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At least 1,081 records · Page 60Linked to original sources
PubMed1997

Conscious sedation with combined hypnotic agents for implantation of implantable cardioverter-defibrillators.

OBJECTIVES: The objective of this study was to evaluate the feasibility, safety and efficacy of placing implantable cardioverter-defibrillators (ICDs) in the electrophysiology laboratory using conscious sedation with combined hypnotic agents and deep sedation with etomidate. BACKGROUND: Implantable cardioverter-defibrillators with transvenous leads permit the use of simplified implantation techniques similar to those used for the insertion of permanent pacemakers. However, implantation of ICDs without general anesthesia has thus far gained limited acceptance. METHODS: In 162 patients, conscious sedation during ICD placement was achieved with combined intravenous midazolam, morphine and promethazine (Phenergan). Intravenous etomidate was administered to induce deep sedation for defibrillation threshold testing. First-time implantations were in the prepectoral position (n = 142), but some patients with preexisting devices received abdominal implants (n = 20). The results were compared with those of concurrent patients (n = 56) who received prepectoral implants under propofol anesthesia administered by an attending anesthesiologist. RESULTS: The anesthetic protocol was implemented without major intraoperative complications. During deep sedation with etomidate, episodes of apnea, hypoxia or arterial hypotension requiring therapeutic intervention did not occur. During a mean (+/-SD) follow-up period of 257 +/- 140 days (median 227, range 14 to 482), there were, among the 162 patients, a total of two nonsudden cardiac deaths-one 71 days and the other 157 days after the operation. There were two nonsudden deaths in the concurrent control subjects (n = 56)-one 13 days and the other 110 days after the operation. CONCLUSIONS: Implantation of ICDs under conscious sedation with combined hypnotic agents and deep sedation with etomidate is a safe and effective procedure with low perioperative morbidity and low long-term complication rates.

Aged↗
PubMed2003

[Which propofol target concentration for ASA III elderly patients for conscious sedation combined with regional anaesthesia?].

OBJECTIVE: To determine the optimal propofol target concentration between 0.9-1.1 and 1.3 mg l(-1), for conscious sedation and amnesia using Diprifusor in ASA III patients over 60 years. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: In ASA III patients over 60 years presented for elective vascular procedures under regional anaesthesia, sedation was induced with propofol TCI by increasing target concentrations from 0.9 to 1.3 mg l(-1) by 0.2 mg l(-1) steps up to a sedation score corresponding to light level (patient awakable with tactile stimulation). At baseline and each step, specific pictures were shown to the patient and clinical parameters and unwanted side effects occurrence were recorded. In PACU, memorisation of pictures and events was looked for. RESULTS: Conscious sedation was obtained in 100% of the patients at 0.9 mg l(-1), 94% at 1.1 and 78% at 1.3 mg l(-1). Amnesia was concentration-dependent and for each concentration was always more important for pictures than for events. Haemodynamic parameters did not change significantly. Incidents occurred in 12% of cases at 1.1 and 39.4% at 1.3 mg l(-1). DISCUSSION: None of those three concentrations was satisfying in 100% of cases for the three criterias (sedation < S2, amnesia and none side effects). These results suggest that propofol target concentration 0.9 microg ml(-1) could be used safely for sedation in elderly ASA III patients. Moreover, we have shown that amnesia for events requires higher propofol concentrations than amnesia for pictures during conscious sedation.

Aged↗
PubMed2001

Dyspnea, anxiety, body consciousness, and quality of life in patients with lung cancer.

Dyspnea is a common symptom of lung cancer that can impact patient physical, social, and psychological well-being. Study goals were to evaluate quality of life (QOL) and dyspnea in patients with lung cancer and the relationships between QOL, dyspnea, trait anxiety, and body consciousness. Sociodemographic and cancer-related variables (stage, cell type, performance status) were evaluated. One hundred twenty outpatients with stage I-IV lung cancer participated in the study. Patients completed 5 questionnaires assessing QOL, dyspnea, trait anxiety, body consciousness, and pain. Eighty-seven percent of study participants experienced dyspnea. Patients with high dyspnea scores had lower QOL (P = 0.04). Dyspnea was worse in men than in women (P = 0.02), and there was a trend towards older patients reporting more severe dyspnea than younger patients (P = 0.06). There was no difference in dyspnea based on cancer stage, cell type, or performance status. Pain and anxiety scores were higher in patients with high dyspnea (P = 0.02, P = 0.03). Dyspnea was more severe in patients taking opioid analgesics when compared to non-opioids or no pain medications (P = 0.03). No significant association was found between dyspnea, anxiety, and private body consciousness.

