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Chapter 2 - Pharmacology Principles in Sedation

Published online by Cambridge University Press:  12 December 2024

By
Aaron J. Kaye ,
Alan D. Kaye ,
Julie A. Gayle ,
Richard D. Urman  and
Adam M. Kaye
Edited by
Richard D. Urman  and
Alan David Kaye
Richard D. Urman
Affiliation:
Ohio State University
Alan David Kaye
Affiliation:
Louisiana State University School of Medicine
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Summary

Today, there are an increasing number of procedures requiring moderate and deep sedation being performed outside the surgical suite. As a result, qualified non-anesthesia providers are administering varying levels of sedation to patients for a variety of diagnostic, therapeutic, and/or surgical procedures. Practitioners should provide patients with the benefits of sedation and/or analgesia while minimizing the associated risks. To do so, providers should understand the pharmacology of the agents being administered as well as the role of pharmacologic antagonists for opioids and benzodiazepines. Today’s practitioners are equipped with an abundance of versatile sedative agents that can be used alone and in combination. Furthermore, combinations of sedative and analgesics should be administered as appropriate for the procedure being performed and the condition of the patient. Policies and standards regarding administration of sedation and analgesia by non-anesthesia providers are addressed elsewhere in the book. This chapter focuses on the pharmacology of the drugs most used to provide moderate and deep sedation and their available reversal agents.

Type
Chapter
Information
Moderate and Deep Sedation in Clinical Practice , pp. 11 - 38
Publisher: Cambridge University Press
Print publication year: 2024

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References

References

Kim, KM. Remimazolam: pharmacological characteristics and clinical applications in anesthesiology. Anesth Pain Med. 2022;17(1):1–11. doi: 10.17085/apm.21115CrossRefGoogle ScholarPubMed
Urman, R, Vadivelu, N. Acute and postoperative pain management. In Pocket Pain Medicine. Philadelphia, PA: Lippincott, Williams & Wilkins, 2011.Google Scholar
Flower, RJ. Prostaglandins, bioassay and inflammation. Br J Pharmacol. 2006;147(Suppl 1):S182–92. doi: 10.1038/sj.bjp.0706506CrossRefGoogle ScholarPubMed
Habenicht, A, Salbach, P, Goerig, M. et al. The LDL receptor pathway delivers arachidonic acid for eicosanoid formation in cells stimulated by platelet-derived growth factor. Nature. 1990;345;634–6. doi: 10.1038/345634a0CrossRefGoogle ScholarPubMed
Windle, ML. Infiltrative administration of local anesthetic agents. Medscape emedicine, 2011. emedicine.medscape.com/article/149178-overview (updated 2022)Google Scholar
Arthur, GR. Pharmacokinetics. In Strichartz, GR, ed., Handbook of Experimental Pharmacology, vol. 81. Berlin: Springer-Verlag, 1987, 165–86.Google Scholar
Clarkson, CW, Hondeghem, LM. Mechanism for bupivacaine depression of cardiac conduction: fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiology. 1985;62:396–405.CrossRefGoogle ScholarPubMed
Thomas, RD, Behbehani, MM, Coyle, DE, Denson, DD. Cardiovascular toxicity of local anesthetics: an alternative hypothesis. Anesth Analg. 1986;65: 444–50.CrossRefGoogle ScholarPubMed
Nath, S, Häggmark, S, Johansson, G, Reiz, S. Differential depressant and electrophysiologic cardiotoxicity of local anesthetics: an experimental study with special reference to lidocaine and bupivacaine. Anesth Analg. 1986;65: 1263–70.CrossRefGoogle ScholarPubMed
Weinberg, GL. Treatment of local anesthetic systemic toxicity (LAST). Reg Anesth Pain Med. 2010;35:188–193.CrossRefGoogle ScholarPubMed
American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–17.Google Scholar

Additional Reading

Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, eds. Clinical Anesthesia, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2009.Google Scholar
Faust, RJ, Cucchiara, RF, Rose, SH, et al. Anesthesiology Review, 3rd ed. Philadelphia, PA: Churchill Livingstone, 2002.Google Scholar
Hospira. Dosing guidelines for Precedex®: nonintubated procedural sedation and ICU sedation. https://aamsn.org/wp-content/uploads/2010/02/Precedex_Dosing_Guide.pdfGoogle Scholar
Mirrakhimov, AE, Voore, P, Halytskyy, O, et al. Propofol infusion syndrome in adults: a clinical update. Crit Care Res Pract. 2015;15:1–10.Google Scholar
Morgan, GE, Mikhail, MS, Murray, MJ. Clinical Anesthesiology, 4th ed. New York, NY: McGraw-Hill, 2006.Google Scholar
Orlewicz, MS. Procedural sedation. Medscape emedicine, September 14, 2015. https://emedicine.medscape.com/article/109695-overview?form=fpf (updated 2022).Google Scholar
Riker, RR, Shehabi, Y, Bokesch, PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 2009; 301:489–99.Google ScholarPubMed
Stoelting, RK, Hillier, SC. Pharmacology and Physiology in Anesthetic Practice, 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2006.Google Scholar
Stoelting, RK, Miller, RD. Basics of Anesthesia, 5th ed. Philadelphia, PA: Churchill Livingstone, 2007.Google Scholar
Watson, DS, Odom-Forren, J. Practical Guide to Moderate Sedation/Analgesia, 2nd ed. New York, NY: Mosby, 2005.Google Scholar

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