Introduktion: I dag ska patienter som vårdas på intensivvårdsavdelning vara så lätt sederade som möjligt. Detta kan vid samtidig respiratorvård inge känslor av panik, rädsla och otrygghet. Det är därför av stor vikt att intensivvårdssjuksköterskor vet hur de ska skapa trygghet hos patienterna, då trygghetskänslan även reducerar känslorna av panik och rädsla. Syfte: Syftet med examensarbetet var att belysa hur intensivvårdssjuksköterskor skapar trygghet för lätt sederade patienter vårdade i respirator. Metod: En kvalitativ metod användes och data samlades in genom intervjuer med 14 intensivvårdssjuksköterskor på 3 olika sjukhus. Data bearbetades utifrån Elo och Kyngäs kvalitativa innehållsanalys. Huvudresultat: I resultatet framkom fyra huvudkategorier; Genom att finnas där, Genom upprepad och anpassad information, Genom en bra miljö och yttre resurser samt Genom individanpassad vård. Diskussion: Det framkom att intensivvårdssjuksköterskorna skapade trygghet genom att involvera patienterna och de anhöriga i vården genom en god kommunikation och information. Miljön spelade även en viktig roll i trygghetsskapandet genom att minska störande ljud och inte själva vara stressade. Att skapa trygghet för lätt sederade patienter som vårdas i respirator är viktigt, då trygga patienter kan släppas upp snabbare från sederingen och ändå uppleva välbefinnande. / Introduction: The aim of caring for today’s intensive care patient is to have the patient sedated so light as possible. This can induce a sense of panic, fear and insecurity for the patient, when cared for in a mechanical ventilation. It is therefore very important that the intensive care nurse has the ability to create a sense of security for the patient, thus reducing feelings of fear and panic. Aim: The aim of this study was to illustrate how the intensive care nurses creates a sense of security when caring for light sedated patients in mechanical ventilation. Method: A qualitative method was selected and data collected through interviews with 14 intensive care nurses at 3 different hospitals. The data was processed by using Elo and Kyngäs qualitative content analysis. Main Results: The result of the study presents with four main categories; Being there, Through repeating and adapting information, Through a good climate and outer resources as well as Through individually modified care. Conclusions: It showed that the intensive care nurses created a sense of security through involve the patients and their near ones in the care of the patient through good communication and information. The environment also played a critical role through minimizing distracting noise and not to appear stressed themselves. To create sense of security for light sedated patients in mechanical ventilation is important, as when the patients experience a sense of security they could be more quickly weaned of the sedation and yet still experience a sense of wellbeing.

Procedursmärta är den vanligaste orsaken till smärta hos barn i sjukvården. Dagligen genomförs diagnostiska och terapeutiska procedurer på barn, som både är skrämmande och smärtsamma. Barn som upplever otillräcklig smärtlindring under medicinska procedurer har en högre nivå av rädsla och ångest inför framtida procedurer, de reagerar dessutom kraftigare på akut smärta. Att låta barn inhalera en blandning av lustgas och syrgas ger både en smärtlindring och sedering. Stor fördel är att lustgas är enkel att administrera, har en kort anslagstid och effekten avklingar snabbt när inhalationen avslutas, och ger få biverkningar. Syftet med litteraturstudien var att beskriva effekten av lustgas i samband med att barn utsätts för smärtsamma procedurer inom hälso- och sjukvården. En litteraturstudie utfördes där tio vetenskapliga studier grundlade resultetet. Vid bearbetningen identifierades tre olika teman, dessa var; Lustgas och smärta, Lustgas och biverkningar, Lustgas och fasta. I resultatet framkom att lustgassedering är en effektiv och säker metod för att uppnå smärtlindring och sedering under mindre, men smärtsamma medicinska procedurer, med få biverkningar. Allt fler barn sederas med lustgas vid olika medicinska procedurer av icke anestesiutbildade sjuksköterskor. En konklusion av resultatet var, för att sjuksköterskan ska kunna möta kraven måste systematisk utbildning och träning finnas och tydliga guidelines utarbetas och vara förankrad hos all personal. Detta måste prioriteras, förbättras och kontinuerligt uppdateras.

