively. RESULTS: The baseline characteristics did not differ between the MP and propofol alone groups. The mean required doses of propofol was (mean ± standard deviation) 0.3 ± 0.3 and 0.8 ± 0.2 mg/kg in the MP and propofol alone groups, respectively (P < 0.001). In addition, sedation-related adverse events and recovery time did not differ between the two groups. The proportion of satisfactory did not differ between the two groups (MP vs propofol alone; proportion; patient, 95.0% vs 93.3%, P > 0.999; endoscopist, 73.3% vs 80.0%, P = 0.064; nurse, 73.3% vs 76.7%, P = 0.551). CONCLUSION: Adding midazolam to propofol did not reduced the safety and efficacy, and sedation using propofol alone could be suitable for sedation during diagnostic EGD.

High-risk respiratory patients' experiences of bronchoscopy with conscious sedation and analgesia: A qualitative study.

AIMS AND OBJECTIVES: To understand the experiences of high-risk respiratory patients undergoing bronchoscopy with conscious sedation. BACKGROUND: Due to possible complications, high-risk respiratory patients are usually given smaller, cautious doses of sedation and analgesia for bronchoscopy. Described as "conscious sedation," this facilitates depression of the patient's consciousness without causing respiratory compromise. Previously, studies have investigated patient experience using quantitative methods. This is the first study that has explored the patient experience during bronchoscopy from a qualitative perspective. DESIGN: Qualitative, phenomenological approach as described by Van Manen. METHODS: The setting was an endoscopy unit within an Australian tertiary hospital. Unstructured interviews were conducted with 13 patients with chronic obstructive pulmonary disease who underwent day-case bronchoscopy. All participants received conscious sedation. They were interviewed twice, within a week, postprocedure. Interviews were transcribed verbatim and analysed using Van Manen's interpretive approach. FINDINGS: Participants had varying experiences. Five themes emerged from the analysis: Frustration and fear; Comfort and safety; Choking and coughing; Being aware; and Consequences. Whilst not all participants experienced procedural awareness or remembered it, for those who did it was a significant event. Overall, experiences were found to be negative; however, participants accepted and tolerated them, perceiving them as necessary to obtain a diagnostic result. CONCLUSION: The findings demonstrate that often patients are aware during the procedure and their experience may be uncomfortable and distressing. RELEVANCE TO CLINICAL PRACTICE: These findings have implications for patient preparation pre- and post-bronchoscopy in terms of what they might expect, and to discuss what has happened after the procedure. Some practices of the bronchoscopy team during the procedure may need modification. For example, in anticipation of the possibility that the patient may be aware, healthcare professionals should provide patient-focused explanations of what is happening during the procedure, as well as providing ongoing reassurance that everything is going as planned.

Patients' Perioperative Experience of Awake Deep-Brain Stimulation for Parkinson Disease.

BACKGROUND: Awake craniotomy for tumor resection and epilepsy surgery is a well-tolerated procedure. Qualitative data on patients' experience of awake deep-brain stimulation (DBS) are, however, lacking. We collected qualitative data on patients' experience of awake DBS with a view to identifying areas for improvement. METHODS: Forty-one patients undergoing DBS for Parkinson disease between 2009 and 2015 were surveyed with a structured questionnaire designed to receive patient feedback regarding perioperative management of the awake stage of the procedure. RESULTS: More than 90% of patients felt well-informed. Most remembered the procedure, and almost all were happy that they did. One half of the patients experienced pain, often significant, during the procedure. This mainly occurred during burr-hole drilling and stereotactic frame placement. CONCLUSIONS: Although awake DBS is well-tolerated, pain and off-period symptoms are an issue for a significant number of patients. Efforts should be made to minimize these unpleasant aspects of awake DBS.

Validation of Adapted Dartmouth Operative Conditions Scale for sedation during pediatric esophagogastroduodenoscopy.

AIMS: Pediatric esophagogastroduodenoscopy requires deep sedation as it involves stimulation of the airway. Frequency of adverse events is higher with esophagogastroduodenoscopy. Hence, monitoring needs sedation scales like the Dartmouth Operative Condition Scale that identifies safe states of sedation. This study aims at validating the Adapted Dartmouth Operative Condition Scale for sedation rating by pediatricians during pediatric esophagogastroduodenoscopy. METHODS: Items in the Dartmouth Operating Conditions Scale were adapted for pediatric esophagogastroduodenoscopy. Videos of 35 procedures were recorded. The recording started 10 min before sedation and continued till recovery. The videos were split into preprocedure videos, intraprocedure videos, and recovery videos, and further split into 30-s clips. Twenty representative intraprocedure videos clips were selected. Ten raters scored the videos with the Adapted Dartmouth Operating Conditions Scale and modified-COMFORT score. The Adapted Dartmouth Operating Conditions Scale scoring was repeated after a month. The preprocedure videos, intraprocedure videos, and recovery videos of ten patients (six clips each) were scored by one rater to assess responsiveness. RESULTS: The Adapted Dartmouth Operating Conditions Scale detected nonoptimal sedation states including laryngospasm due to undersedated states. It showed fair interrater reliability at timeline-1 (intraclass correlation coefficient = 0.45) and timeline-2 (intraclass correlation coefficient = 0.65) but poor intrarater reliability (intraclass correlation coefficient = 0.32). There was significant positive correlation with modified-COMFORT (Spearman's rank order correlation, r = 0.150). Responsiveness was demonstrated by the difference in the preprocedure videos, intraprocedure videos, and recovery videos scores (F = 126.50). CONCLUSION: The Adapted Dartmouth Operating Conditions Scale detects nonoptimal sedation states during pediatric-esophagogastroduodenoscopy. It shows good criterion validity, interrater reliability, and responsiveness. Poor intrarater reliability seen in our study could be due to item ambiguity arising from the mode of training of the raters in the Dartmouth Operating Conditions Scale.