Adult↗
PubMed2000

Life expectancy of children in vegetative and minimally conscious states.

We determined estimates of survival in children, 3-15 years of age, in the vegetative state (VS) (n = 564), immobile minimally conscious state (MCS) (n = 705), and mobile MCS (n = 3,806). Data were extracted from the annual Client Development Evaluation Reports of the California Department of Developmental Services between 1988 and 1997 using the operational definitions for these three states on the basis of 15 descriptive behavioral categories. Patients were also categorized according to the following four etiologies: acquired (traumatic and nontraumatic) brain injury; perinatal/genetic; degenerative; and unknown/undetermined. The percentage of patients surviving 8 years was 63%, 65%, and 81%, for the VS, immobile MCS, and mobile MCS, respectively. Children in the VS and MCSs with acquired brain injury had lower mortality rates and those with degenerative diseases the highest mortality rates. We observed little difference in survival between patients in the VS and immobile MCS, suggesting that the presence of consciousness is not a critical variable in determining life expectancy. Furthermore, survival was much greater for patients in the mobile MCS than for those in the immobile MCS, suggesting that mobility is more important in predicting survival than the level of consciousness.

Adolescent↗
PubMed2004

The neural fate of consciously perceived and missed events in the attentional blink.

Cognitive models of attention propose that visual perception is a product of two stages of visual processing: early operations permit rapid initial categorization of the visual world, while later attention-demanding capacity-limited stages are necessary for the conscious report of the stimuli. Here we used the attentional blink paradigm and fMRI to neurally distinguish these two stages of vision. Subjects detected a face target and a scene target presented rapidly among distractors at fixation. Although the second, scene target frequently went undetected by the subjects, it nonetheless activated regions of the medial temporal cortex involved in high-level scene representations, the parahippocampal place area (PPA). This PPA activation was amplified when the stimulus was consciously perceived. By contrast, the frontal cortex was activated only when scenes were successfully reported. These results suggest that medial temporal cortex permits rapid categorization of the visual input, while the frontal cortex is part of a capacity-limited attentional bottleneck to conscious report.

Analysis of Variance↗
PubMed1997

[Indications for emergency EEG in disease, a brief loss of consciousness in generalized epileptic seizures in the adult].

EEG provides essential information for the management of patients in whom a first epileptic seizure is suspected because of transient alteration of consciousness. Postictal or interictal EEG abnormalities are useful to the clinician even when the diagnosis of epileptic seizure appears clinically evident. EEG is especially useful when recordings are performed immediately after the episode, in the absence of benzodiazepine therapy, and repeated later. After a transient loss or alteration of consciousness, the EEG should be considered as part of the emergency management, and thus rapidly obtained, whenever the evolution and/or the clinical signs of the episode are consistent with a focal epileptic seizure, especially if gestual or oro-facial automatisms, or bizarre deambulatory behavior have preceded the episode. EEG should also be considered as an emergency examination when a tonic-clonic seizure is suspected clinically, eg, when loss of consciousness is prolonged and inconsistent with a syncopal attack; when it is accompanied by clonic movements or spasms and followed by postictal confusion or stertor; when it entails a head injury or a tongue biting, or when it is preceded by premonitory signs or symptoms consistent with epilepsy. In the absence of such clinical suspicion, an EEG is not justified.

Adult↗
PubMed1997

A protocol for conscious sedation in microlaparoscopy.

To establish a protocol for conscious sedation in microlaparoscopy, we conducted a prospective, observational study of 74 women undergoing the procedure under local anesthesia with conscious sedation for the evaluation and treatment of chronic pelvic pain. Our protocol for conscious sedation allowed us to perform diagnostic microlaparoscopy under local anesthesia in all 74 women and operative microlaparoscopy in 52 (70.2%). This procedure is a safe and effective alternative to general anesthesia during microlaparoscopy in selected patients.