Purpose: To determine whether Bispectral Index Monitoring is an effective tool for quantifying sedation depth after the administration of oral drug regimens in children.Methods: This retrospective study reviewed the charts of 75 children who received oral conscious sedation for dental treatment. Data collected from the chart included; 1) BIS values at 5 minute intervals and at five critical events: pre-operative, local anesthesia delivery, rubber dam placement (if utilized), during operative treatment, and postoperatively, 2) behavior ratings at the five critical events and an overall behavior assessment, 3) treatment data, and 4) demographic data. Results: The mean BIS value for orally sedation children in this study was 84.53 (SD = 5.76). The mean overall sedation assessment was 2.04 (SD = 1.16). No significant correlation was found between BIS values and behavioral ratings.Conclusion: The BIS monitor provided limited information regarding the depth of sedation in children undergoing oral sedation for dental treatment.

Objective: The purpose of the study was to determine if a co-payment resulted in a differential preference for general anesthesia (GA) or oral sedation (OS) and, if so, to examine whether age, the number of appointments, perceived risks of treatment, child's awareness during treatment, or insurance type appeared to play a role in this preference.Methods: Using a cross-sectional survey design, questionnaires were distributed to caregivers of patients in the waiting room of the Virginia Commonwealth University Pediatric Dental Clinic. Two different questionnaires were distributed randomly. Both surveys described a scenario with the need for dental treatment under general anesthesia (GA) or oral conscious sedation (OS). Seventy five surveys required a $50 co-payment for treatment completed under general anesthesia and the other 75 required the same co-payment for treatment completed under oral conscious sedation. Caregivers were asked to choose treatment modalities as well as to rate factors in their decision making including perceived risks and the number of dental visits. Results: Seventy seven survey respondents selected GA as their preferred treatment option for the described scenario. The other sixty six respondents chose OS sedation. For the insured population, the GA/OS odds ratio for the OS-co-payment group versus the GA-co-payment group was OR=2.21 (95% CI = 1.06, 4.60). In terms of the uninsured, the GA/OS odds ratio for the OS-co-payment group versus the GA-co-payment group was OR=17.5 (95% CI = 1.60, 191). The child's age, awareness during treatment, and type of insurance (public versus private) were not significantly related to treatment choice. The importance of the number of appointments was found to be significant (p-value = 0.0170) and outweighed the effect of the co-payment (p-value = 0.1757). The importance of associated risks was found to be significant (p-value = 0.0171) and this outweighed the effect of the co-payment (p-value = 0.8157).Conclusions: The presence of a co-payment does not as significantly impact the GA versus OS preference while the number of appointments and perceived risks associated with the treatment remain significant.

The purpose of this study was to investigate the role of child temperament and its effect on the outcome of conscious sedation using the following agents: Chloral Hydrate (35mg/kg), Meperidine (2mg/kg), and Hydroxyzine (2mg/kg).The Emotionality, Activity, Sociability (EAS) Temperament Survey for Children was used to measure the child's temperament. The temperament survey measures three realms (Emotionality, Activity, Sociability/Shyness). The sedation outcomes were rated using the modified North Carolina Behavior Rating Scale (NCBRS) from 1-4 (Quiet, Annoyed, Upset, and Wild). The final sample population consisted of 34 children, 24 girls (71%) and 10 boys (29%), ranging in age from 0-9 years old (M=5.6 years old, SD=1.8 years old). The sample population showed moderate emotionality (M=2.56, SD=0.96, p=0.5707), high activity (M=4.15, SD=0.72, p=0.2423), high sociability (M=3.63, SD=0.60, p=0.7853), and moderate shyness (M=2.50, SD=0.86, p=0.9930). Of the critical events, local anesthesia (F=74%, M=1.31, SD=0.58) and rubber dam placement (F=77%, M=1.26, SD=0.51) showed the most disruptive behaviors. Correlation results showed no significant temperament influence on overall effectiveness of sedation for the EAS sub-scales. Individual EAS scores, moderate emotionality, high activity, high sociability, and moderate shyness, did not predict the overall effectiveness of the sedation in this population.

