orm_asc_october-2024 - 8

Dr. Patel says does not see a new anesthetic coming out in the market with markedly better
properties and comparable cost-effectiveness in the near future. However, the quest for the
perfect anesthesia drug with a rapid onset and offset, little negative effects on the circulatory
and respiratory systems, a minimal amount of side effects, and anti-emetic or analgesic effe
continues. Originally published June 2022 in the Journal of Clinical Medicine, the graph belo
highlights the new drugs going through various stages of the approval process.
Novel hypnotics in development
between the surgeon and anesthesiologist.
Appropriately dosing the drug in
response to the procedure's outcome
and the patients' condition is critical,
especially in cases warranting a separate
local anesthetic or pain medication.
An overview of novel hypnotics and their current status in drug development, originally
published June 2022 in the Journal of Clinical Medicine. Blue: Benzodiazepine
derivative. Red: Propofol derivatives. Green: Etomidate derivatives. Orange:
Steroid.
New models, applications for intravenous
anesthesia
Newer drugs and combinations of drugs such
as fospropofol and remimazolam are not the
only examples of innovation in PSA. New
administration models and new applications
of existing drugs can also help improve outcomes.
An
overview of novel hypnotics and their current status in drug development, originally published June
2022 in the Journal of Clinical Medicine. Blue: Benzodiazepine derivative. Red: Propofol derivatives.
Green: Etomidate derivatives. Orange: Steroid. 1 By the Food and Drug Administration.
One of the two examples approved by the Food and Drug Administration is fospropofol, a wa
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 injectio
site, the risk of bacterial contamination, and hypertriglyceridemia with prolonged infusion. It h
been shown to be effective and safe for sedation during colonoscopy, bronchoscopy, and mi
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 managem
Combining remimazolam-the second FDA-approved drug on this list-with oliceridine is an
emerging trend in moderate sedation, says Shawn Craddock, DNP, RN, CNOR, NE-BC, Sen
Consultant at Sullivan Healthcare Consulting. The pairing of a short-active anesthetic
(remimazolam) and a potent short-acting opioid (oliceridine) provides effective sedation and
analgesia, but with fewer side effects (such as nausea, vomiting, constipation and respirator
depression) than their relatively older peers. Both drugs were approved individually in 2020.
the future, combining the two could become widespread enough to rival \ established sedativ
analgesic combinations (eg, propofol and fentanyl) for moderate sedation procedures.
For example, target-controlled infusion
(TCI) can help improve the accuracy
of drug administration through the use of
a computerized infusion pump, adjusting
the drug titration, calculated according to
pharmacokinetic-pharmacodynamic (PKPD)
models. For example, propofol models have
been developed for use in children. Generalpurpose
models designed for a broad popudynamic
status during administration,
as high doses could cause decreased
cardiac output and arrhythmias. According
to Folina et al, potential reactions
include airway obstruction and apnea,
hypotension, myoclonus, QT interval
prolongation on EKG (an irregular heart
8
ASC Leader | October 2024
lation range (children, adults, elderly, and
obese patients) have also been developed.
These general-purpose models have fewer
restrictions for patient selection and, thus,
increase the match between a model and a
clinical situation, reducing incorrect usage
and unfamiliarity with a specific TCI model
and increasing the clinical acceptance of TCI.
As for new applications, intranasal administrations
for dexmedetomidine and midazolam
have been tried on trypanophobic
patients. The nasal mucosa absorbs both
drugs well, providing an alternative for these
patients for procedural sedation.
rhythm that is rarely clinically significant
in this context), and discolored urine (a
green tint-very rare).
Dr Patel emphasizes that safe, effective
administration depends on the
skills and training of the practitioners as
well as teamwork and communication
Pursuing PSA perfection
Dr Patel says he does not anticipate
a new anesthetic hitting the market
with markedly better properties than
and comparable cost-effectiveness to
propofol in the near future. However,
the quest for the perfect anesthesia
drug with a rapid onset and offset, few
negative effects on the circulatory and
respiratory systems, minimal side effects,
and antiemetic or analgesic effects
continues. Originally published in
June 2022 in the Journal of Clinical
Medicine, the graph on the left (sidebar,
Novel 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 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
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