Adolescent↗
PubMed2001

A quantum approach to visual consciousness.

A theoretical approach relying on quantum computation in microtubules within neurons can potentially resolve the enigmatic features of visual consciousness, but raises other questions. For example, how can delicate quantum states, which in the technological realm demand extreme cold and isolation to avoid environmental 'decoherence', manage to survive in the warm, wet brain? And if such states could survive within neuronal cell interiors, how could quantum states grow to encompass the whole brain? We present a physiological model for visual consciousness that can accommodate brain-wide quantum computation according to the Penrose-Hameroff 'Orch OR' model. In this view, visual consciousness occurs as a series of several-hundred-millisecond epochs, each comprising 'crescendo sequences' of quantum computations occurring at approximately 40 Hz.

Journal Article↗
PubMed2002

The conscious access hypothesis: origins and recent evidence.

Consciousness might help to mobilize and integrate brain functions that are otherwise separate and independent. Evidence for this 'conscious access hypothesis' was described almost two decades ago, in a framework called global workspace theory. The theory had little impact at first, for three reasons: because consciousness was controversial; the evidence, though extensive, was indirect; and integrative theory was unfashionable. Recent neuroimaging evidence appears broadly to support the hypothesis, which has implications for perception, learning, working memory, voluntary control, attention and self systems in the brain.

Journal Article↗
PubMed2002

Paying attention to consciousness.

Despite being much studied by cognitive neuroscience, consciousness has resisted attempts to understand it. Recent neuroscientific papers on the problem have surprisingly neglected attention as a guide to consciousness. A new neural mechanism is proposed here, guided by a control approach to attention, which identifies the source of consciousness, especially that of the ownership of experience.

Journal Article↗
PubMed2003

How conscious experience and working memory interact.

Active components of classical working memory are conscious, but traditional theory does not account for this fact. Global Workspace theory suggests that consciousness is needed to recruit unconscious specialized networks that carry out detailed working memory functions. The IDA model provides a fine-grained analysis of this process, specifically of two classical working-memory tasks, verbal rehearsal and the utilization of a visual image. In the process, new light is shed on the interactions between conscious and unconscious aspects of working memory.

Journal Article↗
PubMed2004

Diagnostic conscious pain mapping using laparoscopy under local anaesthetic and sedation in general surgical patients.

BACKGROUND: Patients in whom extensive investigations have failed to identify the cause of abdominal pain present a challenge to surgeons. We present our initial experience of using laparoscopy under local anaesthetic and sedation in the diagnosis of chronic abdominal pain. METHODS AND PATIENTS: Nine patients with chronic abdominal pain and multiple normal investigations underwent laparoscopy under local anaesthetic and sedation. By touching and grasping intra-abdominal viscera and peritoneum, an attempt was made to reproduce the patient's pain. RESULTS: Two patients were found to have pain arising from the gall bladder and subsequently underwent laparoscopic cholecystectomy with resolution of their symptoms. A third patient had a clinical presentation of chronic acalculous cholecystitis and a normal laparoscopy. She decided to undergo laparoscopic cholecystectomy, which cured her pain. Another patient had pain arising from the appendix, which resolved after an appendicectomy. Three patients had pelvic adhesions, which caused chronic abdominal pain. After adhesiolysis, one is pain free; the others declined surgery for adhesions and their pain resolved. Conscious pain mapping was negative in two patients. CONCLUSION: Laparoscopy can be carried out in the conscious patient, who is then usually able to collaborate with the surgeon in establishing the source of the pain experienced during conscious pain mapping. Long-term effectiveness and diagnostic accuracy has not yet been established.

Abdominal Pain↗
PubMed2003

Elimination of the post-hypoxic frequency decline in conscious rats lesioned in pontine A5 region.

