Background: SEDATION has a beneficial impact on patient’ s tolerance to the endoscopic procedure. CONSCIOUS SEDATION is the anesthetic techniques of choice for endoscopic procedure. CONSCIOUS SEDATION for endoscopic procedure could be with one drug or a combination of drugs. There have been broad variations in SEDATION procedure between different countries, and even between different units within the same country. All drugs which depress the central nervous system have the ability to produce respiratory or cardiovascular complications. Endoscopy has a recorded mortality of 1 in 2000 and a morbidity rate of 1 in 200. These SEDATION techniques have their effects on patients. The main goal of this study is to describe the effects of CONSCIOUS SEDATION on patients' outcome for endoscopic procedure. Methods: The design for this study was a review of literature in the medical databases of PubMed, Scopus, Embase, Cochrane and hand search journals from conferences in English. All studies that evaluated the use of CS for endoscopic procedure were included. Results: The results showed that the pain level of the patient (visual analogue scale) was substantially positive when CONSCIOUS SEDATION was used. CONSCIOUS SEDATION, however is a lightly sedated patient who is CONSCIOUS, amnesic, co-operative on demand and free from fear and anxiety. It is often used during endoscopic procedures to minimize discomfort and relax the patients. The intraoperative hypotension has also been extreme in some medications relative to others. Conclusion: The study revealed that CS is reliable and well tolerated anesthetic technique for endoscopic procedures, and is a better option for elective endoscopic procedures CS benefits for endoscopisit and patient outcome is superior to GA such as; short recovery times, less analgesia requirement, comfortable for patient which in turn, leads to faster induction, faster endoscopy, faster discharge, and faster turnaround time. Patients are usually willing to go home after a couple of hours. Rapid recovery is a benefit not only for patients, but also for hospital and day surgery departments. This increases the overall performance of the endoscopy unit.

In this prospective, placebo -controlled study, the effect of oral Midazolam premedication on CONSCIOUS SEDATION in children undergoing ambulatory surgery was examined. Two oral preanesthetic medication regimens according to a randomized protocol were studied in 60 healthy children ages 2-6 years old. Group A (Placebo) received 5 ml of fruit juice, and group B received Midazolam 0.5 mg/ml with fruit juice to a total volume of 5 ml, 1 hr before induction of anesthesia. 73.3% of the children who were separated from their parents within 60 min after administration of oral Midazolam had satisfactory separation scores (vs 13.3% of non - Midazolam treated children, P=0.00002). Midazolam -treated patients were more cooperative compared with non – Midazolam treated children (79% vs 17%). The time to early recovery from anesthesia was somewhat longer in children premedicated with Midazolam cooperative with controls (17% vs 13%). In conclusion, Midazolam (0.5 mg/kg) given orally 1hr before induction of anesthesia is safe and effective without any major side effects after ambulatory surgery.        

Background: Endoscopic procedures are performed for diagnosis and treatment of GI disturbances and require adequate, short-time anesthesia. Propofol is a rather recently introduced IV drug used for its CONSCIOUS SEDATION effects. This study has compared the effects and complications of propofol versus midazolam in endoscopic procedures in Hamedan in 2001.Materials and Methods: This double blind randomized clinical trial was performed on 70 patients at ASA class I- II who underwent endoscopy or colonoscopy at Ekbatan Hospital in Hamedan. After randomization of the patients into 2 study groups: test (propofol) and control (midazolam), phentanil (5mg/kg) was administered as a sedative and after 3 minutes contents of syringe A (propofol) or B (midazolam) were injected by an anesthesiologist. Then, the 2 groups were compared regarding such points as injection pain, CONSCIOUS SEDATION, operation satisfaction (by the patient), duration of recovery, nausea and vomiting, hypotension and decrease in O2 saturation.Results: Average score of CONSCIOUS SEDATION in midazolam group (4.1) was slightly higher than propofol group (4). Mean duration of recovery was 15.3 in midazolam and 14.8 in propofol groups. A total of 14 patients (40%) in midazolam group and 7 patients (20%) in propofol group experienced complications whose difference was not statistically significant. Mean pain score in midazolam group (2.7) was slightly higher than propofol group (2.6). Mean satisfaction score was also slightly higher in midazolam group (3.23) vs propofol group (3.2).Conclusion: There was no statistically significant difference between propofol and midazolam from the point of view of CONSCIOUS SEDATION, patient satisfaction, duration of recovery, injection pain and other complications.

