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Alisa B Goldberg - One of the best experts on this subject based on the ideXlab platform.
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a randomized comparison of Intravenous Sedation using a dosing algorithm compared to standard care during first trimester surgical abortion
Contraception, 2018Co-Authors: Kari P Braaten, Richard D Urman, Rie Maurer, Jennifer Fortin, Alisa B GoldbergAbstract:Abstract Objective The objective was to compare the safety and efficacy of an algorithm for abortion Intravenous Sedation dosing (AAID) to standard dosing during first-trimester surgical abortion. Study design This was a randomized, single-blinded, controlled trial in which women undergoing first-trimester surgical abortion received fentanyl and midazolam dosed per either an algorithm or clinic standard. Patient-level factors including weight, airway risk, anxiety, and drug and alcohol use determined AAID doses. The primary outcome was pain with suction curettage measured immediately on a 21-point verbal numerical rating scale ranging from 0 to 100. Secondary outcomes included pain with cervical dilation and postprocedure, intraoperative pain as recalled postprocedure, need for additional doses of medication, oxygen saturation Results We enrolled 196 women and randomized 98 to the AAID and 98 to standard care. Baseline factors were similar between groups. Median intraoperative pain scores did not differ between groups when measured immediately (47.5 vs. 50, p=.81) or on recall (30 in both arms, p=.68). There were no significant differences in other secondary outcomes. Women with a body mass index (BMI) 30–35 trended toward improved pain control with the algorithm (60 vs. 27.5, p=.07). Conclusions Intravenous Sedation determined by an algorithm did not produce differences in pain scores in a setting with highly experienced providers. Implications An Intravenous Sedation algorithm did not demonstrate significant benefit for the general population of surgical abortion patients. Providers with less experience titrating Intravenous Sedation might find it a helpful tool to guide Sedation dosing. A possible benefit in obese patients warrants further study.
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moderate Intravenous Sedation for first trimester surgical abortion a comparison of adverse outcomes between obese and normal weight women
Contraception, 2018Co-Authors: Gillian Horwitz, Alisa B Goldberg, Kari P Braaten, Rie Maurer, Jennifer Fortin, Danielle RoncariAbstract:Abstract Objective To determine if obese women experience increased rates of adverse outcomes with moderate Intravenous Sedation during first trimester surgical abortion compared to normal weight women. Study design We performed a retrospective cohort study of all first trimester surgical abortions with moderate Intravenous Sedation at an outpatient facility between September 2010 and June 2015. The primary outcome was supplemental oxygen administration. Secondary outcomes included reversal agent administration, anesthesia-related adverse events, and intraoperative lowest level of consciousness (LLOC). We compared three obesity groups [I (Body Mass Index, BMI=30–34.9), II (BMI=35–39.9), and III (BMI ≥40)] to normal weight women (BMI Results Of 20,381 first trimester surgical abortion procedures, 31 (0.15%) utilized supplemental oxygen, 24 (0.12%) utilized a reversal agent, 40 (0.20%) had a presumed anesthesia-related adverse event and 184 of 19,725 (0.93%) had a documented low intraoperative LLOC. One patient (0.005%) required hospital transfer or hospitalization. Supplemental oxygen administration (obesity versus normal weight: obese I, aOR 0.52, 95% CI 0.12–2.27; II/III, aOR 1.51, 95% CI 0.50–4.54), low intraoperative LLOC, and anesthesia-related adverse events were not associated with obesity. The rate of reversal agent administration was lower among obese I, II and III women combined compared to normal weight women (aOR 0.13, 95% CI 0.02–0.96). Conclusions Adverse outcomes were rare across all BMI categories with no detectable increased risk among obese women compared to normal weight women. Implications With appropriate clinical screening, obese women can safely receive moderate Intravenous Sedation for first trimester surgical abortion in an outpatient clinical setting. Restrictions on moderate Intravenous Sedation based on BMI alone may be unnecessary.
