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Related Concept Videos

Stages of General Anesthesia01:22

Stages of General Anesthesia

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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...
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Sedatives and Hypnotics: Overview01:23

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Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
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General Anesthesia: Overview01:24

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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...
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Parenteral Anesthetics: Overview01:24

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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.
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Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

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Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
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Sedatives and Hypnotics Drugs: Barbiturates01:20

Sedatives and Hypnotics Drugs: Barbiturates

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Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A...
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Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention
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[General practitioner and palliative sedation].

Bart Schweitzer1

  • 1VUmc, afd. Huisartsgeneeskunde en Ouderengeneeskunde, Amsterdam.

Nederlands Tijdschrift Voor Geneeskunde
|January 23, 2014
PubMed
Summary

Palliative sedation in general practice is not increasing, and GPs distinguish it from euthanasia. Patient involvement varies by condition, highlighting the need for earlier palliative care identification.

Area of Science:

  • Palliative Care
  • General Practice
  • Medical Ethics

Background:

  • Concerns regarding palliative sedation in Dutch general practice have been raised in national media.
  • Evidence suggests no significant increase in the incidence of palliative sedation.
  • General practitioners (GPs) demonstrate awareness of the distinction between palliative sedation and euthanasia.

Purpose of the Study:

  • To assess the current practice of palliative sedation in Dutch general practice.
  • To investigate the incidence and justification of palliative sedation.
  • To evaluate patient involvement in decisions regarding palliative sedation.

Main Methods:

  • Analysis of recent publications and data on palliative sedation in Dutch general practice.
  • Review of cases where palliative sedation was performed, including pending euthanasia requests.

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  • Assessment of patient involvement in decision-making for cancer and non-cancer patients.

    • Main Results:

    • No significant increase in the incidence of palliative sedation was observed.
    • Euthanasia requests were pending in 20.8% of palliative sedation cases, with clear GP justifications.
    • Patient involvement was high in cancer cases but lower in non-cancer conditions.
    • GP practices align with the Dutch National Guideline on Palliative Sedation.

    Conclusions:

    • Palliative sedation practice in Dutch general practice is stable and adheres to national guidelines.
    • GPs maintain a clear distinction between palliative sedation and euthanasia.
    • Improved identification of patients needing palliative care, especially in non-cancer conditions, is warranted.