Pharmacodynamic considerations for moderate and deep sedation.

Moderate and deep sedation can be provided using various classes of drugs, each having unique mechanisms of action. While drugs within a given classification share similar mechanisms and effects, certain classes demonstrate superior efficacy but added concern regarding safety. This continuing education article will highlight essential principles of pharmacodynamics and apply these to drugs commonly used to produce moderate and deep sedation.

[1]  P. Jatlow,et al.  Serum diazepam concentrations in overdose. Their significance. , 1979, American journal of clinical pathology.

[2]  D. Chernik,et al.  Validity and Reliability of the Observer's: Assessment of Alertness/Sedation Scale Study with Intravenous Midazolam , 1990, Journal of clinical psychopharmacology.

[3]  D. Greenblatt,et al.  Acute overdosage with benzodiazepine derivatives , 1977, Clinical pharmacology and therapeutics.

[4]  D. Becker.  Nausea, vomiting, and hiccups: a review of mechanisms and treatment. , 2010, Anesthesia progress.

[5]  P. White,et al.  Comparison of Midazolam and Diazepam for Sedation During Plastic Surgery , 1988, Plastic and reconstructive surgery.

[6]  R. Dionne,et al.  Differential Pharmacology of Drugs Used for Intravenous Pre-medication , 1984, Journal of dental research.

[7]  C. Chudnofsky,et al.  Comparison of midazolam and diazepam for conscious sedation in the emergency department. , 1993, Annals of emergency medicine.

[8]  F. C. Greiss,et al.  Obstetric Anesthesia , 2018, Maternal and Fetal Cardiovascular Disease.

[9]  Welcome Guimera,et al.  Practice Guidelines for Sedation and Analgesia by Non- Anesthesiologists , 2005 .

[10]  Erwin K. Kastrup,et al.  Drug facts and comparisons , 1977 .

[11]  D. Becker,et al.  Nitrous oxide and the inhalation anesthetics. , 2008, Anesthesia progress.

[12]  D. Greenblatt.  Clinical Pharmacokinetics of Oxazepam and Lorazepam , 1981, Clinical pharmacokinetics.

[13]  R. L. Vaughn,et al.  Fentanyl chest wall rigidity syndrome--a case report. , 1981, Anesthesia progress.

[14]  D. Reich,et al.  Ketamine: an update on the first twenty-five years of clinical experience , 1989, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[15]  Vaughn Rl,et al.  Fentanyl chest wall rigidity syndrome--a case report. , 1981 .

[16]  P. White,et al.  Ketamine--its pharmacology and therapeutic uses. , 1982, Anesthesiology.

[17]  Genís Carrasco,et al.  Instruments for monitoring intensive care unit sedation , 2000, Critical care.

[18]  V A Feshchenko,et al.  The Comparative Amnestic Effects of Midazolam, Propofol, Thiopental, and Fentanyl at Equisedative Concentrations , 1997, Anesthesiology.

[19]  F. D. Boudinot,et al.  Age-Related Changes in Protein Binding of Drugs , 2000, Clinical pharmacokinetics.

[20]  M. A. Hughes,et al.  Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. , 1992, Anesthesiology.

[21]  E. Kharasch,et al.  Pharmacokinetics and Clinical Effects of Multidose Sublingual Triazolam in Healthy Volunteers , 2006, Journal of clinical psychopharmacology.

[22]  J. E. Pickrell,et al.  Flumazenil reversal of sublingual triazolam: a randomized controlled clinical trial. , 2009, Journal of the American Dental Association.

[23]  C. Zhang,et al.  The analgesic action of nitrous oxide is dependent on the release of norepinephrine in the dorsal horn of the spinal cord. , 1999, Anesthesiology.

[24]  F. E. Shideman.  Hypnotics and sedatives. , 1958, Postgraduate medicine.

[25]  J. E. Pickrell,et al.  Expanded Studies of the Pharmacokinetics and Clinical Effects of Multidose Sublingual Triazolam in Healthy Volunteers , 2009, Journal of clinical psychopharmacology.

[26]  D. Greenblatt,et al.  Kinetic and dynamic study of intravenous lorazepam: comparison with intravenous diazepam. , 1989, The Journal of pharmacology and experimental therapeutics.

[27]  D. Vinson,et al.  Diphenhydramine for the prevention of akathisia induced by prochlorperazine: a randomized, controlled trial. , 2001, Annals of emergency medicine.

[28]  M. Rosen,et al.  Management of anesthesia for the pregnant surgical patient. , 1999, Anesthesiology.

[29]  D. Greenblatt,et al.  Comparative kinetics and response to the benzodiazepine agonists triazolam and zolpidem: evaluation of sex-dependent differences. , 2000, The Journal of pharmacology and experimental therapeutics.

[30]  D. Greenblatt,et al.  Neurochemical and pharmacokinetic correlates of the clinical action of benzodiazepine hypnotic drugs. , 1990, The American journal of medicine.

[31]  S. Rothrock,et al.  Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. , 1998, Annals of emergency medicine.

[32]  K. A. East,et al.  Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. , 1990, Anesthesiology.

[33]  E. Bradley,et al.  Triple Anesthetic Combination: Propofol‐Midazolam‐Alfentanil , 1994, Anesthesia and analgesia.

[34]  C. Bannister,et al.  Midazolam premedication in children: a comparison of two oral dosage formulations on sedation score and plasma midazolam levels. , 2003, Anesthesia and analgesia.

[35]  David J. Hermann,et al.  The Pharmacokinetics of the New Short‐acting Opioid Remifentanil (GI87084B) in Healthy Adult Male Volunteers , 1993, Anesthesiology.

[36]  S. Nicolson,et al.  Comparison of oral and intramuscular preanesthetic medication for pediatric inpatient surgery. , 1989, Anesthesiology.

[37]  J G Reves,et al.  Midazolam: Pharmacology and Uses , 1985, Anesthesiology.

[38]  S. Shafer,et al.  Advances in propofol pharmacokinetics and pharmacodynamics. , 1993, Journal of clinical anesthesia.

[39]  W. Cordell,et al.  Comparison of routes of flumazenil administration to reverse midazolam-induced respiratory depression in a canine model. , 1997, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[40]  I. Wainer,et al.  The Clinical Pharmacology of Meperidine—Comparison of Routes of Administration , 1976, Journal of clinical pharmacology.

[41]  M. J. Harris.  INTRAVENOUS ANESTHETICS , 1954, Orvosi hetilap.

[42]  D. Greenblatt,et al.  Age and gender effects on the pharmacokinetics and pharmacodynamics of triazolam, a cytochrome P450 3A substrate , 2004, Clinical pharmacology and therapeutics.

[43]  D. Greenblatt,et al.  Effect of Age, Gender, and Obesity on Midazolam Kinetics , 1984, Anesthesiology.

[44]  Roger L. Black,et al.  Goodman and Gilman's The Pharmacological Basis of Therapeutics , 1991 .

[45]  Hypnotics and sedatives , 1986 .

[46]  R. Pearce,et al.  Inhaled Anesthetics: Mechanisms of Action , 2010 .

[47]  B. C. Bloor,et al.  Histamine Release by Four Narcotics: A Double‐Blind Study in Humans , 1987, Anesthesia and analgesia.