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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.
To induce general anesthesia, propofol is the drug used almost exclusively, having largely replaced sodium thiopental. [13]It is often administered as part of an anesthesia maintenance technique called total intravenous anesthesia, using either manually programmed infusion pumps or computer-controlled infusion pumps in a process called target controlled infusion (TCI).
Propofol (di-isopropyl phenol) was synthesized by Glen and colleagues in the early 1970s, [7] but its first formulations were temporarily withdrawn due to a number of adverse reactions during clinical studies. [1] In 1983, a lipid emulsion formulation of propofol was available, which carried great potential during clinical trials. [8]
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.
Ciprofol is used for the intravenous induction of general anesthesia. [1] [2] As of 2023, it is still an investigational drug.Thus far, it has been found to be efficacious as a general anesthetic in patients undergoing gynecological surgery [4] [8] and kidney transplantation, [16] as well as for endoscopic procedures such as bronchoscopy, [12] [17] esophagogastroduodenoscopy and colonoscopy.
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.
Dexmedetomidine can also be used for procedural sedation such as during colonoscopy. [18] It can be used as an adjunct with other sedatives like benzodiazepines, opioids, and propofol to enhance sedation and help maintain hemodynamic stability by decreasing the requirement of other sedatives.