Résumé : L’hémiplégie laryngée (HP) est une affection courante et une cause majeure de contre-performances dans l’espèce équine. Plusieurs études ont montré que la prévalence était variable selon les races et les disciplines étudiées. De plus, un développement important des techniques chirurgicales peu invasives ont émergé ces dernières années. Les objectifs de ce travail étaient de 1) déterminer la prévalence de l’HL chez une population de Trotteurs Français (TF) à l’entrainement et son impact sur les performances, 2) évaluer la pertinence des protocoles actuels de sédanalgésie utilisés lors d’interventions chirurgicales sur cheval debout.Deux études ont été réalisées pour répondre aux objectifs. La première étude portait sur 112 TF en situation d’entrainement. La prévalence a été calculée sur l’ensemble de l’effectif puis une étude longitudinale sur l’évolution du grade HL a été réalisée sur 18 chevaux. La prévalence de l’HL chez ces chevaux était relativement importante mais aucune corrélation avec les performances, ni le sexe ou l’âge des animaux n’a pu être montrée. Une large proportion de chevaux voit son grade d’abduction se dégrader avec le temps. La deuxième étude a comparé 4 protocoles de sédanalgésie. Huit juments saines ont été utilisées et les effets des protocoles ont été notés. Les protocoles testés étaient adéquats pour les interventions envisagées mais des différences notoires ont été démontrées. L’utilisation du butorphanol entrainait des mouvements involontaires et brusques de la tête, tandis que la lidocaïne pouvait engendrer un collapsus pharyngé. Des recommandations pour l’utilisation de ces protocoles ont été émises. / Abstract : Laryngeal hemiplegia (LH) is a common disease in sport- and racehorses, but also a frequent cause of poor performance. Several studies have shown that the prevalence of the disease is rather variable among the different breeds and disciplines. Furthermore, minimally invasive surgical therapies to correct this condition have recently gained popularity. The objectives of our work were to 1) determine the prevalence of LH in a population of French Trotters in training and 2) assess the efficacy of sedation and analgesia protocols in minimally invasive upper airway surgery. Two experiments were conducted. The first experiment investigated the prevalence of LH in 112 French Trotters horses in training, showing that a large number of horses were affected but it did not severely impact their performance. A longitudinal study was performed in 18 of these horses showing that the LH grade decreased with time in a large proportion of horses. The second study compared 4 sedation/analgesia protocols used in upper airway standing surgery. All protocols tested were adequate to provide sedation and analgesia of the pharynx and larynx but there were some important differences between protocols. Butorphanol induced frequent head jerking as lidocaine caused pharyngeal collapse, which can impair proper surgical accuracy. Recommandations were made for the use of these protocols in upper airway surgery.

