Topic
Hypnotic
About: Hypnotic is a research topic. Over the lifetime, 2024 publications have been published within this topic receiving 64467 citations. The topic is also known as: hypnotics & soporific drug.
Papers published on a yearly basis
1 / 2
Papers
TL;DR: Patients can be reassured that short sleep and insomnia seem associated with little risk distinct from comorbidities, and Slight risks associated with 8 or more hours of sleep and sleeping pill use need further study.
Abstract: Background Patients often complain about insufficient sleep or chronic insomnia in the belief that they need 8 hours of sleep. Treatment strategies may be guided by what sleep durations predict optimal survival and whether insomnia might signal mortality risks. Methods In 1982, the Cancer Prevention Study II of the American Cancer Society asked participants about their sleep duration and frequency of insomnia. Cox proportional hazards survival models were computed to determine whether sleep duration or frequency of insomnia was associated with excess mortality up to 1988, controlling simultaneously for demographics, habits, health factors, and use of various medications. Results Participants were more than 1.1 million men and women from 30 to 102 years of age. The best survival was found among those who slept 7 hours per night. Participants who reported sleeping 8 hours or more experienced significantly increased mortality hazard, as did those who slept 6 hours or less. The increased risk exceeded 15% for those reporting more than 8.5 hours sleep or less than3.5 or 4.5 hours. In contrast, reports of "insomnia" were not associated with excess mortality hazard. As previously described, prescription sleeping pill use was associated with significantly increased mortality after control for reported sleep durations and insomnia. Conclusions Patients can be reassured that short sleep and insomnia seem associated with little risk distinct from comorbidities. Slight risks associated with8 or more hours of sleep and sleeping pill use need further study. Causality is unproven.
1,701 citations
TL;DR: The current pattern of hypnotic usage, an issue of widespread concern, is subjected to a behavioral analysis based on a new model of conditioned tolerance and the intermittent administration of placebo within a hypnotic regimen is predicted to be especially beneficial in sustaining hypnotic efficacy.
1,100 citations
TL;DR: Advantages of midazolam over thiopental are those of the more versatile pharmacologic properties of a benzodiazepine compared with a barbiturate such as amnestic and anxiolytic properties.
Abstract: Midazolam is an imidazobenzodiazepine with unique properties when compared with other benzodiazepines It is water soluble in its acid formulation but is highly lipid soluble in vivo Midazolam also has a relatively rapid onset of action and high metabolic clearance when compared with other benzodiazepines The drug produces reliable hypnosis, amnesia, and antianxiety effects when administered orally, intramuscularly, or intravenously There are many uses for midazolam in the perioperative period including premedication, anesthesia induction and maintenance, and sedation for diagnostic and therapeutic procedures Midazolam is preferable to diazepam in many clinical situations because of its rapid, nonpainful induction and lack of venous irritation Compared with thiopental, midazolam is not as rapid acting nor predictable in hypnotic effect It will not replace thiopental as an induction agent Advantages of midazolam over thiopental are those of the more versatile pharmacologic properties of a benzodiazepine compared with a barbiturate such as amnestic and anxiolytic properties Midazolam should be a useful addition to the formulary
1,048 citations
TL;DR: Benzodiazepines are safe and effective when administered by paramedics for out-of-hospital status epilepticus in adults and Lorazepam is likely to be a better therapy than diazepam.
Abstract: Background It is uncertain whether the administration of benzodiazepines by paramedics is an effective and safe treatment for out-of-hospital status epilepticus. Methods We conducted a randomized, double-blind trial to evaluate intravenous benzodiazepines administered by paramedics for the treatment of out-of-hospital status epilepticus. Adults with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures received intravenous diazepam (5 mg), lorazepam (2 mg), or placebo. An identical second injection was given if needed. Results Of the 205 patients enrolled, 66 received lorazepam, 68 received diazepam, and 71 received placebo. Status epilepticus had been terminated on arrival at the emergency department in more patients treated with lorazepam (59.1 percent) or diazepam (42.6 percent) than patients given placebo (21.1 percent) (P=0.001). After adjustment for covariates, the odds ratio for termination of status epilepticus by the time of arrival in the lorazepam group as compa...
866 citations
TL;DR: Based on clinical studies and computer simulations, midazolam has the shortest recovery profile followed by lorazepam and diazepam, and flumazenil is very useful in reversing benzodiazepine-induced sedation as well as to diagnose or treat benzodiazine overdose.
Abstract: The actions of benzodiazepines are due to the potentiation of the neural inhibition that is mediated by gamma-aminobutyric acid (GABA). Practically all effects of the benzodiazepines result from their actions on the ionotropic GABAA receptors in the central nervous system. Benzodiazepines do not activate GABAA receptors directly but they require GABA. The main effects of benzodiazepines are sedation, hypnosis, decreased anxiety, anterograde amnesia, centrally mediated muscle relaxation and anti-convulsant activity. In addition to their action on the central nervous system, benzodiazepines have a dose-dependent ventilatory depressant effect and they also cause a modest reduction in arterial blood pressure and an increase in heart rate as a result of a decrease of systemic vascular resistance. The four benzodiazepines, widely used in clinical anaesthesia, are the agonists midazolam, diazepam and lorazepam and the antagonist flumazenil. Midazolam, diazepam and flumazenil are metabolized by cytochrome P450 (CYP) enzymes and by glucuronide conjugation whereas lorazepam directly undergoes glucuronide conjugation. CYP3A4 is important in the biotransformation of both midazolam and diazepam. CYP2C19 is important in the biotransformation of diazepam. Liver and renal dysfunction have only a minor effect on the pharmacokinetics of lorazepam but they slow down the elimination of the other benzodiazepines used in clinical anaesthesia. The duration of action of all benzodiazepines is strongly dependent on the duration of their administration. Based on clinical studies and computer simulations, midazolam has the shortest recovery profile followed by lorazepam and diazepam. Being metabolized by CYP enzymes, midazolam and diazepam have many clinically significant interactions with inhibitors and inducers of CYP3A4 and 2C19. In addition to pharmacokinetic interactions, benzodiazepines have synergistic interactions with other hypnotics and opioids. Midazolam, diazepam and lorazepam are widely used for sedation and to some extent also for induction and maintenance of anaesthesia. Flumazenil is very useful in reversing benzodiazepine-induced sedation as well as to diagnose or treat benzodiazepine overdose.
505 citations
Related Topics (5)
Performance Metrics
| Year | Papers |
|---|---|
| 2025 | 31 |
| 2024 | 66 |
| 2023 | 81 |
| 2022 | 113 |
| 2021 | 36 |
| 2020 | 24 |