The safe sedation of patients for diagnostic or therapeutic procedures requires a combination of properly trained physicians and suitable facilities.Additionally,appropriate selection and preparation of patients,suita...The safe sedation of patients for diagnostic or therapeutic procedures requires a combination of properly trained physicians and suitable facilities.Additionally,appropriate selection and preparation of patients,suitable sedative technique,application of drugs,adequate monitoring,and proper recovery of patients is essential.The goal of procedural sedation is the safe and effective control of pain and anxiety as well as to provide an appropriate degree of memory loss or decreased awareness.Sedation practices for gastrointestinal endoscopy(GIE) vary widely.The majority of GIE patients are ambulatory cases.Most of this procedure requires a short time.So,short acting,rapid onset drugs with little adverse effects and improved safety profiles are commonly used.The present review focuses on commonly used regimens and monitoring practices in GIE sedation.This article is to discuss the decision making process used to determine appropriate pre-sedation assessment,monitoring,drug selection,dose of sedative agents,sedation endpoint and post-sedation care.It also reviews the current status of sedation and monitoring for GIE procedures in Thailand.展开更多
A three-dimensional suspended sediment model （SED） developed by the present authors is coupled with the combinatorial model of COHERENS （Luyten et al., 1999） （the three-dimensional coupled hydrodynamical-ecologic...A three-dimensional suspended sediment model （SED） developed by the present authors is coupled with the combinatorial model of COHERENS （Luyten et al., 1999） （the three-dimensional coupled hydrodynamical-ecological model for Regional and Shelf Seas） and SWAN （Holthuijsen et al., 2004） （the third generation wave model）. SWAN is regarded as a subroutine of COHERENS and gets time- and space-varying current velocity and surface elevation from COHERENS. COHERENS gets time- and space- varying wave relevant parameters provided by SWAN. Effects of wave on current are applied in bottom shear stress, wave-induced depth-dependent radiation stress and surface drag coefficient calculation. At the same time, the damping function of suspended sediment on turbulence is introduced into COHERENS. So the sediment model SED has feedback on circulation model COHERENS. The SED obtains current associated parameters from COHERENS. Then a coupled hydrodynamic-sediment model COHERENS-SED being able to account for interaction between wave and current is obtained. COHERENS-SED is adopted to simulate three-dimensional suspended sediment transport in the Huanghe River delta. In terms of simulation results, there is obvious difference between top and bottom layer of wave-induced longshore current. The values of time series of sediment concentration gotten by COHERENS-SED have, generally, an accepted agreement extent with measurement. Significant wave heights and wave periods obtained by COHERENS-SED show that wave simulation case with currentts effect can give better agreement extent with measurement than case without current＇s effect. In the meantime, suspended sediment concentration distributing rule obtained by COHERENS-SED is similar to former researches and measurement.展开更多
A three-dimensional wave radiation stress is introduced into the hydrodynamic sediment coupled model COHERENS-SED, which has been developed through introducing wave-enhanced bottom shear stress, wave dependent surface...A three-dimensional wave radiation stress is introduced into the hydrodynamic sediment coupled model COHERENS-SED, which has been developed through introducing wave-enhanced bottom shear stress, wave dependent surface drag coefficient, wave-induced surface mixing, SWAN, damping function of sediment on turbulence, sediment model and depth-dependent wave radiation stress to COHERENS. The COHERENS-SED is adopted to study the effects induced by wave-induced three-dimensional longshore current on suspended sediment spreading of the Huanghe River （Yellow River） mouth. Several different cases divided by setting different wave parameters of inputting boundary waves are carried out. The modeling results agree with measurement data. In terms of simulation results, it is easy to know that three-dimensional wave radiation stress plays an obvious role when inputting boundary wave height is stronger than 3 m. Moreover, wave direction also affects the sediment spreading rules of the mouth strongly too.展开更多
Sedation and analgesia comprise an important element of unpleasant and often prolonged endoscopic retrograde cholangiopacreatography (ERCP), contributing, however, to better patient tolerance and compliance and to the...Sedation and analgesia comprise an important element of unpleasant and often prolonged endoscopic retrograde cholangiopacreatography (ERCP), contributing, however, to better patient tolerance and compliance and to the reduction of injuries during the procedure due to inappropriate co-operation. Although most of the studies used a moderate level of sedation, the literature has revealed the superiority of deep sedation and general anesthesia in performing ERCP. The anes- the siol ogist's presence is mandatory in these cases. A mod erate sedation level for ERCP seems to be adeq uate for octogenarians. The sedative agent of choice for sedation in ERCP seems to be propofol due to its fast distribution and fast elimination time without a cumulative effect after infusion, resulting in shorter recovery time. Its therapeutic spectrum, however, is much narrower and therefore careful monitoring is much more de manding in order to differentiate between moder ate, deep sedation and general anesthesia. Apart from conventional monitoring, capnography and Bispectral index or Narcot rend monitoring of the level of sedation seem to be useful in titrating sedatives in ERCP.展开更多
文摘The safe sedation of patients for diagnostic or therapeutic procedures requires a combination of properly trained physicians and suitable facilities.Additionally,appropriate selection and preparation of patients,suitable sedative technique,application of drugs,adequate monitoring,and proper recovery of patients is essential.The goal of procedural sedation is the safe and effective control of pain and anxiety as well as to provide an appropriate degree of memory loss or decreased awareness.Sedation practices for gastrointestinal endoscopy(GIE) vary widely.The majority of GIE patients are ambulatory cases.Most of this procedure requires a short time.So,short acting,rapid onset drugs with little adverse effects and improved safety profiles are commonly used.The present review focuses on commonly used regimens and monitoring practices in GIE sedation.This article is to discuss the decision making process used to determine appropriate pre-sedation assessment,monitoring,drug selection,dose of sedative agents,sedation endpoint and post-sedation care.It also reviews the current status of sedation and monitoring for GIE procedures in Thailand.
