• atrial fibrillation
• catheter ablation
• cryoballoon catheter
• pharmacoeconomy
• pulmonary vein isolation

• Ambulatory care
• Colonoscopy
• Conscious sedation
• Endoscopy
• Risk assessment
• Risk factors

• Female
• Humans
• Male
• Analgesia/methods
• Analgesia/adverse effects
• Capnography/methods
• Conscious Sedation/methods
• Conscious Sedation/adverse effects
• Early Diagnosis
• Monitoring, Physiologic/methods
• Oximetry/methods
• Respiratory Insufficiency/diagnosis
• Gastrointestinal Tract/surgery

• deep
• endoscopy
• gastroenterology
• quality of care
• sedation

• COVID-19
• adverse events
• anaesthesia
• complications
• gastrointestinal
• legal
• midazolam
• propofol
• sedation

• Female
• Pregnancy
• Humans
• Brazil
• Anticoagulants/therapeutic use
• Cost-Benefit Analysis
• Venous Thromboembolism/prevention & control
• Heparin, Low-Molecular-Weight/therapeutic use

• Cardinal Health

• bronchoscopies
• colonoscopies
• cost analysis
• micro-costing
• midazolam
• procedural sedation
• propofol
• remimazolam

Capnography has been associated with a reduced incidence of events related to respiratory compromise during procedural sedation.

A prospective service evaluation was conducted at a large United Kingdom (UK) teaching hospital to assess the impact of capnography on patient safety within four speciality services: bronchoscopy, endoscopy, interventional cardiology, and interventional radiology. Events were defined as provided by the World Society of Intravenous Anaesthesia. One thousand four hundred one patients were enrolled in the evaluation, with 666 patients before and 735 after implementation of capnography. Data was entered as a convenience sample on site in an offline data-collection tool. Results were assessed for the relative reduction in the incidence and resulting adjusted odds ratio for the combined incidence of oxygen desaturation (75–90% for <60s), severe oxygen desaturation (<75% at any time) or prolonged oxygen desaturation (<90% for >60s), bradycardia (>25% from baseline) and tachycardia (>25% from baseline). The adjusted odds ratio was controlled for both procedure and patient characteristics.

After implementation of capnography, a significant reduction (43.2%, p ≤ 0.05) in adverse events was observed: 147 adverse events occurred during 666 procedures without capnography compared with 93 adverse events that occurred during 735 procedures with capnography. The adjusted odds ratio for the occurrence of the target adverse events was 0.57 (95% CI: 0.42–0.77). Multivariable linear regression indicated that capnography was a significant predictor (p 0.001) of reduced adverse events.

These results suggest improved patient safety following capnography implementation.

• Medtronic

The experience of undergoing magnetic resonance imaging (MRI) can be anxiety provoking, particularly for pediatric patients and their families. Alternative methods to improve success and experiences without the use of sedation are needed.

This study aims to compare the effectiveness of a virtual reality (VR)—based simulation app (VR-MRI) with a standard preparatory manual (SPM) and a hospital-based Child Life Program (CLP) on success and anxiety during a simulated pediatric MRI scan. Our secondary aim is to compare caregivers’ reported anxiety, procedural data, caregiver usability, child satisfaction, and fun.

This unblinded, randomized, triple-arm clinical trial involved 92 children aged 4-13 years and their caregivers. Recruitment was conducted through posters, public libraries, community centers, and social media. At a 2-hour session, participants were instructed to prepare for a simulated MRI head scan using one of three randomly assigned preparation materials: the VR-MRI app, SPM, or the CLP. Data were collected before preparation, during a simulated MRI head scan, and after the simulated scan. The primary outcomes were the success of the simulated MRI scan (MoTrak head motion tracking system), and child-reported anxiety (Venham picture test). We secondarily measured caregivers’ reported anxiety (short State-Trait Anxiety Inventory), procedural data (minutes), usability (Usefulness, Satisfaction, and Ease of Use Questionnaire), and child-reported satisfaction and fun (visual analog scales).

