Joo J, et al. J Korean Med Sci. 2016 Jun;31(6):989-996. http://dx.doi.org/10.3346/jkms.2016.31.6.989

Safe and effective sedation depends on various factors, such as the choice of sedatives, sedation techniques used, experience of the sedation provider, degree of sedation-related education and training, equipment and healthcare worker availability, the patient’s underlying diseases, and the procedure being performed. The purpose of these evidence-based multidisciplinary clinical practice guidelines is to ensure the safety and efficacy of sedation, thereby contributing to patient safety and ultimately improving public health. These clinical practice guidelines comprise 15 key questions covering various topics related to the following: the sedation providers; medications and equipment available; appropriate patient selection; anesthesiologist referrals for high-risk patients; pre-sedation fasting; comparison of representative drugs used in adult and pediatric patients; respiratory system, cardiovascular system, and sedation depth monitoring during sedation; management of respiratory complications during pediatric sedation; and discharge criteria. The recommendations in these clinical practice guidelines were systematically developed to assist providers and patients in sedation-related decision making for diagnostic and therapeutic examinations or procedures. Depending on the characteristics of primary, secondary, and tertiary care institutions as well as the clinical needs and limitations, sedation providers at each medical institution may choose to apply the recommendations as they are, modify them appropriately, or reject them completely.

Perioperative neurocognitive disorders (PNDs), including postoperative delirium, delayed neurocognitive recovery, and long-term postoperative neurocognitive disorders, present significant challenges for older patients undergoing surgery. Inflammation is a protective mechanism triggered in response to external pathogens or cellular damage. Historically, the central nervous system (CNS) was considered immunoprivileged due to the presence of the blood–brain barrier (BBB), which serves as a physical barrier preventing systemic inflammatory changes from influencing the CNS. However, aseptic surgical trauma is now recognized to induce localized inflammation at the surgical site, further exacerbated by the release of peripheral pro-inflammatory cytokines, which can compromise BBB integrity. This breakdown of the BBB facilitates the activation of microglia, initiating a cascade of neuroinflammatory responses that may contribute to the onset of PNDs. This review explores the mechanisms underlying neuroinflammation, with a particular focus on the pivotal role of cytokines in the pathogenesis of PNDs.

Background: Children undergoing moderate to deep sedation for diagnostic and therapeutic procedures are susceptible to hypoxemia because of their anatomical and physiologic features. However, optimal oxygen administration methods are unclear. This study aimed to evaluate the efficacy of oxygen supplementation during sedation using either low-flow or high-flow nasal cannula. Methods: This prospective, multicenter randomized controlled trial included children (younger than 18 yr) undergoing moderate to deep sedation. The participants were randomly assigned to three groups as follows: (1) control (no oxygen), (2) low-flow (2 to 6 l/min oxygen via nasal cannula), and (3) high-flow (oxygen administration via high-flow nasal cannula with a flow rate of 2 l/kg and 50% fraction of inspired oxygen). The primary outcome was hypoxemia incidence (saturation of peripheral oxygen, oxygen saturation measured by pulse oximetry 95% or less for more than 5 s). Secondary outcomes included oxygen saturation measured by pulse oximetry less than 90%, rescue interventions, and sedation-related complications. Between-group differences were compared using a logistic regression model. Results: A total of 253 participants were randomized, with 250 completing the study. Hypoxemia occurred in 27.6% of participants in the control group, 7.2% in the low-flow group, and 1.2% in the high-flow group (P < 0.001). The odds of hypoxemia in the low-flow and high-flow groups were lower than that in the control group (odds ratio [OR], 0.184; 95% CI, 0.067 to 0.503; P = 0.001 for low-flow; OR, 0.026; 95% CI, 0.003 to 0.207; P < 0.001 for high-flow). However, hypoxemia incidence of the high-flow group was not statistically lower than the low-flow group (OR, 0.143; 95% CI, 0.017 to 1.245; P = 0.078). Rescue interventions were conducted more frequently in the control group (52.9%) than in the low-flow (10.8%) and high-flow (3.6%) groups (P < 0.001). Sedation-related complications such as desaturation and apnea were lower in the low-flow and high-flow groups than in the control group (P < 0.001). Conclusions: Routine oxygen supplementation prevents hypoxemia during pediatric moderate and deep sedation. Low-flow oxygen can be a reasonable choice as it effectively reduces hypoxemia while being more cost-effective and widely accessible than high-flow oxygen.

Purpose: During general anesthesia, human body easily reaches a hypothermic state, which is mainly caused by heat redistribution. Most studies suggested that humidified heated breathing circuits (HHBC) have little influence on maintenance of the core temperature during early phase of anesthesia. This study was aimed at examining heat preservation effect with HHBC in case of undergoing surgery with less exposure of surgical fields and short surgical duration.