Sedative Drugs – Opiates and Sedatives

by Brian Warriner, MD

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    00:00 been done is nausea and vomiting, not pain. So let's talk a little bit about some of the other drugs.

    00:02 The most effective anti-anxiety medications we have are benzodiazepines. These are drugs such as, Valium is the one that people remember, that's an older drug. Currently we use midazolam and lorazepam primarily.

    00:20 We used to use these drugs as part of a pre-med, before the patient came to surgery, an hour or two before surgery. But this is largely been abandoned much to everyone's surprise. Patients found the sedation and the often accompanying amnesia associated with these drugs, to be unpleasant.

    00:38 With very anxious patients, a drug such as midazolam, will bring some relief prior to induction of anesthesia. Plus the amnestic effect usually associated with the medication may reduce the possibility of recall during anesthesia.

    00:56 These agents are generally utilized as sleep aids or anti-anxiety medications, and are not widely used for patients who are going to receive general anesthesia.

    01:08 They are very effective however improving anxiety levels when patients are undergoing regional anesthesia or surgery under local anesthetic injection. So we're now going to talk about local anesthetics. Local anesthetics are used both in just infiltration of the skin or other tissue areas, so the surgeon can work on them, but more commonly are used in a regional format where a block is used to anesthetize a group of nerves, a plexus of nerves so that more than one area is affected at the same time. So when the dentist gives you local anesthetic in your mouth, he or she is actually not just infiltrating the gums, they're actually blocking a series of nerves that enter your face, and that's a regional block, that's not really a local infiltration. So your whole face is numb, not just one tooth. Ester local anesthetics, are the oldest of these drugs, and they include drugs such as cocaine. Yes, it's a local anesthetic. Procaine, tetracaine and many others. They are characterized by having an ester link that is metabolized like Succinylcholine by Pseudocholinesterase. So they're broken down by Pseudocholinesterase. They often have a core configuration of para-amino benzoic acid, PABA, same as sunscreens. And this PABA is associated with a high incidence of allergic reactions and anaphylaxis, which is the most severe type of allergic reactions. So Ester anesthetics are rarely used by modern anesthesiologists. The other type of local anesthetic is an amide local anesthetic and this is the more modern type of drug. And you can always differentiate between an ester and a amide local anesthetic by knowing its generic name. If there is no 'i' before the 'caine' in the generic name, it's a ester. If there is an 'i', then it's an amide. So think of lignocaine or lidocaine, 'i' comes before a 'caine', ropivicaine, there's an 'i' before a 'caine', bupivicaine, there's an 'i' before a 'caine', cocaine, no 'i' before a 'caine' so it's an ester.

    03:26 Amide local anesthetics such as lidocaine, which is also known as lignocaine, bupivicaine, ropivicaine, mepivicaine, and others, are preferred for regional anesthesia of all kinds because they are predictable in their onset and duration of action, and they virtually never produce allergic reactions.

    03:44 So in summary, in this lecture we've talked about the management of acute pain, surgical pain, trauma pain. We've talked about addiction and tolerance to opiates.

    03:56 We've talked about sedation with sedating drugs. We've talked about the incidence and the treatment or prevention of post-operative nausea and vomiting. And we've talked a little bit about regional anesthesia, and we'll talk more about that in a future slide. All the drugs that I've mentioned, must be well recognized by every anesthesiologist who must, in addition to understanding how to use them, understand the potential for side effects and how to manage side effects when they occur.

    About the Lecture

    The lecture Sedative Drugs – Opiates and Sedatives by Brian Warriner, MD is from the course Anesthesiology: Introduction.

    Included Quiz Questions

    1. They are generally used in neuraxial blocks or regional blocks.
    2. They are effective amnestics in anesthesia.
    3. They are comprised of amide and phenolic forms.
    4. They block only the pain nerves.
    1. It predicts the likelihood of nausea and vomiting after anesthesia.
    2. It indicates that post-operative nausea and vomiting is rare and does not require prophylaxis.
    3. It is a useful predictor of postoperative nausea and vomiting only after the use of general anesthesia for more than 2 hours duration.
    4. It shows that smoking is a major cause of postoperative nausea and vomiting.
    1. Benzodiazepines are no longer a preference for pre-operative use in patients receiving general anesthesia.
    2. Benzodiazepines are not very effective as sleep aids.
    3. Benzodiazepines are not effective in improving anxiety levels of patients receiving regional anesthesia.
    4. Benzodiazepines contain a chemical substance called PABA.
    5. Benzodiazepines are the second most effective drugs in improving anxiety levels.
    1. Bupivacaine
    2. Cocaine
    3. Procaine
    4. Tetracaine
    5. Benzocaine
    1. The absence of PABA
    2. The high rates of allergic reactions
    3. The slower than predicted onset
    4. The faster than predicted onset
    5. The unpredictable duration of action

    Author of lecture Sedative Drugs – Opiates and Sedatives

     Brian Warriner, MD

    Brian Warriner, MD

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