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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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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: 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.
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Sedatives and Hypnotics Drugs: Barbiturates01:20

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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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Skeletal Muscle Relaxants: Therapeutic Uses01:31

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Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
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Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
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Palliative sedation for intolerable suffering.

Marco Maltoni1, Emanuela Scarpi, Oriana Nanni

  • 1aPalliative Care Unit bUnit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.

Current Opinion in Oncology
|May 15, 2014
PubMed
Summary
This summary is machine-generated.

Palliative sedation is a medical procedure for refractory symptoms in terminally ill patients, not intended to hasten death. It should be used judiciously by experienced teams to relieve suffering, ensuring ethical end-of-life care.

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Area of Science:

  • Palliative Care
  • Oncology
  • Medical Ethics

Background:

  • Palliative sedation is a specialized medical intervention.
  • It addresses refractory symptoms in advanced cancer patients when other treatments fail.
  • Understanding its appropriate application is crucial in end-of-life care.

Purpose of the Study:

  • To provide an updated review of palliative sedation in palliative and end-of-life care.
  • To clarify the definition and scope of palliative sedation.
  • To emphasize its role in managing intractable symptoms.

Main Methods:

  • Review of current literature and clinical guidelines on palliative sedation.
  • Analysis of ethical and clinical considerations.
  • Discussion of patient-centered approaches and team collaboration.

Main Results:

  • Palliative sedation, when used proportionately (proportionate palliative sedation, PPS), is an individualized procedure to relieve refractory symptoms in terminally ill patients.
  • It is distinct from end-of-life decisions aimed at hastening death and has not been shown to negatively impact survival.
  • The procedure is intended solely for symptom relief, not to shorten life.

Conclusions:

  • Palliative sedation must be reserved for refractory suffering, as determined by the patient and a palliative care team.
  • Maintaining its legitimacy requires strict adherence to its intended purpose, avoiding association with other end-of-life decisions.
  • Close collaboration between oncologists and palliative care physicians is essential for appropriate implementation.