orm_april-2024 - 27

g
Ambulatory Surgery Centers
Dr. Patel says does not see a new anesthetic coming out in th
properties and comparable cost-effectiveness in the near futu
perfect anesthesia drug with a rapid onset and offset, little neg
and respiratory systems, a minimal amount of side effects, an
continues. Originally published June 2022 in the Journal of Cl
highlights the new drugs going through various stages of the a
In fact, propofol's
antiemetic properties-
along with its rapid
onset, short duration,
and relative safety for a
wide range of patients-
often leads it to be preferred
over other drugs,
says Biraj Patel, MD, an
Novel hypnotics in development
Biraj Patel,
MD
anesthesiologist practicing in New York
City and founder of PreferredMD. According
to literature, although propofol does
not have much of an analgesic effect,
analgesics such as fentanyl or Toradol
can be added to the regimen. Propofol
also can be used to reverse some of the
effects of local anesthetics, such as seizures.
The drug's quick half-life reduces
the risk of overdose in ASC settings,
even with a bolus dose. Patients can
quickly emerge from procedural sedation
with no hallucinations. Propofol's costeffectiveness
also makes it a drug of
choice for many ASCs.
Transient local pain at the injection
site is the most common adverse reaction.
Dr Patel advises caretakers to
monitor patients for airway and hemodynamic
status during administration,
as high doses could cause decreased
cardiac output and arrhythmias. According
to Folina et al, potential reactions
include airway obstruction and apnea,
hypotension, myoclonus, QT interval
prolongation on EKG (an irregular heart
rhythm that is rarely clinically significant
in this context), and discolored urine (a
green tint-very rare).
Dr Patel emphasizes that safe, effective
administration depends on the
skills and training of the practitioners as
well as teamwork and communication
between the surgeon and anesthesiologist.
Appropriately dosing the drug in
response to the procedure's outcome
and the patients' condition is critical,
especially in cases warranting a separate
local anesthetic or pain medication.
Pursuing PSA perfection
Dr Patel says he does not anticipate a
www.ormanager.com
An overview of novel hypnotics and their current status in drug development, originally
published June 2022 in the Journal of Clinical Medicine. Blue: Benzodiazepine
derivative. Red: Propofol derivatives. Green: Etomidate derivatives. Orange:
Steroid.
An overview of novel hypnotics and their current status in drug deve
2022 in the Journal of Clinical Medicine. Blue: Benzodiazepine deri
Green: Etomidate derivatives. Orange: Steroid. 1 By the Food and D
One of the two examples approved by the Food and Drug Adm
soluble prodrug of propofol with prolonged onset and recovery
15715, fospropofol was approved as an alternative to propofo
site, the risk of bacterial contamination, and hypertriglyceridem
been shown to be effective and safe for sedation during colon
surgical procedures. Although it is expected to cause less hyp
depression than propofol, these benefits have not been clearl
burning sensation and pruritus are common side effects. Simi
management is essential and should be performed by person
Combining remimazolam-the second FDA-approved drug on
emerging trend in moderate sedation, says Shawn Craddock,
Consultant at Sullivan Healthcare Consulting. The pairing of a
(remimazolam) and a potent short-acting opioid (oliceridine) p
analgesia, but with fewer side effects (such as nausea, vomiti
depression) than their relatively older peers. Both drugs were
the future, combining the two could become widespread enou
analgesic combinations (eg, propofol and fentanyl) for modera
New models, applications for intravenous
anesthesia
Newer drugs and combinations of drugs such
as fospropofol and remimazolam are not the
only examples of innovation in PSA. New
administration models and new applications
of existing drugs can also help improve outcomes.
For
example, target-controlled infusion
(TCI) can help improve the accuracy
of drug administration through the use of
a computerized infusion pump, adjusting
the drug titration, calculated according to
pharmacokinetic-pharmacodynamic (PKPD)
models. For example, propofol models have
been developed for use in children. Generalpurpose
models designed for a broad popunew
anesthetic hitting the market with
markedly better properties than and
comparable cost-effectiveness to propofol
in the near future. However, the
quest for the perfect anesthesia drug
with a rapid onset and offset, few negalation
range (children, adults, elderly, and
obese patients) have also been developed.
These general-purpose models have fewer
restrictions for patient selection and, thus,
increase the match between a model and a
clinical situation, reducing incorrect usage
and unfamiliarity with a specific TCI model
and increasing the clinical acceptance of TCI.
As for new applications, intranasal administrations
for dexmedetomidine and midazolam
have been tried on trypanophobic
patients. The nasal mucosa absorbs both
drugs well, providing an alternative for these
patients for procedural sedation.
tive effects on the circulatory and respiratory
systems, minimal side effects,
and antiemetic or analgesic effects
continues. Originally published in June
2022 in the Journal of Clinical Medicine,
the graph above (sidebar, Novel
OR Manager | April 2024
27
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