A decrease in the frequency of breathing following a hypoxic exposure that is below baseline values is called the post-hypoxic frequency decline (phfd) and is due to an elongation of expiratory time (TE). We hypothesized that lesioning the pontine A5 region would eliminate the phfd in conscious rats. Fourteen conscious male rats that demonstrated a phfd received lesions either within the A5 region (n=9) or outside this region (controls, n=5). Compared with pre-lesion values, body temperature decreased and frequency of breathing was lower during exposure to air, hypoxia, and hypercapnia in A5-lesioned, but not in the control-lesioned rats. No effect of A5 lesions was noted on tidal volume. Rats with A5 lesions no longer exhibited a phfd, and TE values following hypoxia were comparable to baseline TE values. These data suggest that the A5 region of the ventrolateral pons modulates the phfd in conscious rats and affects frequency of breathing in response to both hypoxia and hypercapnia.

Animals↗
PubMedDate not supplied

Does the level of prehospital care influence the outcome of patients with altered levels of consciousness?

HYPOTHESIS: Significant differences exist in the outcome of patients with altered level of consciousness (ALOC) cared for by advanced life support (ALS) compared with basic life support (BLS) prehospital providers. METHODS: Patients transported by ambulance to a community teaching hospital during an 11-month period were studied retrospectively. Study patients were those considered not alert by prehospital personnel. Exclusion criteria included; trauma, intoxication, drowning, shock, and cardiac arrest. Data were abstracted from the ambulance reports and hospital records. RESULTS: Two hundred three patients with an ALOC were identified; 113 were transported by ALS providers (56%) and 90 (44%) by BLS providers. Prehospital levels of consciousness, according to the "alert, verbal, painful, unresponsive" scale (ALS vs BLS) were: "verbal" (40% vs 51%), "painful" (23% vs 23%), and "unresponsive" (37% vs 25%). The mean value for some time was 15 +/- 6 minutes for ALS versus 10 +/- 4 minutes for BLS (p < 0.001). On arrival in the emergency department, the LOC of 72 (64%) ALS patients and 58 (64%) BLS patients had improved to "alert." The level of consciousness in one ALS patient worsened. Fifty-two ALS (46%) and 38 (42%) BLS patients were admitted. Principal final diagnoses were seizure (27% ALS vs 38% BLS), hypoglycemia (23% ALS vs 23% BLS), and stroke (22% ALS vs 20% BLS). Remaining diagnoses each constituted less than 7% of total discharge diagnoses. No statistically significant differences in measures of outcome were noted between ALS or BLS patients. Diagnoses of seizure, stroke, and hypoglycemia were studied individually. No differences in admission rate, mortality rate, or disposition were identified. Hypoglycemic patients conveyed by ALS providers had significantly shorter emergency department treatment times than did those transported by BLS providers (160 +/- 62 minutes ALS vs 229 +/- 67 minutes BLS [p < 0.005]). CONCLUSION: Advanced life support levels of care of patients with an ALOC does not significantly change outcome compared with those receiving BLS care with the exception of shorter emergency department treatment times for hypoglycemic patients.

Adult↗
PubMed1999

Recording the photopic electroretinogram from conscious adult Yucatan micropigs.

The micropig is viewed by many as one of the best animal models of human system physiology. The purpose of this study was to develop a simple, rapid and reliable method to record clinical electroretinograms from conscious adult Yucatan micropigs. Photopic ERGs were recorded from 18 conscious animals following a 3-h period of preadaptation to a moderate photopic environment. Rectal temperature and blood pressure were monitored throughout the experiment. In order to test the reproducibility of our procedure, the same protocol was repeated (n=6 micropigs) on three different recording sessions each separated by a 48-h period. Our results indicate that the recording of reproducible ERGs, in the conscious Yucatan micropig, is feasible provided that an adequate experimental approach is used. We believe that our method will enable investigators to perform retinal physiology experiments using an approach which is compatible with that used in a human clinical setup thus facilitating the transposition of experimental data from animal to human.

Adaptation, Ocular↗
PubMed2000

Craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex.