O presente estudo objetivou determinar um protocolo para sedação de veados-mateiros (Mazama americana) que permitisse procedimentos comumente utilizados no manejo dessa espécie em cativeiro. Foram utilizados seis animais adultos, pesando 38,4 ± 5 Kg, pertencentes ao Núcleo de Pesquisa e Conservação de Cervídeos (UNESP - Jaboticabal). Os animais foram submetidos a dois tratamentos, com um intervalo mínimo de 30 dias entre eles, a saber: AX-0,5 - associação de 1 mg/kg de azaperone e 0,5 mg/kg de xilazina via intramuscular (IM) e AX-1,0 - associação de 1 mg/kg de azaperone e 1 mg/kg de xilazina (IM). A partir da administração do tratamento (0 minuto) foram avaliados os tempos para latência da sedação, para decúbito esternal, para a manipulação segura e para a manipulação sem segurança. Ainda, foram avaliados a qualidade da contenção química por meio da somatória de pontos obtida com a utilização de uma escala descritiva adaptada, a cada 10 minutos, por até 90 minutos, parâmetros fisiológicos (FC, fR, PAM e To) a cada 10 minutos, durante 60 minutos, perfil ácido-base e eletrolítico (pH, PaCO2, PaO2, HCO3-, EB, SaO2, Na+ e K+) aos 10, 30 e 60 minutos e lactato sérico aos 30 e 60 minutos pós-tratamentos. As diferenças foram consideradas significantes quando P < 0,05. O período de latência da sedação e período para os animais apresentarem decúbito esternal foram maiores em AX-0,5 (7 ± 6,6 e 12 ± 9,7 minutos, respectivamente) em relação a AX-1,0 (5 ± 2,0 e 6 ± 3,1 minutos respectivamente), porém não houve diferenças entre os grupos para os demais tempos avaliados. A qualidade da contenção química diferiu entre os grupos a partir de 60 minutos, observando-se possibilidade de manipulação sem segurança a partir de 60 minutos para AX-0,5 e de 90 minutos para AX-1,0. Não houve diferenças entre FC, fR, PAM e To e o lactato sérico entre os momentos nem entre os grupos. Em relação ao perfil ácido-base e eletrólitico, AX-0,5 apresentou diferenças em pH, HCO3-,, EB e K+, com valores aos 60 minutos superiores aos valores em 10 minutos, e AX-1,0 apresentou diferenças apenas para EB também com valores aos 60 minutos superiores aos 10 minutos. Diante dos resultados conclui-se que os dois protocolos promoveram sedação adequada e que a escolha entre eles deve ser pautada pela índole do animal. Embora não tenham ocorrido alterações fisiológicas consideráveis em nenhum dos grupos, sugere-se a suplementação de oxigênio nos primeiros 30 minutos de contenção química. / The aim of this study was to determine a sedation protocol for red brockets (Mazama Americana) that allows common handling procedures for captive individuals of this species. Six adult animals, weighing 38.4 ± 5 kg, from Núcleo de Pesquisa e Conservação de Cervídeos (UNESP - Jaboticabal) were used in the study. They underwent two treatments with a 30 days washout period: AX-0.5 with 1 mg/kg azaperone and 0.5 mg/kg xylazine, intramuscularly (IM), and AX-1.0 with 1 mg/kg azaperone and 1 mg/kg xylazine, IM. From the moment of drug administration (0 minute) latency periods for sedation, sternal recumbency, safe handling and unsafe handling were recorded. The quality of chemical restraint was quantified every 10 minutes, for up to 90 minutes, through a descriptive scale, and the physiological variables (FC, fR, PAM and To) every 10 minutes, up to 60 minutes. Acid base status and blood electrolytes (pH, PaCO2, PaO2, HCO3-, EB, SaO2, Na+ e K+) were assessed at 10, 30 and 60 minutes, while blood lactate was assessed at 30 and 60 minutes after treatment. Differences were considered significant when P < 0.05. Sedation latency periods and period for sternal recumbency were longer in AX-0.5 (7 ± 6,6 e 12 ± 9,7 minutes, respectively) in comparison to (AX-1.0 5 ± 2,0 e 6 ± 3,1 minutes respectively), however no other significant differences in periods between groups were observed. Quality of chemical restraint was significantly different between treatments after 60 minutes, when safe handling of the animals was no longer possible in AX-0.5, but only after 90 minutes in AX-1.0. No differences between FC, fR, PAM, To and blood lactate levels were observed between groups or between moments. Regarding the acid base status and blood electrolytes, animals from AX-0,5 showed significant differences in pH, HCO3-,, BE and K+ between 10 and 60 minutes, being values at 10 minutes higher. Same tendency was also observed in AX-1.0, however only for BE. In conclusion, both protocols led to adequate sedation and predilection between them should be based on the animal\'s behavior. Even though no alterations in physiological parameters were detected in any of the experimental groups, oxygen therapy is recommended for the first 30 minutes of chemical restraint in all animals.