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oral compared with Intravenous Sedation for first trimester surgical abortion a randomized controlled trial
Obstetrics & Gynecology, 2009Co-Authors: Rebecca H Allen, Garrett M Fitzmaurice, Karen L Lifford, Morana Lasic, Alisa B GoldbergAbstract:OBJECTIVE To test the equivalency of oral Sedation and Intravenous Sedation for pain control in first-trimester surgical abortion. METHODS Women undergoing suction curettage at less than 13 weeks of gestation were randomly assigned to oral Sedation, 10 mg of oxycodone and 1 mg of lorazepam, or Intravenous Sedation, 100 micrograms fentanyl and 2 mg midazolam. All patients received 800 mg of preoperative ibuprofen and a 20-mL paracervical block with 1% lidocaine. The primary outcome was intraoperative pain as measured on a 21-point verbal rating scale that had a range from 0 to 100 (0=no pain and 100=worst pain ever) with an equivalence margin for the treatment group comparison of +/-10. RESULTS Of 130 women, 65 were randomly assigned to oral Sedation and 65 to Intravenous Sedation. The groups differed at baseline by age and preoperative ratings of depression, stress, and anxiety; however, when adjusted for these differences, the primary results were unaffected. Mean intraoperative pain scores, controlling for age and preoperative depression, stress, and anxiety, were 61.2 for oral Sedation and 36.3 for Intravenous Sedation (mean difference 24.9, 95% confidence interval 15.9-33.9). Other findings included no difference in postoperative adverse effects and less satisfaction with pain control with oral Sedation compared with Intravenous Sedation. CONCLUSION Oral Sedation, as studied, is not equivalent to Intravenous Sedation for pain control during first-trimester surgical abortion. CLINICAL TRIAL REGISTRATION : ClinicalTrials.gov, www.clinicaltrials.gov, NCT00337792 LEVEL OF EVIDENCE I.
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pain management of first trimester surgical abortion effects of selection of local anesthesia with and without lorazepam or Intravenous Sedation
Contraception, 2006Co-Authors: Rebecca H Allen, Garrett M Fitzmaurice, Karen L Lifford, Divya Kumar, Alisa B GoldbergAbstract:Abstract Objective This prospective observational study compared the effectiveness and acceptability of three commonly used regimens to reduce pain during first-trimester surgical abortion with local anesthesia. Method Women undergoing suction curettage at less than 14 weeks gestation received preoperative ibuprofen and an intraoperative paracervical block. Participants then selected (1) no additional medication (local arm), (2) sublingual lorazepam (0.5 to 1 mg, approximately 20 min preoperatively) or (3) Intravenous Sedation with fentanyl and midazolam (doses from 50 to 125 ��g of fentanyl and 1���2 mg of midazolam). Our primary outcome was intraoperative pain as measured on an 11-point verbal rating scale (0= no pain and 10= worst pain ever ). Results Three-hundred thirty women were enrolled, 105 chose local, 106 opt for lorazepam and 119 picked Intravenous Sedation. Mean pain scores were 6.2 for local, 6.8 for lorazepam and 5.7 for Intravenous Sedation. Increased preoperative anxiety, depression and expected pain and a lower volume of local anesthesia used (10 mL vs. 20 mL) were positive predictors of intraoperative pain. Using multivariable analyses to control for these confounders, plus gestational age, alcohol use and body mass index, Intravenous Sedation was associated with a 0.86 point lower pain score (p Conclusion In women who self-selected their type of anesthesia, Intravenous Sedation using fentanyl and midazolam decreased pain with suction curettage under local anesthesia. Sublingual lorazepam as studied did not decrease pain compared with local anesthesia alone and was associated with more dissatisfaction with pain control.
Jason M Souza - One of the best experts on this subject based on the ideXlab platform.
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a multi institutional propensity score matched comparison of post operative outcomes between general anesthesia and monitored anesthesia care with Intravenous Sedation in umbilical hernia repair
Hernia, 2016Co-Authors: M M Vu, Robert D Galiano, Jason M SouzaAbstract:Purpose Monitored anesthesia care with Intravenous Sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia; however the possibility of overSedation and respiratory distress is a widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes.
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a multi institutional propensity score matched comparison of post operative outcomes between general anesthesia and monitored anesthesia care with Intravenous Sedation in umbilical hernia repair
Hernia, 2016Co-Authors: Robert D Galiano, Jason M Souza, C Du Qin, John Y S KimAbstract:Monitored anesthesia care with Intravenous Sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia; however the possibility of overSedation and respiratory distress is a widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes. A retrospective analysis of anesthesia type in UHR was performed in the National Surgical Quality Improvement Program 2005–2013 database. General anesthesia and MAC/IV groups were propensity-score-matched (PSM) to reduce treatment selection bias. Surgical complications, medical complications, and post-operative hospital stays exceeding 1 day were the primary outcomes of interest. Pre-operative characteristics and post-operative outcomes were compared between the two anesthesia groups using univariate and multivariate statistics. PSM removed all observed differences between the two groups (p > 0.05 for all tracked pre-operative characteristics). MAC/IV cases required fewer post-operative hospital stays exceeding 1 day (3.5 vs 6.3 %, p < 0.001). Univariate analysis showed that overall complication rate did not differ (1.7 vs 1.8 %, p = 0.569), however MAC/IV cases resulted in fewer incidences of septic shock (<0.1 vs 0.1 %, p = 0.016). After multivariate logistic regression, MAC/IV was revealed to yield significantly lower chances of overall medical complications (OR = 0.654, p = 0.046). UHR under MAC/IV causes fewer medical complications and reduces post-operative hospital stays compared to general anesthesia. The implications for surgeons and patients are broad, including improved surgical safety, cost-effective care, and patient satisfaction.
