Abstract
Anxiolytics and sedatives are used in current anaesthetic practice for two main reasons:
for anxiolysis before surgery and as adjuvants during anaesthesia. A wide choice of
agents are available. Their safety profile is dependent on their pharmacokinetic and
pharmacodynamic profiles, patient comorbidity and the experience of the clinician
using them. All sedative drugs have the potential to cause severe respiratory depression,
and hence they should only be used with standard physiological cardiorespiratory monitoring.
This is especially true of procedural sedation administered by non-anaesthetists in
remote locations. Drugs used for anaesthesia vary in their pharmacology, but have
broadly similar clinical effects. The choice of drug is usually a matter of individual
preference, although pharmacokinetic and pharmacodynamic parameters do influence the
selection of anaesthetic agents, especially in day case surgery. Most intravenous
agents are thought to alter consciousness by an effect at the γ-aminobutyric acid
type A (GABAA) or N-methyl-D-aspartate (NMDA) receptors or both. Our understanding of the mechanisms
of action of anaesthetic drugs is incomplete, not least because of a lack of understanding
of consciousness. Several theories have been proposed over the last century, but none
of them has managed to comprehensively elucidate the processes involved. There is
now a sense of expectation that with the use of modern imaging techniques, anaesthetic
drug action can be better understood, and that this may help in our understanding
of consciousness and cognitive functions.
Keywords
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Article Info
Publication History
Published online: August 04, 2022
Royal College of Anaesthetists CPD Skills Framework: PharmacologyPublication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Published by Elsevier Ltd.
