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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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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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CNS Depressants: Barbiturates and Benzodiazepines01:14

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CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
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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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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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[Sedation outside the hospital].

Loïse Béchet1, Vanessa Letourneau1, Espéranza Silva Juarez1

  • 1Équipe mobile d'accompagnement et de soins palliatifs, Chic Alençon-Mamers, 25 rue de Fresnay, 61000 Alençon, France.

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PubMed
Summary

Deep and continuous sedation for dependent elderly individuals at home or in nursing facilities is rare. Collegial physician input is essential, with anxiolysis often being sufficient for symptom management.

Keywords:
EMSPEhpaddomicileend-of-life projecthomelieu de vieliving spaceprojet de fin de vie

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Area of Science:

  • Geriatric Medicine
  • Palliative Care
  • End-of-Life Care

Context:

  • Elderly care settings, including nursing homes (EHPADs) and home environments.
  • Challenges in implementing deep and continuous sedation for dependent elderly individuals.
  • The role of medical teams in end-of-life decision-making for dependent elderly patients.

Purpose:

  • To explore the current practices and considerations surrounding deep and continuous sedation in dependent elderly patients.
  • To highlight the exceptional nature of this end-of-life care strategy.
  • To emphasize the necessity of a collegial approach involving the attending physician.

Summary:

  • Deep and continuous sedation until death is an infrequent practice for dependent elderly individuals, whether at home or in EHPADs.
  • Implementation necessitates a collaborative decision-making process involving the attending physician.
  • Anxiolysis is frequently employed as a primary treatment and often proves adequate for managing patient distress.

Impact:

  • Informs clinical practice regarding the judicious use of sedation in elderly end-of-life care.
  • Underscores the importance of interdisciplinary communication and consensus in complex care decisions.
  • Provides insights into alternative or primary palliative interventions like anxiolysis.