基金supported by 973 Project "Land-Sea interaction and its effect on the environment in the typical estuaries and offishore areas of China" under contract No. 2002CB412408Natural Science Foundation of Shandong Provinceunder contract No. Q2007E05
文摘A three-dimensional suspended sediment model （SED） developed by the present authors is coupled with the combinatorial model of COHERENS （Luyten et al., 1999） （the three-dimensional coupled hydrodynamical-ecological model for Regional and Shelf Seas） and SWAN （Holthuijsen et al., 2004） （the third generation wave model）. SWAN is regarded as a subroutine of COHERENS and gets time- and space-varying current velocity and surface elevation from COHERENS. COHERENS gets time- and space- varying wave relevant parameters provided by SWAN. Effects of wave on current are applied in bottom shear stress, wave-induced depth-dependent radiation stress and surface drag coefficient calculation. At the same time, the damping function of suspended sediment on turbulence is introduced into COHERENS. So the sediment model SED has feedback on circulation model COHERENS. The SED obtains current associated parameters from COHERENS. Then a coupled hydrodynamic-sediment model COHERENS-SED being able to account for interaction between wave and current is obtained. COHERENS-SED is adopted to simulate three-dimensional suspended sediment transport in the Huanghe River delta. In terms of simulation results, there is obvious difference between top and bottom layer of wave-induced longshore current. The values of time series of sediment concentration gotten by COHERENS-SED have, generally, an accepted agreement extent with measurement. Significant wave heights and wave periods obtained by COHERENS-SED show that wave simulation case with currentts effect can give better agreement extent with measurement than case without current＇s effect. In the meantime, suspended sediment concentration distributing rule obtained by COHERENS-SED is similar to former researches and measurement.
基金The Natural Science Foundation Study on Mechanics of Non-breaking wave-induced vertical mixing on Pollutant Dispersion of Huanghe River Estuary under contract No.51179178Project from Establishment of Fine Sediment Transport Modeling System for the Yellow Sea+1 种基金which is a sub-project of Development of Operational Oceanographic systemScience & Technology Development Project of Qingdao under contract No.09-1-3-18-jch
文摘A three-dimensional wave radiation stress is introduced into the hydrodynamic sediment coupled model COHERENS-SED, which has been developed through introducing wave-enhanced bottom shear stress, wave dependent surface drag coefficient, wave-induced surface mixing, SWAN, damping function of sediment on turbulence, sediment model and depth-dependent wave radiation stress to COHERENS. The COHERENS-SED is adopted to study the effects induced by wave-induced three-dimensional longshore current on suspended sediment spreading of the Huanghe River （Yellow River） mouth. Several different cases divided by setting different wave parameters of inputting boundary waves are carried out. The modeling results agree with measurement data. In terms of simulation results, it is easy to know that three-dimensional wave radiation stress plays an obvious role when inputting boundary wave height is stronger than 3 m. Moreover, wave direction also affects the sediment spreading rules of the mouth strongly too.
文摘Sedation and analgesia comprise an important element of unpleasant and often prolonged endoscopic retrograde cholangiopacreatography (ERCP), contributing, however, to better patient tolerance and compliance and to the reduction of injuries during the procedure due to inappropriate co-operation. Although most of the studies used a moderate level of sedation, the literature has revealed the superiority of deep sedation and general anesthesia in performing ERCP. The anes- the siol ogist's presence is mandatory in these cases. A mod erate sedation level for ERCP seems to be adeq uate for octogenarians. The sedative agent of choice for sedation in ERCP seems to be propofol due to its fast distribution and fast elimination time without a cumulative effect after infusion, resulting in shorter recovery time. Its therapeutic spectrum, however, is much narrower and therefore careful monitoring is much more de manding in order to differentiate between moder ate, deep sedation and general anesthesia. Apart from conventional monitoring, capnography and Bispectral index or Narcot rend monitoring of the level of sedation seem to be useful in titrating sedatives in ERCP.
