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Propofol [6] is a non-barbiturate derivative that is thought to act by stimulating inhibitory GABA receptors and blocking excitatory NMDA receptors. It takes 40 seconds for the effects of propofol to kick in, and effects last six minutes. [3] Propofol has both sedative and amnestic effects, but provides no analgesia.
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]
When used for IV sedation, a single dose of propofol typically wears off within minutes. Onset is rapid, in as little as 15–30 seconds. [5] Propofol is versatile; the drug can be given for short or prolonged sedation, as well as for general anesthesia. Its use is not associated with nausea as is often seen with opioid medications.
Sedation scales are used in medical situations in conjunction with a medical history in assessing the applicable degree of sedation in patients in order to avoid under-sedation (the patient risks experiencing pain or distress) and over-sedation (the patient risks side effects such as suppression of breathing, which might lead to death).
Propofol for sedation for intubation; Switching from oxygen to a mixture of oxygen and inhalational anesthetic once intubation is complete; Laryngoscopy and intubation are both very stimulating. The process of induction blunts the response to these manoeuvres while simultaneously inducing a near-coma state to prevent awareness.
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phenol) was synthesized by Glen and colleagues in the early 1970s, [7] but its first formulations were temporarily withdrawn due to a number of adverse reactions during clinical studies.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]
Certain procedures, such as endoscopies or colonoscopies, are managed a technique called conscious sedation or monitored anesthesia care. These cases are performed with regional anesthetics and a "twilight sleep" achieved through sedation with propofol and analgesics, and patients may remember perioperative events. [4]
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.