O Objetivo deste estudo controlado e duplo-cego foi avaliar os efeitos cardiovasculares induzidos pelo bloqueio pterigomandibular com o anestésico local cloridrato de lidocaína 2%, associado à epinefrina, seguido da administração de ansiolítico (midazolam 15mg) ou placebo, para realização de cirurgia de colocação de implantes dentários inferiores bilaterais, em 22 pacientes (13 mulheres 9 homens). Os parâmetros cardiovasculares Pressão Arterial Sistólica (PAS), Diastólica (PAD), Média (PAM) e Freqüência Cardíaca (FC) foram monitorados pelos métodos oscilométrico e fotopletismográfico. Os valores médios foram registrados a cada minuto e de forma contínua durante as etapas do experimento da seguinte forma: Fase 0 Período basal; Fase 1 Anestesia local; Fase 2 incisão; Fase 3 perfuração; Fase 4 colocação dos implantes; Fase 5 sutura; Fase 6 período final. Os indivíduos que receberam midazolam não apresentaram alterações de PAS, PAD, PAM e FC significativas (p>0,01) comparada ao placebo. Ocorreram alterações significantes dos valores para o grupo que recebeu placebo e dos valores médios do grupo que receberam midazolam na freqüência cardíaca / The purpose of this controlled and double-blind trial was to evaluate cardiovascular effects induced by pterigomandibular block of local anesthetic (LA) 2 % lidocaína hydrochloride with epinephrine, followed administration of benzodiazepine (midazolam 15mg on hour prior) or placebo during the surgical phase of placement of the lower bilateral dental implant in 22 normotensive outpatients (13 female and 9 male). The cardiovascular parameters systolic (SP), diastolic (DP) and mean (MP) pressures and heart rate (HR) were monitored by oscillometric and photopletismographic methods in 06 clinical phases during the procedure. The mean values were recorded every minute and in a continuous way during the phases of the experiment following the sequence: phase 0 basal period; phase 1 - anesthesia local; phase 2 mucoperiostal flap; phase 3 perforation; phase 4 placement of dental implants; phase 5 suture; phase 6 the end period. The group with received midazolam didnt induce significant SP, DP, MP and HR changes (p>0.01) compared to placebo. Significantly higher values in placebo group and mean values in midazolam group in heart-frequency were observed.

O medo ou a ansiedade são emoções frequentemente presentes nos pacientes que nos procuram na clínica odontológica para tratamento odontológico. Estes pacientes são denominados pacientes odontofóbicos. O objetivo deste estudo é avaliar o efeito ansiolítico do Maleato de midazolam e/ou Óxido Nitroso usado para promover sedação consciente nestes pacientes para se observar posteriormente a percepção dos usuários . Foram colhidas suas narrativas descrevendo qual a contribuição do sedativo usado no alívio da ansiedade. O presente estudo foi realizado como pesquisa de campo pautada na técnica da representação social ou discurso do sujeito coletivo proposto por Lefevre et al. (2000). Foram entrevistados de 10 pacientes diagnosticados como odontofóbicos, suas respostas catalogadas e transformadas em resultados qualitativos. De todos os sujeitos da pesquisa, todos aprovaram a utilização de ansiolíticos durantes procedimentos cirúrgicos. Sendo assim, dentro desta amostra, concluímos que a sedação consciente por meio de sedativos é uma excelente forma de se controlar a ansiedade frente ao tratamento odontológico / Fear and anxiety are emotions often present in patients who come to us in the dental clinic for treatment. These patients suffer of dental anxiety. The objective of this study is to evaluate the anxiolytic effects of midazolam maleate and / or Nitrous Oxide used to promote conscious sedation in these patients. We collected the narratives describing the contribution of the sedative used to relieve their anxiety. This study was conducted as a field research based in the technique of representing social or collective subject discourse proposed by Lefevre et al. (2000). We interviewed 10 patients with a dental fear background, their narratives processed in qualitative results. After the surgery all patients described that the procedures were softer than usual, and by this results we can conclude that the use of sedatives in oral surgery should be encouraged.

Introduction: Palliative sedation is the use of sedatives to lower the alertness for symptomcontrol, when suffering is otherwise uncontrollable. Its role in palliative care is frequentlyargued, with both proponents and opponents. End-of-life decisions raise many concerns,including ethical ones, regarding which ethical principle should be valued the most. Someopponents argue that palliative sedation is ethically similar to euthanasia, but there alsoappears to be some confusion concerning concepts and definitions. Aim: To discuss ethical arguments for and against palliative sedation, and relevant ethicaldifferences between palliative sedation and euthanasia. Furthermore, to try to clarify differentconcepts and definitions used in the discussion of the matter. Materials and methods: This work is based on a qualitative literature study, and anargumentative- and concept analysis on hermeneutic ground. Material was gathered through aliterature search, and contains official material, debate articles and scientific articles. Results: Palliative sedation can be argued to protect the ethical values of autonomy,beneficence, dignity and integrity, but simultaneously it is argued to violate those ethicalconcepts. There seems to be disagreements regarding which principle should be highestvalued. Conclusion: The matter of palliative sedation is delicate, and engages a lot of people. Pro- andcontra-arguments vary in strength, partly because of an inconsistency in the use of differentconcepts and definitions. In most of the material studied, it is argued that palliative sedation isethically acceptable, whereas euthanasia is not.