Background: Establishment of a patent airway and preserving spontaneous ventilation is a necessity in predicted difficult airway. Airway regional blocks are commonly used in predicted difficult airway but the known limitations of these techniques propose the need to suggest alternative methods. This study compares subcutaneous dissociative CONSCIOUS SEDATION (sDCS); a recently reported method of CONSCIOUS SEDATION versus airway regional blocks in patients with predicted difficult airway. Methods: This study was conducted in 60 patients scheduled for direct laryngoscopic biopsy (DLB). Patients were randomly assigned into two groups: subcutaneous dissociative CONSCIOUS SEDATION (sDCS) (n=30) and airway regional blocks (ARB) (n=30). Patients were compared for direct laryngoscopy, insertion of endotracheal tube, hemodynamic changes, oxygen saturation, patient cooperation, patient comfort, hallucination, nystagmus, salivation and event of recall. Results: Direct laryngoscopy was successfully performed in all patients in sDCS group and 28 patients in ARB group. Insertion of endotracheal tube was successfully done in 28 patients of sDCS group and failed in two cases. In group ARB, endotracheal intubation was successfully done in 26 patients. Despite the lower success rate in group, ARB it was not statistically significant. Patient cooperation was significantly higher in sDCS group. No event of recall was observed in sDCS group versus 8 in group ARB. Conclusion: Subcutaneous dissociative CONSCIOUS SEDATION (sDCS) is a safe anesthesia method for endotracheal intubation and it is comparable and even superior to airway regional blocks in some aspects.

Background and the purpose of the study: Midazolam is preferably used in pediatric dentistry for quick onset of action and recovery. The aim of this prospective, observer-blind and placebo-controlled study was to assess the efficacy of a low dose of oral midazolam in modification of the behavior of young pediatric dental patients.Methods: Forty children aged 3 to 5 years who displayed ratings 1 or 2 on the Frankl Scale and were healthy by the American Society of Anesthesiologists-I status were randomly divided into two experimental and control groups of 20 each. All children required pulpotomy and restoration of D and E teeth and received either 0.25mg/kg of a 15mg/3ml IV midazolam mixed in black cherry syrup or the syrup alone. Subjects were continuously observed and monitored with pulse oximetry. Houpt's Behavioral Ratings was used to determine the overall behavior, the degree of crying and movement during treatment. Mann-Whitney U test was used for statistical analysis.Results and major conclusion: Patients who received 0.25mg/kg of the prepared oral midazolam significantly behaved better during treatment than the placebo controls (P<0.05). In comparison with the placebo group, reduced movement and crying were observed in the midazolam group (P<0.05). No adverse effects were observed and treatments were completed successfully. A low dose of 0.25mg/kg of a 15mg/3ml IV midazolam mixed in black cherry syrup was found to be effective in CONSCIOUS SEDATION of young pediatric dental patients.

Background: Colonoscopy is performed without preparing SEDATION in many countries. However, according to the current literature patients are more satisfied when appropriate SEDATION is prepared for them.Objectives: We hypothesize that propofol-ketamine may prepare more patient satisfaction compared to propofol-fentanyl combination.Patients and Methods: Sixty adult patients older than 18 with ASA physical status of I, II or III were enrolled in the present study after providing the informed consent. They were prospectively randomized into two equal groups: 1- Group PF: was scheduled to receive IV bolus dose of fentanyl 1mg/kg and propofol 0.5mg/kg. 2- Group PK: was scheduled to receive IV bolus dose of ketamine 0.5mg/ kg and propofol 0.5mg/kg. As a primary goal, patient’s satisfaction was assessed by the use a Likert five-item scoring system in the recovery. Comparisons of hemodynamic parameters (mean heart rate, mean systolic blood pressure, mean diastolic blood pressure), mean Spo2 values during the procedure and side effects such as nausea, vomiting, and psychological reactions during the recovery period were our secondary goals. Level of SEDATION during the colonoscopy was assessed with the Observer’s Assessment of Alertness/SEDATION score (OAA/S).Results: Mean satisfaction scores in the group PK were significantly higher than the group PF (P= 0.005) while the level of SEDATION during the procedure was similar (P= 0.17). Hemodynamic parameters and SpO2 values were not significantly different (P>0.05). Incidence of nausea and vomiting was the same in both groups.Conclusions: IV bolus injection of propofol-ketamine can lead to more patients’ satisfaction than the other protocols during colonoscopy.

