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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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Inhalational Anesthetics: Overview01:20

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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...
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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.
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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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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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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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Ketamine in Critically Ill Patients: Use, Perceptions, and Potential Barriers.

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Critical care practitioners are comfortable using ketamine for various procedures but inconsistently apply its use. Barriers include adverse effects and lack of routine use, indicating a need for targeted education on appropriate ketamine administration.

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Area of Science:

  • Critical care medicine
  • Pharmacology

Background:

  • Ketamine is an anesthetic with analgesic and sedative properties.
  • Its use in acute and critically ill patients is increasing.
  • Understanding practitioner use and barriers is crucial for optimizing patient care.

Purpose of the Study:

  • To evaluate practitioner use of ketamine in acutely and critically ill patients.
  • To identify barriers to ketamine use.
  • To compare users and non-users of ketamine.

Main Methods:

  • An online survey was distributed to members of the Society of Critical Care Medicine (SCCM).
  • The survey queried self-reported practices, beliefs, and barriers regarding ketamine use.
  • 341 responses were analyzed.

Main Results:

  • Most clinicians were comfortable using ketamine for intubation, analgesia, and sedation.
  • Fewer clinicians were comfortable using ketamine for alcohol withdrawal or opioid detoxification.
  • Common barriers included adverse effects, lack of routine use by peers, and insufficient evidence or familiarity.

Conclusions:

  • While critical care practitioners are generally comfortable with ketamine, significant practice inconsistencies exist regarding dosing and indications.
  • Barriers such as adverse effects and peer non-use hinder optimal ketamine application.
  • Targeted educational interventions are needed to improve appropriate ketamine use in critical care settings.