Fospropofol disodium injection for the sedation of patients undergoing colonoscopy

Levitzky, Benjamin E; Vargo, John J.

doi:10.2147/tcrm.s3091

Cited by 18 publications

(1 citation statement)

References 23 publications

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“…Propofol's narrow therapeutic index, lack of therapeutic antagonist [ 56 ], and lipid formulation [ 57 ] limit its use in some patient populations.…”

Section: Mac Agentsmentioning

confidence: 99%

Perspectives on the Role of Fospropofol in the Monitored Anesthesia Care Setting

Pergolizzi

Gan

Plavin

et al. 2011

Anesthesiology Research and Practice

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Monitored anesthesia care (MAC) is a safe, effective, and appropriate form of anesthesia for many minor surgical procedures. The proliferation of outpatient procedures has heightened interest in MAC sedation agents. Among the most commonly used MAC sedation agents today are benzodiazepines, including midazolam, and propofol. Recently approved in the United States is fospropofol, a prodrug of propofol which hydrolyzes in the body by alkaline phosphatase to liberate propofol. Propofol liberated from fospropofol has unique pharmacological properties, but recently retracted pharmacokinetic (PK) and pharmacodynamic (PD) evaluations make it difficult to formulate clear conclusions with respect to fospropofol's PK/PD properties. In safety and efficacy clinical studies, fospropofol demonstrated dose-dependent sedation with good rates of success at doses of 6.5 mg/kg along with good levels of patient and physician acceptance. Fospropofol has been associated with less pain at injection site than propofol. The most commonly reported side effects with fospropofol are paresthesia and pruritus. Fospropofol is a promising new sedation agent that appears to be well suited for MAC sedation, but further studies are needed to better understand its PK/PD properties as well its appropriate clinical role in outpatient procedures.

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“…Propofol's narrow therapeutic index, lack of therapeutic antagonist [ 56 ], and lipid formulation [ 57 ] limit its use in some patient populations.…”

Section: Mac Agentsmentioning

confidence: 99%

Perspectives on the Role of Fospropofol in the Monitored Anesthesia Care Setting

Pergolizzi

Gan

Plavin

et al. 2011

Anesthesiology Research and Practice

View full text Add to dashboard Cite

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Newer Drugs for Sedation: Soft Pharmacology

Brohan

Lee

2016

Out of Operating Room Anesthesia

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Medical, Political, and Economic Considerations for the Use of MAC for Endoscopic Sedation: Big Price, Little Justification?

2020

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The last few decades of gastrointestinal (GI) endoscopy have seen phenomenal growth. In many aspects, GI endoscopy has led the field of nonsurgical interventional medicine. In many aspects, this growth is facilitated by advancements in sedation—both drugs and techniques. Unfortunately, the topic of GI endoscopy sedation is also mired in many controversies, mainly emanating from the cost of anesthesia providers. While no one debates their role in the majority of advanced endoscopic procedures, the practice of universal propofol sedation in the USA, delivered by anesthesia providers, needs a closer look. In this review, medical, political, and economic considerations of this important topic are discussed in a very frank and honest way. While such ubiquitous propofol use has increased satisfaction of both patients and gastroenterologists, there is little justification. More importantly, going by the evidence, there is even less justification for the mandated anesthesia providers use for such delivery. Unfortunately, the FDA could not be convinced otherwise. The new drug fospropofol met the same fate. Approval of SEDASYS ® , the first computer-assisted personalized sedation system, was a step in the right direction, nevertheless an insufficient step that failed to takeoff. As a result, in spite of years of research and efforts of many august societies, the logjam of balancing cost and justification of propofol sedation has continued. We hope that recent approval of remimazolam, a novel benzodiazepine, and potential approval of oliceridine, a novel short-acting opioid, might be able to contain the cost without compromising the quality of sedation.

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Fospropofol disodium injection for the sedation of patients undergoing colonoscopy

Cited by 18 publications

References 23 publications

Perspectives on the Role of Fospropofol in the Monitored Anesthesia Care Setting

Perspectives on the Role of Fospropofol in the Monitored Anesthesia Care Setting

Newer Drugs for Sedation: Soft Pharmacology

Medical, Political, and Economic Considerations for the Use of MAC for Endoscopic Sedation: Big Price, Little Justification?

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