Etomidate (AMIDATE) is used as an intravenous anesthetic, often in combination with fentanyl. It is advantageous because it lacks pulmonary and vascular depressant activity, although it has a negative inotropic effect on the heart. Its pharmacology and anesthetic uses are described in
Chapter 13. It also is used in some countries as a sedative-hypnotic drug in intensive care units, during intermittent positive-pressure breathing, in epidural anesthesia, and in other situations. The myoclonus commonly seen after anesthetic doses is not seen after sedative-hypnotic doses.
Clomethiazole has sedative, muscle relaxant, and anticonvulsant properties. It is used outside the U.S. for hypnosis in elderly and institutionalized patients, for preanesthetic sedation, and especially in the management of withdrawal from ethanol. Given alone, its effects on respiration are slight, and the therapeutic index is high. However, deaths from adverse interactions with ethanol are relatively frequent.
Propofol (diprivan) is a rapidly acting and highly lipophilic di-isopropylphenol used in the induction and maintenance of general anesthesia (see Chapter 13), as well as in the maintenance of long-term sedation. propofol sedation is of a similar quality to that produced by midazolam. Emergence from sedation occurs quickly owing to its rapid clearance. Propofol has found use in intensive care sedation in adults, as well as for sedation during GI endoscopy procedures and transvaginal oocyte retrieval. Propofol is believed to act primarily through enhancement of GABAA-receptor function. Effects on other ligand-gated and G protein-coupled receptors, however, also have been reported.
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