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Parenteral Anesthetics: Overview

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.

Stages of General Anesthesia

Stages of General Anesthesia

Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...

Inhalational Anesthetics: Overview

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...

General Anesthesia: Overview

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...

Local Anesthetics: Clinical Application as Epidural Anesthesia

Local Anesthetics: Clinical Application as Epidural Anesthesia

Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...

Local Anesthetics: Clinical Application as Spinal Anesthesia

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...

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Updated: Jul 3, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

Pediatric sedation/anesthesia outside the operating room.

David Gozal¹, Yaacov Gozal

¹Department of Anesthesiology and Critical Care Medicine, Hadassah University Hospital, Israel.

Current Opinion in Anaesthesiology

|July 29, 2008

Summary

Pediatric procedural sedation is increasingly vital, with evolving best practices for safety and efficiency. Key debates include fasting guidelines, monitoring tools like bispectral index, and the role of specific anesthetic agents.

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Guidelines for Elective Pediatric Fiberoptic Intubation

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Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery

Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery

Published on: June 2, 2022

Area of Science:

Pediatric Anesthesiology
Procedural Sedation
Medical Education

Background:

The demand for pediatric procedures outside the operating room is rapidly increasing, challenging anesthesia service capacity.
The number of children requiring sedation in non-operating room settings is approaching that of operating room anesthesia.
This evolving field presents significant challenges and ongoing controversies.

Purpose of the Study:

To address major issues and controversies in pediatric procedural sedation.
To review current debates and emerging trends in the field.
To highlight the importance of safety and efficiency in non-operating room anesthesia.

Main Methods:

Review of current literature and expert discussions on pediatric sedation.
Analysis of recent findings and controversies in the field.
Examination of emerging technologies and training standards.

Main Results:

Pediatric sedation remains a complex area with active debates among experts.
Key issues include fasting protocols (nil per os status), utility of bispectral index monitoring, simulation-based training standards, and the use of specific agents like propofol, dexmedetomidine, and etomidate.
The recent creation of the Society of Pediatric Sedation reflects the field's growing importance.

Conclusions:

A standardized approach encompassing preparation, assessment, fasting, and sedation planning is crucial for safety and efficiency.
Sedation is a continuum, necessitating careful monitoring to prevent unintended progression to general anesthesia.
Advanced monitoring modalities, including end-tidal CO2 and bispectral index, enhance the safety of procedural sedation and analgesia.