orm_april-2024 - 28

Ambulatory Surgery Centers
hypnotics in development) highlights the
new drugs going through various stages
of the approval process.
One of the two examples approved by
the FDA is fospropofol, a water-soluble
prodrug of propofol with prolonged onset
and recovery times. Initially known as
GPI 15715, fospropofol was approved
as an alternative to propofol to address
pain at the injection site, the risk of bacterial
contamination, and hypertriglyceridemia
with prolonged infusion. It has
been shown to be effective and safe for
sedation during colonoscopy, bronchoscopy,
and minor surgical procedures.
Although it is expected to cause less
hypotension and less respiratory depression
than propofol, these benefits have
not been clearly demonstrated. A perineal
burning sensation and pruritus are
common side effects. Similar to propofol,
airway management is essential
and should be performed by personnel
trained in airway management.
Combining remimazolam-the second
FDA-approved drug on this list-with
Midazolam
(Benzodiazepines)
Onset
2-3
minutes
minutes
oliceridine is an emerging
trend in moderate
sedation, says Shawn
Craddock, DNP, RN,
CNOR, NE-BC, senior
consultant at Sullivan
Healthcare Consulting
in Alpharetta, Georgia.
Pairing a short-active anesthetic
(remimazolam)
and a potent short-actShawn
Craddock,
DNP,
RN,
CNOR, NE-BC
ing opioid (oliceridine) provides effective
sedation and analgesia, but with fewer
side effects (such as nausea, vomiting,
constipation, and respiratory depression)
than their relatively older counterparts.
Both drugs were approved individually in
2020, and the combination could eventually
rival established sedative-analgesic
combinations (eg, propofol and fentanyl)
for moderate sedation.
More information about the remimazolam
and oliceridine combination can
be found in an article by Goudra and
Mason listed under the References. In
clinical trials, remimazolam significantly
Duration
5-10
Comments
Most commonly used
of the benzodiazepines
thanks to its faster
onset of sedation, more
complete amnesia, and
improved awakening
Fentanyl
(Opiates)
Ketamine
1-2
minutes
1 minute
5-15
minutes
Etomidate
Dexmedetomidine
(Precedex)
Methohexital
(Barbiturates)
1-2
minutes
3-5
minutes
15-30
seconds
1-2 minutes Increases pain
threshold. Naloxone is
a strong antidote
PSA doses maintain
a patent airway
and spontaneous
respiration
5-7 minutes Minimal cardiovascular
and respiratory effects
15 minutes
Does not cause
respiratory suppression
4-7 minutes Onset within seconds
Side Effects
Hiccoughs, cough,
nausea, and vomiting.
Thrombophlebitis,
thrombosis, and pain on
injection. Hangover effects
with nighttime administration
Euphoria, confusion,
respiratory depression, visual
disturbances, dyskinesia,
hallucinations, delirium
Recovery agitation, transient
airway complications such
as laryngospasm, and
emesis
Transiently lowers cerebral
blood flow and transient
adrenal suppression
Bradycardia, hypotension,
mild respiratory effects,
upper airway obstruction
possible
Respiratory depression,
transient hypotension
decreased the incidence of hypotension
and respiratory depression and had a
faster recovery time compared to propofol.
Compared to midazolam, it had
a faster time to discharge and to return
to neuropsychiatric function. Oliceridine
(Olinvyk®)
is approximately five times
more potent than morphine and has a
wider therapeutic window, as well as
an onset of 3 to 4 minutes. It also has
relatively lower respiratory depressant
properties. As an analgesic, it can pair
well with benzodiazepines and other
intravenous anesthetics, such as propofol,
in moderate and deep sedation.
Other common PSA agents
Examples of other common intravenous
anesthetics are outlined in the table below,
based on articles by Benzoni and Cascella,
Ramos-Matos et al, Lingamchetty et al,
and NYSORA. The list of IV PSA agents and
their characteristics are by no means comprehensive.
Practitioners should consult
clinical indications, dosage, side effects,
and caution for each drug.
Caution
Neurocognitive alterations in elderly
patients
Alcohol or opioids greatly increase
the sedative and respiratorydepressant
effects, and the risk for
cardiovascular depression
Alcohol and other drugs (ie,
cocaine, heroin) can synergistically
exacerbate fentanyl's side effects.
Life-threatening overdose
May cause emergence phenomena
(visual hallucinations, disorientation).
Contraindicated in patients with
increased blood pressure or heart rate
Hypnotic effects only, no analgesic
properties
Use of other analgesics necessary
for the more painful procedures
Contraindicated in patients with
acute intermittent porphyria. No
analgesic properties (may even
reduce the pain threshold)
28
OR Manager | April 2024
www.ormanager.com
http://www.ormanager.com

orm_april-2024

Table of Contents for the Digital Edition of orm_april-2024

orm_april-2024 - 1
orm_april-2024 - 2
orm_april-2024 - 3
orm_april-2024 - 4
orm_april-2024 - 5
orm_april-2024 - 6
orm_april-2024 - 7
orm_april-2024 - 8
orm_april-2024 - 9
orm_april-2024 - 10
orm_april-2024 - 11
orm_april-2024 - 12
orm_april-2024 - 13
orm_april-2024 - 14
orm_april-2024 - 15
orm_april-2024 - 16
orm_april-2024 - 17
orm_april-2024 - 18
orm_april-2024 - 19
orm_april-2024 - 20
orm_april-2024 - 21
orm_april-2024 - 22
orm_april-2024 - 23
orm_april-2024 - 24
orm_april-2024 - 25
orm_april-2024 - 26
orm_april-2024 - 27
orm_april-2024 - 28
orm_april-2024 - 29
orm_april-2024 - 30
orm_april-2024 - 31
orm_april-2024 - 32
https://www.nxtbook.com/accessintelligence/ORManager/orm_august-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_july-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_june-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_may-2024
https://www.nxtbook.com/accessintelligence/ORManager/ormc_brochure_march-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_april-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_asc_march-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_march-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_february-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_january-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_november-2023
https://www.nxtbook.com/accessintelligence/ORManager/orm_october-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2023
https://www.nxtbook.com/accessintelligence/ORManager/ormc-brochure-march-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2023
https://www.nxtbook.com/accessintelligence/ORManager/orm-february-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-november-december-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-october-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2022
https://www.nxtbook.com/accessintelligence/ORManager/ormc-brochure-may-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-february-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-november-december-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-october-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-April-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-february-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-december-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-october-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-february-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-december-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-november-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-october-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-february-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-december-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-november-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-october-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-february-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2018
https://www.nxtbookmedia.com