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What is the best sedative technique for patients undergoing endoscopic cholangiopancreatography (ERCP)?

Patients have to be given medicines to make them adequately drowsy (sedated) or unconscious (anaesthetized) to tolerate the ERCP procedure. These medicines may be administered by anaesthetic or non‐anaesthetic healthcare personnel, and there is currently some debate as to who should administer these drugs to patients for ERCP procedures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Nonsteroidal anti‐inflammatory drugs and opioids can significantly relieve the pain in acute renal colic, but opioids (especially pethidine) cause more adverse effects

Acute renal colic occurs when mineral or organic solids pass though the urinary tract and obstruct the urinary flow. It causes a sudden onset of severe pain, which radiates from the flank to the groin and requires immediate treatment with pain‐killers. It can also cause nausea, vomiting, hypertension and blood in the urine. Opioids and non‐steroidal anti‐inflammatory drugs (NSAIDs) are commonly used to reduce the pain. The review found that both NSAIDs and opioids significantly reduce the pain. People experienced more adverse effects, such as vomiting, when using opioids (particularly pethidine) than when using NSAIDs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Local anaesthetic nerve block for pain management in labour

Most women find labour painful, although a few do not. Women who give birth more than once, can find very different levels of pain in their different labours. Women generally seek ways to help themselves cope with the labour, and some women look for additional help to manage the pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Magnesium sulphate versus lytic cocktail for eclampsia

Magnesium sulphate performs better than lytic cocktail in preventing maternal deaths, further fits, respiratory depression, coma and pneumonia for pregnant women with eclampsia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Sedation of children undergoing dental treatment

Fear of the dentist may be expressed as unco‐operative behaviour in children requiring dental treatment. Behaviour management problems can result in a child's tooth decay going untreated. While behavioural techniques play an important role in managing children, some children still find it difficult to co‐operate with dental treatment and may require sedation. This review examined the effectiveness of drugs to sedate a child whilst keeping them conscious. There is some weak evidence that midazolam administered in a drink of juice is effective, and nitrous oxide (laughing gas) may also be effective.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

A comparison between remifentanil and meperidine for labor analgesia: a systematic review

BACKGROUND: Remifentanil is an ultrashort-acting opioid with favorable pharmacokinetic properties that make it suitable as a labor analgesic. Although it crosses the placenta freely, it is eliminated quickly in the neonate by rapid metabolism and redistribution. We aimed to determine whether remifentanil compared with meperidine is effective in reducing pain scores in laboring parturients. Other effects on the mother, the labor process, and the neonate were also examined.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

The relative efficacy of meperidine for the treatment of acute migraine: a meta-analysis of randomized controlled trials

The authors concluded that meperidine is less effective for migraine headache than dihydroergotamine regimens and may be more likely to cause adverse events. Meperidine may also be less effective than antiemetics. A degree of caution may be necessary in interpreting these conclusions because the primary trials were small, their quality was mixed and there were marked differences between them.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Does the administration of nalbuphine provide effective and safe postoperative pain treatment in children?

Postoperative pain is still a major problem following surgery in children. There is currently clear evidence that multimodal postoperative pain treatment is the best choice. This approach may involve using nonsteroidal anti‐inflammatory drugs (NSAIDs) and opioids. However, due to the fear of side effects such as respiratory depression (where the lungs cannot provide enough oxygen), opioids are not frequently used for postoperative pain treatment in children. Nalbuphine may provide effective pain relief without causing respiratory depression. In this review, we investigated how well nalbuphine worked, compared to placebo and other opioids, in children with postoperative pain. We also looked at the side effects. We performed a systematic literature search in July 2013. Ten randomised controlled trials with 658 patients were included. The patients were children aged from 0 ‐ 18 years and most did not have any other relevant medical conditions. The overall quality of evidence was low, so this review could not definitively show that nalbuphine is better than placebo. The same holds true for the comparison with other opioids (morphine, tramadol, pethidine, piritramid). We were not able to comment on side effects due to the small numbers of participants in the trials. Future studies need to address these issues, including more robust data for effectiveness and side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Sufentanil for Palliative Pain Relief: A Review of the Clinical Effectiveness, Cost-Effectiveness and Guidelines [Internet]

An evaluation of the evidence behind the use of sufentanil in palliative pain relief is warranted given the proposed and observed off-label use in palliative care, and the mention of sufentanil within palliative care guidelines. Further, the relatively high cost of sufentanil necessitates an evaluation of resource implications. This report will review the evidence on clinical effectiveness and cost-effectiveness, as well as evidence-based guidelines regarding sufentanil for pain relief specifically in the context of palliative care.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: November 18, 2015
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Intraarticular lidocaine versus intravenous procedural sedation with narcotics and benzodiazepines for reduction of the dislocated shoulder: a systematic review