Robert D Galiano - One of the best experts on this subject based on the ideXlab platform.
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a multi institutional propensity score matched comparison of post operative outcomes between general anesthesia and monitored anesthesia care with Intravenous Sedation in umbilical hernia repair
Hernia, 2016Co-Authors: M M Vu, Robert D Galiano, Jason M SouzaAbstract:Purpose Monitored anesthesia care with Intravenous Sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia; however the possibility of overSedation and respiratory distress is a widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes.
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a multi institutional propensity score matched comparison of post operative outcomes between general anesthesia and monitored anesthesia care with Intravenous Sedation in umbilical hernia repair
Hernia, 2016Co-Authors: Robert D Galiano, Jason M Souza, C Du Qin, John Y S KimAbstract:Monitored anesthesia care with Intravenous Sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia; however the possibility of overSedation and respiratory distress is a widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes. A retrospective analysis of anesthesia type in UHR was performed in the National Surgical Quality Improvement Program 2005–2013 database. General anesthesia and MAC/IV groups were propensity-score-matched (PSM) to reduce treatment selection bias. Surgical complications, medical complications, and post-operative hospital stays exceeding 1 day were the primary outcomes of interest. Pre-operative characteristics and post-operative outcomes were compared between the two anesthesia groups using univariate and multivariate statistics. PSM removed all observed differences between the two groups (p > 0.05 for all tracked pre-operative characteristics). MAC/IV cases required fewer post-operative hospital stays exceeding 1 day (3.5 vs 6.3 %, p < 0.001). Univariate analysis showed that overall complication rate did not differ (1.7 vs 1.8 %, p = 0.569), however MAC/IV cases resulted in fewer incidences of septic shock (<0.1 vs 0.1 %, p = 0.016). After multivariate logistic regression, MAC/IV was revealed to yield significantly lower chances of overall medical complications (OR = 0.654, p = 0.046). UHR under MAC/IV causes fewer medical complications and reduces post-operative hospital stays compared to general anesthesia. The implications for surgeons and patients are broad, including improved surgical safety, cost-effective care, and patient satisfaction.
John Y S Kim - One of the best experts on this subject based on the ideXlab platform.
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a multi institutional propensity score matched comparison of post operative outcomes between general anesthesia and monitored anesthesia care with Intravenous Sedation in umbilical hernia repair
Hernia, 2016Co-Authors: Robert D Galiano, Jason M Souza, C Du Qin, John Y S KimAbstract:Monitored anesthesia care with Intravenous Sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia; however the possibility of overSedation and respiratory distress is a widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes. A retrospective analysis of anesthesia type in UHR was performed in the National Surgical Quality Improvement Program 2005–2013 database. General anesthesia and MAC/IV groups were propensity-score-matched (PSM) to reduce treatment selection bias. Surgical complications, medical complications, and post-operative hospital stays exceeding 1 day were the primary outcomes of interest. Pre-operative characteristics and post-operative outcomes were compared between the two anesthesia groups using univariate and multivariate statistics. PSM removed all observed differences between the two groups (p > 0.05 for all tracked pre-operative characteristics). MAC/IV cases required fewer post-operative hospital stays exceeding 1 day (3.5 vs 6.3 %, p < 0.001). Univariate analysis showed that overall complication rate did not differ (1.7 vs 1.8 %, p = 0.569), however MAC/IV cases resulted in fewer incidences of septic shock (<0.1 vs 0.1 %, p = 0.016). After multivariate logistic regression, MAC/IV was revealed to yield significantly lower chances of overall medical complications (OR = 0.654, p = 0.046). UHR under MAC/IV causes fewer medical complications and reduces post-operative hospital stays compared to general anesthesia. The implications for surgeons and patients are broad, including improved surgical safety, cost-effective care, and patient satisfaction.
M M Vu - One of the best experts on this subject based on the ideXlab platform.
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a multi institutional propensity score matched comparison of post operative outcomes between general anesthesia and monitored anesthesia care with Intravenous Sedation in umbilical hernia repair
Hernia, 2016Co-Authors: M M Vu, Robert D Galiano, Jason M SouzaAbstract:Purpose Monitored anesthesia care with Intravenous Sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia; however the possibility of overSedation and respiratory distress is a widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes.
