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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: 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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Stages of General Anesthesia01:22

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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

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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.
Unlike...
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Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

Sedatives and Hypnotics Drugs: Miscellaneous Agents

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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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Sedatives and Hypnotics Drugs: Benzodiazepines01:19

Sedatives and Hypnotics Drugs: Benzodiazepines

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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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Updated: Jun 13, 2025

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
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[New recommendations on palliative sedation].

Séverine Marie Surges1, Holger Brunsch2,3, Marta Przyborek2

  • 1Klinik für Palliativmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland. severine.surges@ukbonn.de.

Schmerz (Berlin, Germany)
|September 12, 2024
PubMed
Summary
This summary is machine-generated.

This article updates guidelines for palliative sedation, emphasizing patient autonomy and proportional treatment for refractory suffering in life-limiting illnesses. Key recommendations focus on shared decision-making, separate hydration decisions, and using midazolam.

Keywords:
Informed consentMidazolamPalliative sedation/decision-makingPalliative sedation/proportionalityRefractory suffering

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Area of Science:

  • Palliative Care
  • Medical Ethics

Context:

  • The European Association for Palliative Care (EAPC) framework on palliative sedation has been updated.
  • The SedPall research group in Germany has also formulated recommendations.

Purpose:

  • To describe the social and ethical complexity of decision-making in palliative sedation.
  • To summarize updated recommendations for palliative sedation.

Summary:

  • Patient autonomy is a central tenet, with refractory suffering determined jointly by physician and patient.
  • Palliative sedation should be proportional to the individual patient's situation.
  • Decisions regarding palliative sedation and hydration are separate. Midazolam is the recommended first-choice agent.
  • Attention must be given to the patient's relatives/significant others and the treating team.

Impact:

  • Provides updated guidance for clinicians on ethical and practical aspects of palliative sedation.
  • Promotes patient-centered care by emphasizing autonomy and shared decision-making.
  • Offers a framework for managing complex end-of-life suffering in patients with life-limiting diseases.