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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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Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
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Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
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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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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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Palliative Sedation Therapy: A Case Report.

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  • 1Emily G. Willard is a staff nurse and education coordinator in the medical-respiratory intensive care unit, VCU Health, in Richmond, Virginia. She is a graduate student at the University of Virginia School of Nursing, Charlottesville, Virginia.

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Summary
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Palliative sedation therapy is crucial for dying patients, especially those with severe acute respiratory distress syndrome. Critical care teams need better understanding of palliative sedation to manage symptoms effectively during end-of-life care.

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Area of Science:

  • Critical Care Medicine
  • Palliative Care
  • Respiratory Medicine

Background:

  • Palliative sedation is not widely understood by critical care providers and nurses, despite frequent exposure to dying patients.
  • This case report highlights the consideration of palliative sedation therapy for an intensive care unit patient nearing end of life.

Observation:

  • A 72-year-old female with severe acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia was transferred and subsequently experienced cardiac arrest.
  • The patient required intubation, mechanical ventilation, and continuous epinephrine infusion post-resuscitation.
  • Transition to comfort care was planned, with propofol suggested for dyspnea management post-extubation.

Findings:

  • The patient's condition necessitated a shift from aggressive treatment to comfort-focused care.
  • Palliative sedation was considered as a therapeutic option to alleviate symptoms during the dying process.

Implications:

  • Palliative sedation therapy is an important option for managing symptoms in critically ill dying patients, particularly those with ARDS.
  • Enhanced education on the ethical principles and application of palliative sedation is vital for critical care professionals.
  • Improved understanding and implementation of palliative sedation can ensure better symptom management for patients at the end of life.