Recent Developments in Drugs for GI Endoscopy Sedation
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REVIEW
Recent Developments in Drugs for GI Endoscopy Sedation Basavana Goudra1 · Gowri Gouda2 · Preet Mohinder3 Received: 14 November 2019 / Accepted: 1 January 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Providing sedation for patients undergoing gastrointestinal (GI) endoscopy continues to be a debated topic in both anesthesia and gastroenterology circles. Sedation approaches are widely varied across the globe. While propofol administration is embraced by more endoscopists and patients, its administration evolves controversy. Whereas trained nurses and gastroenterologists are allowed to administer propofol for GI endoscopy sedation in Europe and Asia, it is the sole privilege of anesthesia providers in the USA. However, the costs of anesthesia providers are significant and threaten to derail the screening colonoscopy practice. Efforts were made by both drug and device manufacturers to find alternatives. Fospropofol was one such effort that did not live up to the expectations due to respiratory depressant properties that were similar to propofol. Use of a new tool to administer propofol in the form of Sedasys® was the next experiment that tried to find alternative to anesthesia providers. The device did not succeed due to inadequate sedation. The latest effort is remimazolam, a new benzodiazepine that has quicker recovery profile. In the interim, many drug combinations such as propofol–dexmedetomidine and propofol–ketamine are improving the safety without compromising the quality of sedation. This review attempts to discuss the new drug innovations and drug combinations of existing sedatives for the benefit of readers. Keywords Sedation · Remimazolam · Oliceridine · Propofol · Dexmedetomidine
Drugs in GI Endoscopy Sedation, What Is New? Introduction Sedation for GI endoscopy centers around propofol. However, propofol is fraught with significant limitations including interpatient pharmacokinetic and pharmacodynamic variability, airway compromise, respiratory depression, hypotension, and absence of a reversal agent [1]. Various
approaches to overcome these potential drawbacks include dose titration, preemptive airway management techniques, and use of general anesthesia with endotracheal intubation. Anesthesia providers may also modify their sedation technique by supplementing with other drugs. Such drugs include dexmedetomidine, ketamine, remifentanil, and local anesthetics. The anesthesia community is also eagerly anticipating G-protein-biased µ receptor agonists which can revolutionize the practice of anesthesia and sedation. Oliceridine was recently denied approval by the FDA, however, hopefully similar drugs find success.
* Basavana Goudra [email protected]
Dexmedetomidine
Gowri Gouda [email protected]
Mechanism of Action
1
Perelman School of Medicine, Hospital of the University of Pennsylvania, 680 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA
2
Burrel College of Osteopathic Medicine, 3501 Arrowhead Drive, Las Cruces, NM 88001, USA
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