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Drug selection for ambulatory procedural sedation

Barends, Clemens R.M.a; Absalom, Anthony R.a; Struys, Michel M.R.F.a,b

Current Opinion in Anesthesiology: December 2018 - Volume 31 - Issue 6 - p 673–678
doi: 10.1097/ACO.0000000000000652
AMBULATORY ANESTHESIA: Edited by Claude Meistelman
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Purpose of review Ambulatory procedural sedation is used to relieve anxiety, pain and discomfort in a broad spectrum of patients during many types of diagnostic or therapeutic procedures. This review focuses on recent comparative studies of commonly used and new drugs for adult ambulatory sedation.

Recent findings Midazolam and propofol are commonly used for ambulatory sedation. Their pharmacological properties offer many advantages and there is much experience with their use. Ketamine can be a useful addition to hypnotic drugs but the advantage of the use of ketofol (a mixture of propofol and ketamine) is, although often practiced, difficult to assess. Dexmedetomidine is a relatively new sedative drug and many studies suggest advantages. New findings about its effects, however, show that the hemodynamic consequences of the use of dexmedetomidine may last for several hours. New sedative drugs for procedural sedation are still being developed: remimazolam has many properties that would make it an ideal sedative and has been studied in a phase 3 study.

Summary The properties that would constitute the ideal sedative have yet to be combined in one drug. The selection of the drugs used for ambulatory sedation depends on many factors such as procedure type, patient characteristics and the expectations of patients and the healthcare provider. Because of this, the literature cannot yet provide a definitive answer to the question which drug is best selected in a specific situation.

aDepartment of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

bDepartment of Anaesthesia and Peri-operative Medicine, Ghent University, Ghent, Belgium

Correspondence to Clemens R.M. Barends, MD, Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands. Tel: +31 50 361 6161; e-mail: c.r.m.barends@umcg.nl

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