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Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

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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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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
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Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
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The one-compartment model is a pharmacokinetic tool that models the body as a single, uniform compartment, facilitating the understanding of drug distribution and elimination. This model is particularly beneficial for intravenous (IV) bolus administration, where the drug rapidly circulates throughout the body.
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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Pediatric procedural sedation with propofol using a higher initial bolus dose.

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An initial dose of 2.0 mg/kg propofol for pediatric sedation is safe and effective for various procedures. Physicians reported high satisfaction with this sedation protocol.

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Area of Science:

  • Pediatric Emergency Medicine
  • Anesthesiology
  • Pharmacology

Background:

  • Propofol is a widely used sedative agent.
  • Optimal dosing for pediatric procedural sedation requires further investigation.

Purpose of the Study:

  • To describe propofol doses used for pediatric sedation.
  • To identify procedures performed under propofol sedation.
  • To document physiologic changes and physician satisfaction with propofol.

Main Methods:

  • Prospective observational case series.
  • Physicians completed data collection forms post-sedation.
  • Physiologic changes and satisfaction (100-mm VAS) were recorded.

Main Results:

  • 886 sedation events analyzed.
  • Median initial propofol dose: 2.0 mg/kg; median total dose: 3.6 mg/kg.
  • Most common adverse event: desaturation/hypoxia (7.2%). No deaths or unplanned intubations.

Conclusions:

  • A 2 mg/kg initial propofol dose is well-tolerated and effective for pediatric sedation.
  • High physician satisfaction (median 97 mm) observed.
  • Propofol is suitable for a broad spectrum of pediatric procedures.