The interpersonal work of dental conscious sedation: A qualitative analysis.

AIMS: Whilst there is a considerable body of literature examining the pharmacology of conscious sedation, the social tasks required to successfully provide conscious sedation have not been reported. This paper discusses data regarding the interpersonal work integral to effective conscious sedation provision, from a larger qualitative study exploring how patients and clinicians engage with secondary care conscious sedation provided within the UK. METHOD: Semi-structured interviews were conducted with 13 conscious sedation providers and nine patients within UK-based secondary care sedation settings. Digital audio-recordings were transcribed verbatim and subsequently analysed using a constant comparative method within NVivo Data Analysis Software. RESULTS: Four main themes of interpersonal work were reported by participants: displaying care, containing emotions, demonstrating competence and maximizing the effect. CONCLUSION: This study shows that performing conscious sedation requires more than technical delivery, and involves the projection of attributes in a literal "performance." The importance of managing outward emotional appearance reflects previous dental research. The need to manage outward appearance, and the emotional impact this has, is of relevance to all clinicians.

Mother-child interactions and young child behavior during procedural conscious sedation.

BACKGROUND: As many preschoolers are not able to cooperate with health-related invasive procedures, sedation can help with the child's comfort and allow the intervention to be done. It is scarcely known how parents affect children's behavior during dental treatment under conscious sedation. The aim of this exploratory study was to analyze the association between mother-child interactions in day-to-day family life and preschool children's behavior during dental treatment under conscious sedation. METHODS: This cross-sectional study included 27 children aged 2-6 years and their mothers. The children's behavior during dental treatment under conscious sedation was verified through the analysis of videos and using an observational scale. Social skills of mothers were verified through interviews using the Parental Educative Social Skills Interview Script (RE-HSE-P); the sum of the scores allowed the establishment of the categories "clinical" and "non-clinical". We presented descriptive analyses and bivariate associations. RESULTS: Children's overall behavior during dental sedation was: very poor (n = 2), poor (n = 1), regular (n = 2), good (n = 9), very good (n = 9) and excellent (n = 4). Social skills varied: parental educational social skills (n = 24 clinical vs. n = 3 non-clinical); child social skills (n = 20 vs. n = 7), context variables (n = 15 vs. n = 12), negative educational practices (n = 12 vs. n = 15), child behavior problems (n = 7 vs. n = 20). There was no association between child behavior under sedation and social skills categories (P > 0.05). CONCLUSIONS: The majority of interviewed mothers reported issues in parental educational social skills and child social skills, which did not affect the outcomes of the children's behavior during the procedural conscious sedation.

The association of sleep quality, delirium, and sedation status with daily participation in physical therapy in the ICU.

BACKGROUND: Poor sleep is common in the ICU setting and may represent a modifiable risk factor for patient participation in ICU-based physical therapy (PT) interventions. This study evaluates the association of perceived sleep quality, delirium, sedation, and other clinically important patient and ICU factors with participation in physical therapy (PT) interventions. METHOD: This was a secondary analysis of a prospective observational study of sleep in a single academic medical ICU (MICU). Perceived sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ) and delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Other covariates included demographics, pre-hospitalization ambulation status, ICU admission diagnosis, daily mechanical ventilation status, and daily administration of benzodiazepines and opioids via bolus and continuous infusion. Associations with participation in PT interventions were assessed among patients eligible for PT using a multinomial Markov model with robust variance estimates. RESULTS: Overall, 327 consecutive MICU patients completed ≥1 assessment of perceived sleep quality. After adjusting for all covariates, daily assessment of perceived sleep quality was not associated with transitioning to participate in PT the following day (relative risk ratio [RRR] 1.02, 95 % CI 0.96-1.07, p = 0.55). However, the following factors had significant negative associations with participating in subsequent PT interventions: delirium (RRR 0.58, 95 % CI 0.41-0.76, p <0.001), opioid boluses (RRR 0.68, 95 % CI 0.47-0.99, p = 0.04), and continuous sedation infusions (RRR 0.58, 95 % CI 0.40-0.85, p = 0.01). Additionally, in patients with delirium, benzodiazepine boluses further reduced participation in subsequent PT interventions (RRR 0.25, 95 % CI 0.13-0.50, p <0.001). CONCLUSIONS: Perceived sleep quality was not associated with participation in PT interventions the following day. However, continuous sedation infusions, opioid boluses, and delirium, particularly when occurring with administration of benzodiazepine boluses, were negatively associated with subsequent PT interventions and represent important modifiable factors for increasing participation in ICU-based PT interventions.

Anxiety Levels in Patients Undergoing Sedation for Elective Upper Gastrointestinal Endoscopy and Colonoscopy.

BACKGROUND: Anxiety is a common preprocedural problem and during processing especially in interventional medical processes. AIM: Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and coloscopy. METHODS: Five hundred patients scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Beck Anxiety Inventory (BAI) was administered to each patient before brought to the endoscopy room. Demographic data of patients were collected. RESULTS: BAI scores and anxiety levels were significantly lower in; males compared to females, patients with no comorbidity compared to patients with comorbidity (both P values < 0.001). BAI scores were significantly lower in patients educational status university and upper compared to patients educational status primary-high school (p=0.026). There were no significant difference between BAI and anxiety levels compared to procedures (Respectively, P=0.144 P=0.054). There were no significant difference between BAI scores and anxiety levels compared to age groups (Respectively, P=0.301 P=0.214). CONCLUSIONS: We think that level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonoscopy was effected by presence of comorbidities and gender but was not effected by features such as age, procedure type and educational status.