This review found that the use of intra-articular lidocaine for reduction of the dislocated shoulder resulted in fewer complications and less time spent in the emergency department when compared with opiate/benzodiazepine combinations for intravenous sedation. The increasing use of newer short-acting sedatives for sedation brings into question the applicability of this study to modern practice.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis

This review compared the complication rates of propofol with traditional sedative agents used during gastrointestinal endoscopy. The authors concluded that the risk of cardiopulmonary complications appeared lower during colonoscopy, but there was no difference in complications for other endoscopic procedures. The authors' conclusions should be treated with caution as their results only pertain to hypoxia and hypotension, not all cardiopulmonary complications.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Pain Management Interventions for Hip Fracture [Internet]

To review and synthesize the evidence on pain management interventions in nonpathological hip fracture patients following low-energy trauma. Outcomes include pain management (short and long term), mortality, functional status, pain medication use, mental status, health-related quality of life, quality of sleep, ability to participate in rehabilitation, return to pre-fracture living arrangements, health services utilization, and adverse effects.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: May 2011
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The Management of Inadvertent Perioperative Hypothermia in Adults [Internet]

Inadvertent perioperative hypothermia is a common but preventable complication of perioperative procedures, which is associated with poor outcomes for patients. Inadvertent perioperative hypothermia should be distinguished from the deliberate induction of hypothermia for medical reasons, which is not covered by this guideline.

NICE Clinical Guidelines - National Collaborating Centre for Nursing and Supportive Care (UK).

Version: April 2008
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Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin [Internet]

Chest pain or discomfort caused by acute coronary syndromes (ACS) or angina has a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. Treatments are available to improve symptoms and prolong life, hence the need for this guideline.

NICE Clinical Guidelines - National Clinical Guideline Centre for Acute and Chronic Conditions (UK).

Version: March 2010
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Assessment and Management of Acute Pain in Adult Medical Inpatients: A Systematic Review [Internet]

Poor pain management in surgical settings is known to be associated with slower recovery, greater morbidity, longer lengths of stay, lower patient satisfaction, and higher costs of care, suggesting that optimal pain care in these settings is of utmost importance in promoting acute illness management, recovery, and adaptation. VA/DoD Clinical Practice Guidelines have been developed for the management of acute post-operative pain, although the basis for many of the recommendations was by expert consensus rather than empirical evidence.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: April 2008
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Sedation in Children and Young People: Sedation for Diagnostic and Therapeutic Procedures in Children and Young People [Internet]

Many children present to hospitals and dental clinics needing effective sedation or anaesthesia for painful or distressing diagnostic or therapeutic procedures. There are many sedation techniques available but there is insufficient guidance on which techniques are effective and what resources are required to deliver them safely. Sedation is not always effective enough and will occasionally require the procedure to be delayed until the child can be anaesthetised perhaps in another healthcare setting or on another day. Consequently sedation failure is both distressing for the child and has major NHS cost implications. Excessive doses of sedation can cause unintended loss of consciousness and dangerous hypoxia. In comparison, planned anaesthesia is effective, but may have resource implications. The need for sedation or anaesthesia will depend upon the type of procedure. Some types of procedures are very common and healthcare providers and practitioners need to understand whether sedation or anaesthesia is the most cost effective method of managing them

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: December 2010
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Capnography for Monitoring End-Tidal CO2 in Hospital and Pre-hospital Settings: A Health Technology Assessment [Internet]

Anesthesiologists have been using capnography for decades to monitor end-tidal carbon dioxide (ETCO2) in patients receiving general anesthesia. ETCO2 monitoring using capnography devices has application across several hospital and pre-hospital settings, including monitoring the effectiveness of cardiopulmonary resuscitation (CPR), continuous monitoring of patients in the emergency room or intensive care unit (ICU), during ambulatory transport, to confirm the correct placement of an endotracheal tube (ETT), and monitoring post-operative patients with a history of sleep apnea or who have received high doses of opioids. Depending on the clinical area, the technology is at various stages of adoption.

CADTH Health Technology Assessment - Canadian Agency for Drugs and Technologies in Health.

Version: March 2016
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Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Heavy Menstrual Bleeding

Heavy menstrual bleeding (HMB) has an adverse effect on the quality of life of many women. It is not a problem associated with significant mortality. Many women seek help from their general practitioners and it is a common reason for referral into secondary care.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: January 2007
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Depression in Adults with a Chronic Physical Health Problem: Treatment and Management

This clinical guideline was commissioned by NICE and developed by the National Collaborating Centre for Mental Health. It sets out clear, evidenceand consensus-based recommendations for healthcare staff on how to treat and manage depression in adults with a chronic physical health problem.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2010
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