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Etomidate [3] (USAN, INN, BAN; marketed as Amidate) is a short-acting intravenous anaesthetic agent used for the induction of general anaesthesia and sedation [4] for short procedures such as reduction of dislocated joints, tracheal intubation, cardioversion and electroconvulsive therapy.
Although propofol is widely used in the adult ICU setting, the side effects associated with medication seem to be more concerning in children. In the 1990s, multiple reported deaths of children in ICUs associated with propofol sedation prompted the FDA to issue a warning. [61] As a respiratory depressant, propofol frequently produces apnea.
In 1983, a lipid emulsion formulation of propofol was available, which carried great potential during clinical trials. [8] It was licensed for use in Europe in 1986 and received FDA approval in the US in 1989. [1] Propofol is now used worldwide with a well-defined pharmacological profile for a variety of medical uses.
Procedural sedation and analgesia (PSA) is a technique in which a sedating/dissociative medication is given, usually along with an analgesic medication, in order to perform non-surgical procedures on a patient. The overall goal is to induce a decreased level of consciousness while maintaining the patient's ability to breathe on their own.
This level, called moderate sedation/analgesia or conscious sedation, causes a drug induced depression of consciousness during which the patient responds purposefully to verbal commands, either alone or accompanied with light physical stimulation. Breathing tubes are not required for this type of anesthesia. This is twilight anesthesia. [2]
The American Society of Anesthesiologists defines the continuum of sedation as follows: [9] Minimal sedation – normal response to verbal stimuli. Moderate sedation – purposeful response to verbal/tactile stimulation. (This is usually referred to as "conscious sedation") Deep sedation – purposeful response to repeated or painful stimulation.
Fospropofol is metabolized in the liver by alkaline phosphatases to propofol, formaldehyde, and phosphate.The hepatic metabolism of this prodrug to an active metabolite means that peak plasma levels of propofol after the administration of a bolus of fospropofol are lower than for an equipotent dose of propofol and also that its clinical effect is more sustained.
The purpose of anesthesia can be distilled down to three basic goals or endpoints: [2]: 236 hypnosis (a temporary loss of consciousness and with it a loss of memory.In a pharmacological context, the word hypnosis usually has this technical meaning, in contrast to its more familiar lay or psychological meaning of an altered state of consciousness not necessarily caused by drugs—see hypnosis).