Background: The quality of intraoperative analgesia with paracervical block (PCB) during egg collection in in-vitro fertilization (IVF) is still unclear. Objective: This study performed to compare the pain levels during egg collection and the subsequent intra and postoperative side effects in patients receiving a CONSCIOUS SEDATION with and without paracervical block. Materials and methods: In this prospective, double-blind, and placebo–controlled study, 60 patients undergoing egg collection in their first IVF cycle were randomized to receive CONSCIOUS SEDATION in conjunction with paracervical block with 10 ml lidocaine 1.5% (SEDATION + PCB patients or study group) or with 10 ml normal saline (SEDATION patients or placebo group). Results: Patients in study group experienced significantly less vaginal (10.40±8.40 mm vs 20.77±4.60 mm respectively; p<0.0005) and abdominal pain (10.87±5.08 mm vs 35.33±4.27 mm respectively; p<0.0005) during egg collection, compared with those in placebo group. Propofol requirements was 8.67±2.42 mg in PCB patients vs 25.60±5.29 mg in placebo group (p<0.0005). Incidence of intraoperative (9.90% vs 50% respectively; p=0.002) and postoperative (3.33% vs 56.66% respectively; p<0.0005) side effects were significantly less in study patients compared with placebo group. Conclusion: CONSCIOUS SEDATION with PCB appears to be an effective and safe method of providing analgesia and anesthesia for transvaginal retrieval of oocyte.  

Background: This study compared the safety and efficacy of nitrous oxide (N2O)/midazolam and N2O/promethazine for dental treatment of uncooperative children. Materials and Methods: In this randomized, cross‑ over, clinical trial investigation Eighteen healthy uncooperative children with a pair of similar teeth requiring the same treatment were included. Combination of N2O/midazolam was given in one visit, where N2O/promethazine was administrated in the other appointment for each patient in a cross‑ over manner. Oxygen saturation and heart rate as well as behavior parameters according to Houpt behavior scales were recorded. Postoperatively, patients’ anxiety and parents’ satisfaction were assessed by visual analog score and a questionnaire, respectively. Data were analyzed using Wilcoxon’ s signed rank test and Paired t‑ tests with a P value set at 0. 05. Results: Physiologic parameters were within normal limit in both groups. Children in midazolam group were significantly deeper sedated compared to other groups. In the first phase, children sedated with midazolam behaved superiorly in comparison to promethazine, while there was no difference at the final phase of the treatment between the two groups. Conclusion: Both of the drug combinations resulted in acceptable, efficient, and safe SEDATION outcomes.

Background: Nowadays, according to the large number of cesarean sections under spinal anesthesia, finding a simple and safe pre-delivery SEDATION technique which provides satisfaction for mothers with no over SEDATION and amnesia seems to be necessary. However, there is not enough evidence about the best choice of drug for this purpose. In the present study we aimed in evaluating the clinical effects of different concentrations (0. 25, 0. 5, 0. 75mg/kg) of thiopental Na bolus for the mother’ s satisfaction in cesarean section under spinal anesthesia. Methods: Two hundred and forty term singleton pregnant women with normal ASA physical status were scheduled for an elective term cesarean delivery under spinal anesthesia and allocated into four groups. Groups I, II, III received 0. 25, 0. 5, 0. 75mg/kg/IV of Thiopental Na respectively and group IV as the control group received 1. 5cc of sterile water, 1 min after spinal anesthesia. The level of CONSCIOUSness with observer assessment of alertness/SEDATION score (OAA/S) and mother’ s satisfaction was considered as primary outcomes. Results: The level of mothers’ satisfaction in group II was significantly higher than other groups without any over SEDATION (P<0. 001) and no adverse effect on their verbal contact was observed and they could easily communicate. All women could remember their infants. All babies were healthy with no complications and the Apgar scores were the same in all studied groups. Conclusion: Based on the results of the present study and with comparison of different concenfrations and side effects indicates pre-delivery CONSCIOUS SEDATION with 0. 5 mg/kg/IV of Thiopental Na could be a safe and appropriate technique for SEDATION in cesarean sections surgery under spinal anesthesia.