remimazolam and fospropofol

The current review examines the success and failures of the development of new hypnotic compounds for the human market. One of the important aspects is that one of the key present agents, propofol, is considered by many anaesthesiologists as 'the ideal'. However, all drugs have adverse or side-effects.. The last 30 years since the introduction of propofol has seen many new compounds evaluated; but as at the present time, only three agents may achieve a pivotal position in the market - fospropofol (a sedative agent which may have a role in endoscopic surgery); remimazolam (a short-acting benzodiazepine) whose development is also being focused on the sedation rather than anaesthesia market; and the pregnane steroid, alfaxalone (an anaesthetic agent first introduced in 1972, but withdrawn in 1984 because of adverse allergic reactions to the solvent, Cremophor EL) now solvented in a cyclodextrin.. Studies of these three agents thus far have shown that none of them has any major adverse side-effects; all have properties which warrant further clinical evaluation.

Topics: Anesthesia; Benzodiazepines; Clinical Trials as Topic; Conscious Sedation; Drug Recalls; Humans; Hypnotics and Sedatives; Pregnanediones; Propofol

Over the past decade, the field of pediatric sedation has benefited from contributions which include the introduction and update of policies, procedures, and guidelines regarding training, physiologic monitoring and delivery, the approval of new sedatives, the multispecialty collaborations intended to advance the field and the development of sedatives, and delivery systems. This review will explore new drug innovations as well as evolved formulations of already approved agents, unique sedative delivery systems, the clinical application of pharmacogenetics and will conclude with a reflection on the current and future trends and focus of pediatric sedation research.. In recent years, the number of diagnostic and therapeutic procedures performed on children in nonoperating room anesthetizing locations has exploded at a rate which has in many instances, outpaced the availability of anesthesiologists. Over the past decade, the search for safe and effective sedatives and delivery systems has been embraced by all sedation providers. Dexmedetomidine and fospropofol were recently introduced, along with a computer-assisted personalized sedation delivery system which empowers the patient to assist in his own sedation. The evolution of target-controlled infusion systems with both open and closed-loop design are intended to more precisely deliver sedation using pharmacokinetic models specific for each sedative. New formulations of propofol, ketamine, etomidate, and benzodiazepines are in development, all striving to improve predictability, safety, and recovery profile. Pharmacogenetics is being explored for its role in the effects of analgesics, sedatives, and local anesthetics.. As the demand for procedural sedation continues to expand, the sedation providers must continue to be creative in their search for novel, safe, effective, and efficient methods to deliver care. Approaching the field of sedation as a science is essential for the clinicians and researchers who strive to tailor the sedation to the patient and the procedure.

Topics: Benzodiazepines; Child; Conscious Sedation; Dexmedetomidine; Drug Delivery Systems; Drug Discovery; Humans; Ketamine; Pharmacogenetics; Precision Medicine; Propofol

Sedation plays an integral part in endoscopy. By achieving patient comfort, it allows for a better examination and enhances patient satisfaction. Various medications have been used, propofol being the current favorite. With emphasis on patient safety and quality of endoscopy, various new medications in different combinations are being used to achieve adequate sedation and not escalate the cost of the procedure. With the advent of newer medications and newer modalities to administer these medications, there is need for more specialized training for the endoscopist to feel comfortable while using these medications.

Topics: Anesthesia Recovery Period; Benzodiazepines; Conscious Sedation; Deep Sedation; Dexmedetomidine; Endoscopy, Gastrointestinal; Gastroenterology; Humans; Hypnotics and Sedatives; Ketamine; Patient Satisfaction; Piperidines; Propofol; Remifentanil

Topics: Benzodiazepines; Humans; Hypnotics and Sedatives; Propofol

The increasing request for procedural sedation will create in the upcoming future the need for a specific training in delivering care to patients in a continuum of sedation, whose effects and adverse events are unpredictable. The main debate in the past years has been focused on using drugs that could have few adverse effects and could be considered well tolerated when administered by a nonanaesthesiologist. Propofol remains the most used drug for procedural sedation, but given its side-effects, its administration is limited and suggested only when an anaesthesiologist is available. The main studies recently appearing in the literature are focusing on the use of alternative drugs such as dexmedetomidine, remifentanil, fospropofol, ketofol and remimazolam. The current study is an overview of the different fields of procedural sedation, describing the evidence from the published studies and some upcoming studies.. Propofol is still considered as the drug of choice, and a recent study on its administration in the emergency department by nonanaesthesiologists has revealed a reduced number of adverse events. Dexmedetomidine is considered, at present, the most commonly used alternative to propofol, given its greater safety in terms of haemodynamic stability and lack of respiratory depression. Remifentanil has been suggested as the 'solo' drug during procedural sedation by target-controlled infusion, but it needs a controlled environment and skilled practitioners. Fosprofol and ketofol are new alternatives, but convincing studies that could support their wider use are absent. Remimazolam is another alternative whose efficacy is still to be determined. Most of the studies in the literature are debating on the training that the 'proceduralist' should undergo to deliver sedation safely and to manage any kind of adverse effect caused by it.. Recent studies on procedural sedation are still debating on the use of propofol by nonanaesthesiologists and are exploring the use of other sedatives and analgesics. The main goal in the future should be to have a clear curriculum on the role of the 'sedationalist' outside the operating room.

Topics: Adult; Anesthesia; Benzodiazepines; Dexmedetomidine; Humans; Hypnotics and Sedatives; Piperidines; Propofol; Remifentanil