A total of 84 participants were included in the final analysis (VR-MRI: 30/84, 36%; SPM: 24/84, 29%; and CLP: 30/84, 36%). There were no clinically significant differences between the groups in terms of success during the MRI simulation (P=.27) or the children’s reported anxiety at any timepoint (timepoint 1, P=.99; timepoint 2, P=.008; timepoint 3, P=.10). Caregivers reported being significantly more anxious after preparing with the manual than caregivers in the other 2 groups (P<.001). Child and caregiver anxiety had a significant relationship, increasing together with moderate effect (r₈₄=0.421; P<.001). Participants using VR-MRI took the most time to prepare (P<.001) and participants using the manual took the least time (P<.001). No statistically significant relationships were found between time preparing and time completing the simulated assessment (P=.13). There were no differences found in ease of use (P=.99), ease of learning (P=.48), and usefulness (P=.11) between the groups; however, caregivers reported being significantly more satisfied with the VR-MRI app and CLP than SPM (P<.001). Children reported the most satisfaction with the CLP (P<.001). There were no differences in how much fun the preparation materials were perceived to be (P=.37).

Digital preparation experiences using VR-based media could be a viable solution to improve the success of nonsedated MRI scans, with outcomes comparable with hospital-based in-person preparatory programs. Future research should focus on validating the results in a real MRI setting.

Clinicaltrials.gov NCT03931382; https://clinicaltrials.gov/ct2/show/NCT03931382

• alternatives to sedation
• certified child life specialists
• magnetic resonance imaging procedures
• magnetic resonance imaging simulation
• pediatrics
• preparing children for MRI
• virtual reality

• Williams syndrome
• adverse cardiac events
• blood pressure
• general anesthesia

• 22q11.2 deletion syndrome
• Congenital athymia
• I
• I1
• I10
• I19
• complete DiGeorge syndrome
• cost of care
• cultured thymic tissue
• economic burden
• healthcare resource utilization
• real-world evidence
• thymic aplasia

• Child
• Child, Preschool
• Cost of Illness
• Health Care Costs
• Hospitalization
• Humans
• Patient Acceptance of Health Care
• United States

• Adult
• Aged
• Anesthesia, General/methods
• Anesthetics, Intravenous/administration & dosage
• Dose-Response Relationship, Drug
• Female
• Follow-Up Studies
• Humans
• Male
• Massachusetts/epidemiology
• Middle Aged
• Neoplasms/mortality
• Postoperative Complications/mortality
• Postoperative Complications/prevention & control
• Propofol/administration & dosage
• Retrospective Studies
• Survival Analysis

As a new generation antihistamine, fexofenadine has been widely used in allergic diseases. However, there is still a lack of collective evidence regarding the antihistamine effects and safety profiles of fexofenadine relative to other antihistamine drugs and placebo. Therefore, we aimed to systematically evaluate the antihistamine effects and safety of fexofenadine.

An electronic literature search of randomized controlled trials (RCTs) was performed using Embase, Cochrane and PubMed from establishment to January 1st, 2018. RCTs comparing the antihistamine effects or safety (adverse events, sedative effects, and cognitive/psychomotor function) of fexofenadine with either other antihistamines or placebo for healthy subjects and patients with allergy were selected.

Fifty-one studies of 14,551 participants met the inclusion criteria. When compared with the first-generation antihistamines, fexofenadine produced significantly lower adverse events frequency (OR = 0.446; 95% CI: 0.214 to 0.929, P = 0.031), significantly lower sedative effects frequency (OR = 0.265; 95% CI: 0.072 to 0.976, P = 0.046) and significantly less change of all cognitive/psychomotor function. When compared with the second-generation antihistamines, fexofenadine produced significantly marginal sedative effects (OR = 0.59; 95% CI, 0.38 to 0.93; P = 0.02) and significantly less change of most of the cognitive/psychomotor function. When compared with placebo, fexofenadine produced more significant antihistamine effects.

Fexofenadine has a positive antihistamine effect, which is probably no worse than the second-generation antihistamines. Fexofenadine probably has a favorable safety profile, which is more likely better than that of the first-generation antihistamines. There is lack of data to support that fexofenadine has a better overall safety profile compared to the second-generation antihistamines, however, some presently available evidence on sedative effects and certain aspects of cognitive/psychomotor function favors fexofenadine. Therefore, fexofenadine may be worthy of recommendation for safety related workers.

• Antihistamines
• Fexofenadine
• Meta-analysis
• Randomized controlled trial
• Systematic review