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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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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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Benzodiazepines have both sedative and hypnotic properties. They include compounds such as diazepam (Valium) and alprazolam (Xanax). Structurally, their cores are similar, consisting of the fusion of a benzene ring and a diazepine ring, but they share a common mechanism of action in the central nervous system (CNS).
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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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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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Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: 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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Esketamine: Less Drowsiness, More Analgesia.

Georges Mion1, Sabine Himmelseher2

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Anesthesia and Analgesia
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Summary
This summary is machine-generated.

Esketamine, a component of racemic ketamine, offers distinct advantages in anesthesia and analgesia. It provides potent pain relief with fewer cognitive side effects and faster recovery than racemic ketamine.

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Area of Science:

  • Anesthesiology
  • Pharmacology
  • Neuroscience

Background:

  • Racemic ketamine is a mixture of esketamine and arketamine.
  • Esketamine has higher affinity for the N-methyl-D-aspartate (NMDA) receptor than arketamine.
  • Renewed interest in esketamine is driven by the opioid crisis and expanded clinical use.

Purpose of the Study:

  • To review the literature on esketamine's mental, cardiovascular, cerebral, and antinociceptive effects in anesthesia.
  • To compare esketamine's effects with racemic ketamine at equivalent doses.

Main Methods:

  • Literature review of English-language studies published between 1980 and 2022.
  • Analysis of anesthesia literature focusing on specific physiological and psychological effects.

Main Results:

  • Esketamine and racemic ketamine differ significantly at equivalent anesthetic/analgesic doses.
  • Esketamine demonstrates less pronounced psychomimetic and cognitive side effects compared to racemic ketamine.
  • Esketamine allows for reduced dosage, faster clearance, and shorter recovery times, with potential cardiocirculatory stabilizing and neuroprotective effects.

Conclusions:

  • Esketamine offers a potentially improved therapeutic profile over racemic ketamine in anesthesia and analgesia.
  • Further head-to-head studies comparing esketamine and racemic ketamine at equi-analgesic/anesthetic doses are needed.
  • Esketamine's role in pain management and anesthesia warrants further investigation.