Introduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effects in patients. Despite this, these practices are poorly described in the prehospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African emergency medical service. Methodology: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a single private ambulance service were reviewed. Data was analysed descriptively. Correlations were calculated with Spearman's Rank correlations and group differences were calculated with Independent T tests and Mann-Whitney U tests. Significant correlations were entered into a binomial regression model to determine predictive value of receiving PISA. Results: The number of PRFs included for analysis was 437. Of these, 69% of patients received some type of PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 minutes. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p< 0.01). There was weak but significant correlation between the number of interventions and the mean arterial pressure, (rs = 0.17, p< 0.01) and Glasgow Coma Scale (rs = -0.15, p< 0.01) prior to intubation, along with the transport time to hospital (rs = 0.23, p< 0.01). Conclusion: The PISA practices in the South African pre-hospital setting is comparable to international pre-hospital settings. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Practitioners also take the level of consciousness and blood pressure prior to intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions.

Background Procedural sedation and analgesia (PSA) is considered a core competency in emergency medicine as patients present to the Emergency Centre (EC) on an unscheduled basis, often complex complaints that necessitate emergent management (1). Previous evidence has consistently shown that procedural sedation and analgesia(PSA) in the EC in the paediatric population, even the very young, is safe if appropriate monitoring is performed and appropriate medications are used (2–5). The aim of the study was to describe the indications for PSA in the paediatric EC population, the fasting status of paediatric patients undergoing PSA, and the complications observed during PSA in a single Western Cape emergency centre. Methods A retrospective, descriptive study was conducted at Mitchells Plain Hospital, a district-level hospital situated in Mitchells Plain, Cape Town. All paediatric patients younger than 13 years of age who presented to the EC and received PSA during the study period (December 2020 – April 2021) were included in the study. Data was extracted from a standardised PSA form and simple descriptive statistics were used. Results A total of 116 patients (70,7% male) were included: 13 infants (<1 year of age) 48 young children (1-5 years of age) and 55 older children (5-13 years of age). There were only 2 (1,7%) complications documented, both of which were vomiting and did not require admission. The most of patients received ketamine (93,1%). The standardised PSA form was completed in 49,1% of cases. Indications for PSA included burns debridement (11,2%), suturing (17,2%), fracture reduction (23,3%), lumbar punctures (31,9%) and others (27,6%). The indications for PSA varied between the different age groups. Conclusion The study findings are in accordance with previous international literature. Emergency Centre PSA in the paediatric populations did not show an increase in interventions or complications, despite the fasting status (6). Safe, timely PSA with minimal pain and unnecessary suffering can become the norm in Emergency Medicine practice in South Africa.

Introduction: Prevention and treatment of pain or discomfort is an integral part of modern intensive care. Insufficient or, conversely, excessively deep sedation and analgesia are associated with a number of risks, such as prolonged hospitalization. For this reason, the use of scoring systems to monitor agitation and pain is currently recommended. Objectives and methodology: The aim of the work was to obtain data on the use of scoring systems to assess the pain and depth of sedation in intensive and resuscitation care workplaces in the Czech Republic and to evaluate the satisfaction of nurses with their use. The research was carried out using a quantitative method in the form of a semi-structured questionnaire of my own creation. The research sample consisted of station nurses and head nurses from anesthesiology and resuscitation departments and intensive care units. Results: The research survey involved 62 workplaces of intensive and resuscitation care in the Czech Republic. The existence of a sedation protocol was reported by 26 workplaces (42 %), the use of standardized scales to assess the depth of sedation was reported by 46 workplaces (74 %). Pain in ventilated patients is evaluated in all 62 workplaces (100 %). The most frequently used scale for assessing the depth of sedation is RSS, which...

Durante muitos anos a sedação consciente com a mistura de oxigênio e óxido nitroso foi utilizada por cirurgiões-dentistas em vários países do mundo. Já no Brasil, essa utilização só foi regulamentada com a edição da resolução do Conselho Federal de Odontologia CFO 51/04 (CFO, 2004b). Como todo instrumento de regulamentação, este também deve ser analisado para que possa ser melhor entendido. Assim, o presente estudo teceu comentários acerca dos aspectos integrantes de tal resolução, procurando destacar a importância e a relevância de cada um deles. Tal avaliação reveste-se de grande importância, pois a organização dos cursos que habilitarão os cirurgiões-dentistas a aplicar a sedação consciente com a mistura de oxigênio e óxido nitroso terá que cumprir os requerimentos presentes na citada resolução. Ressalte-se que não se pretendeu esgotar o assunto, até mesmo porque isso seria impossível, mas suscitar o interesse dos pesquisadores no desenvolvimento de investigações mais aprofundadas sobre a matéria. / For many years the conscious sedation with nitrous oxide and oxygen has been used in various countries in the world. This usage in Brazil has only been regulated with the present Resolução do Conselho Federal de Odontologia CFO 51/04. As any other regulating instrument, this also needs analysis for its complete understanding. In this study every aspect of the Conselho´s Resolution were analyzed, trying to underline their importance and relevance of each one of them. This evaluation becomes of great importance because it is based on its requirements that the courses for the habilitation of dentists who intend to use the technique of conscious sedation with nitrous oxide and oxygen will be developed and ruled. This study intends to be one of the tools that will be used to fully understand this resolution.

Durante muitos anos a sedação consciente com a mistura de oxigênio e óxido nitroso foi utilizada por cirurgiões-dentistas em vários países do mundo. Já no Brasil, essa utilização só foi regulamentada com a edição da resolução do Conselho Federal de Odontologia CFO 51/04 (CFO, 2004b). Como todo instrumento de regulamentação, este também deve ser analisado para que possa ser melhor entendido. Assim, o presente estudo teceu comentários acerca dos aspectos integrantes de tal resolução, procurando destacar a importância e a relevância de cada um deles. Tal avaliação reveste-se de grande importância, pois a organização dos cursos que habilitarão os cirurgiões-dentistas a aplicar a sedação consciente com a mistura de oxigênio e óxido nitroso terá que cumprir os requerimentos presentes na citada resolução. Ressalte-se que não se pretendeu esgotar o assunto, até mesmo porque isso seria impossível, mas suscitar o interesse dos pesquisadores no desenvolvimento de investigações mais aprofundadas sobre a matéria. / For many years the conscious sedation with nitrous oxide and oxygen has been used in various countries in the world. This usage in Brazil has only been regulated with the present Resolução do Conselho Federal de Odontologia CFO 51/04. As any other regulating instrument, this also needs analysis for its complete understanding. In this study every aspect of the Conselho´s Resolution were analyzed, trying to underline their importance and relevance of each one of them. This evaluation becomes of great importance because it is based on its requirements that the courses for the habilitation of dentists who intend to use the technique of conscious sedation with nitrous oxide and oxygen will be developed and ruled. This study intends to be one of the tools that will be used to fully understand this resolution.