Sedation of Patients With Disorders of Consciousness During Neuroimaging

Kirsch, M. et al. Anesthesia & Analgesia. Published online: December 8, 2016

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Background: To reduce head movement during resting state functional magnetic resonance imaging, post-coma patients with disorders of consciousness (DOC) are frequently sedated with propofol. However, little is known about the effects of this sedation on the brain connectivity patterns in the damaged brain essential for differential diagnosis. In this study, we aimed to assess these effects.

Conclusions: Our findings indicate that connectivity decreases associated with propofol sedation, involving the thalamus and insula, are relatively small compared with those already caused by DOC-associated structural brain injury. Nonetheless, given the known importance of the thalamus in brain arousal, its disruption could well reflect the diminished movement obtained in these patients. However, more research is needed on this topic to fully address the research question.

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Tablet computers as effective as sedatives for children before operations

ScienceDaily | Published online: August 29, 2016

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Mobile interactive tools have been found to be effective to reduce child anxiety at parental separation in the operating theatre. The authors’ aim in this study was to compare the effects of midazolam (a sedative used regularly before anaesthesia) in premedication with age-appropriate game apps (on an iPad tablet) on children aged 4-10 years during and after ambulatory (day) surgery. Anxiety was assessed both in children and in parents.

Children were randomly allocated to one of the two groups (MDZ [midazolam-54 children] or TAB [iPad — 58 children]). Patients in group MDZ received midazolam 0.3mg/kg orally or rectally, or, in group TAB, were given an electronic tablet (iPAD) 20 min before anaesthesia. Child anxiety (using m-YPAS scale) was measured by 2 independent psychologists at four time points: 1) at arrival at hospital 2) at separation from the parents 3) during induction and 4) in the post anaesthesia care unit (PACU). Parental (using STAI score) anxiety was measured at the same time points except during induction as they were not present at that point. Anaesthetic nurses ranked from 0 (not satisfied) to 10 (highly satisfied) the quality of induction of anaesthesia.

Then, 30 minutes after the child received their last dose of nalbuphine anaesthestic or 45 min after arrival in the PACU, the children were transferred to the ambulatory surgery ward where parental anxiety (STAI 3) and children anxiety (m-YPAS 4) were again evaluated for the final time. In addition, parents’ satisfaction with the anaesthesia procedure was rated from 0 to 10. Postoperative behaviour changes were assessed with the Post Hospital Behaviour Questionnaire (PHBQ).

The researchers found both parental and child anxiety levels to be similar in both groups, with a similar pattern of evolution. Both parents and nurses found anaesthesia more satisfying in the iPad group.

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