OBJECTIVE: Resection or even biopsy of an intra-axial mass lesion in close relationship to eloquent cortex carries a major risk of neurological deficit. We have assessed the safety and effectiveness of craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex. METHODS: We have performed a retrospective review of a consecutive series of 157 adult patients who underwent craniotomy under local anesthesia by one surgeon (P.M.B.) at Brigham and Women's Hospital in Boston. All patients had tumors in close proximity to eloquent cortex, including speech, motor, primary sensory, or visual cortex. In most cases the lesion was considered inoperable by the referring surgeon. All resection was verified by post-operative imaging approximately one month after surgery and all cases were reviewed by an independent neurosurgeon (A.D.). RESULTS: In 122 cases, brain mapping was performed to identify eloquent cortex and in the remainder neurological monitoring was maintained during the procedure. Radiological gross total resection was achieved in 57% of patients and greater than 80% resection was achieved in 23%. Thus 4 out of 5 of patients had major resection despite the close relationship of tumor to eloquent cortex. In 13%, less than 80% of tumor was removed because of danger of neurological deficit. In 7% of patients, only a biopsy could be done because of infiltration into eloquent cortex that could only be assessed at surgery. In 76 patients with pre-operative neurological deficits, there was complete resolution of these deficits in 33%, improvement in 32%, no change in 28%, and long-term worsening in 8%. Among 81 patients with no pre-operative neurological deficit, 1 patient suffered a major permanent neurological deficit, and 2 developed minor deficits. There was a transient post-operative deficit in one-third of cases, but this had resolved at one month in all but three patients. Monitored conscious sedation was performed without anesthetic complications using midazolam, sufentanyl and fentanyl with or without propofol. Only one case needed to be converted to general anesthesia. Patient satisfaction with the procedure has been good. Operating time and hospital stay were lower than the mean for brain tumor craniotomy at this hospital. CONCLUSIONS: Tumor surgery with conscious sedation is a safe technique that allows maximal resection of lesions in close anatomical relationship to eloquent cortex, with a low risk of new neurological deficit. Only 7% of intrinsic cortical tumors were ineligible for partial or complete resection with this technique.

Adolescent↗
PubMed2002

Blockade of spinal dopamine D2 receptors enhances the pressor effect of intravenous quinpirole in normotensive, conscious rats.

The present investigation was undertaken to examine whether in conscious intact rats blockade of spinal dopamine D2 receptors enhances the pressor effect of intravenous quinpirole. In saline-pretreated rats, intravenous quinpirole (1 mg/kg) induced a significant pressor effect, which reached a maximum (17.71+/-0.60 mmHg) within the first min. after injection. Pretreatment with intravenous (0.5 mg/kg) or intrathecal (40 microg/rat at T9-T10) domperidone, a dopamine D2 receptor antagonist that does not cross the blood-brain barrier, significantly enhanced the maximal pressor response to quinpirole (25.60+/-1.52 and 24.00+/-1.72 mmHg, respectively). The pressor effect of quinpirole was also significantly enhanced after combined pretreatment with intravenous and intrathecal domperidone, and its maximum (31.60+/-2.31 mmHg) was significantly higher than that recorded in animals pretreated with intrathecal or intravenous domperidone alone. Intravenous pretreatment with metoclopramide (5 mg/kg) fully abolished the quinpirole-induced pressor effect. These results show that in conscious intact rats, blockade of spinal dopamine D2 receptors enhances the pressor response to systemic quinpirole, suggesting that this agonist can decrease blood pressure through a spinal dopaminergic mechanism. Thus, our previous hypothesis that the entire effect of intravenous quinpirole on blood pressure in conscious rats can be composed of a central pressor action, a peripheral sympathoinhibitory depressor effect and also a spinal depressor effect is strongly supported by the present findings.

Animals↗
PubMed1996

Body consciousness, illness-related impairment, and patient adherence in hemodialysis.

Recent theory and evidence suggests that bodily self-focusing tendencies (e.g. private body consciousness) may be associated with medical regimen adherence among chronically ill patients. The present study examined the joint effects of private body consciousness and degree of illness-related physical impairment on treatment regimen adherence in a sample of 52 hemodialysis patients. It was predicted that the effect of PBC on adherence would vary as a function of patients' level of illness-related physical impairment. For patients experiencing more severe impairment, higher PBC scores were associated with poorer adherence to the prescribed medication and dietary regimen. In contrast, for patients experiencing a relatively low degree of disease-related physical impairment, higher private body consciousness was associated with more favorable adherence. Results are discussed in terms of self-focused attention and behavioral self-regulation theories. Implications for future research and clinical intervention are also discussed.

Activities of Daily Living↗