Anesthetic agents come in various forms, including oral and intravenous (IV), and have different chemical compositions to suit different clinical situations and patient needs. Anesthetics with both oral and IV forms provide versatility, allowing healthcare providers to tailor sedation and analgesia depending on factors such as the procedure type, patient health, and the desired onset of action. These anesthetics include midazolam, ketamine, and certain opioids, with some research on adding other drugs to this list.

Midazolam is a medication used for its sedative and anxiolytic effects. In oral form, it is commonly used as a premedication for anxiety and sedation in pediatric patients. It is also used for conscious sedation. Oral midazolam is easy to administer, especially in children, and can be given before arriving at the hospital or operating room to calm the patient. It offers moderate sedation without the invasiveness of IV lines. In IV form, midazolam is used in anesthesia for sedation, amnesia, and anxiolysis in both adults and children. IV midazolam provides rapid onset, making it ideal for procedures that require immediate sedation. It also allows for continuous infusion or adjustment based on the depth of sedation needed ^1,2.

Another example of anesthetics with oral and IV forms is ketamine, which can provide analgesia and sedation. Oral ketamine is sometimes prescribed for chronic pain management and treatment-resistant depression. Oral ketamine is non-invasive and can be taken at home, offering convenience for chronic pain patients. Its slower onset and longer duration make it ideal for prolonged effects without the need for continuous monitoring. Ketamine is most frequently used intravenously for anesthesia in both short and long procedures. IV ketamine works quickly and can be controlled precisely, making it suitable for acute pain management and surgical anesthesia. It is especially useful in patients who need rapid sedation and pain relief ^3,4.

Though rarely used in oral form due to its high first-pass metabolism, oral propofol formulations are being explored in some research settings, primarily for mild sedation in non-invasive procedures or outpatient treatments. IV propofol, however, is one of the most commonly used anesthetics for induction and maintenance of general anesthesia, as well as procedural sedation. IV propofol offers quick induction of anesthesia and a smooth recovery profile. Its short half-life allows for quick adjustments during surgery, making it one of the most versatile anesthetics in IV form ^5,6.

Oral anesthetics avoid the need for IV lines and are often preferable in children or patients with needle phobia, as they can be administered without the stress of IV placement. For conditions requiring long-term sedation or pain relief, such as chronic pain or anxiety management, oral forms allow patients to take the medication at home under medical guidance.

In contrast, IV anesthetics take effect quickly and can be titrated to achieve the desired level of sedation or anesthesia within seconds, making them ideal for surgical procedures where rapid control is critical. Because IV anesthetics can be delivered continuously or incrementally, the level of anesthesia can be adjusted in real-time, and the effects can be reversed quickly if necessary ^7,8.

Anesthetics available in both oral and IV forms offer flexibility in patient care, allowing healthcare providers to select the most appropriate route of administration based on the clinical situation.

References

1. Midazolam – StatPearls – NCBI Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK537321/.
2. Lingamchetty, T. N., Hosseini, S. A. & Saadabadi, A. Midazolam. xPharm Compr. Pharmacol. Ref. 1–5 (2023). doi:10.1016/B978-008055232-3.62185-3
3. Ketamine – StatPearls – NCBI Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470357/.
4. Rosenbaum, S. B., Gupta, V., Patel, P. & Palacios, J. L. Ketamine. StatPearls (2024).
5. Propofol – StatPearls – NCBI Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK430884/.
6. Aboian, M., Johnson, J. M. & Thomas Ginat, D. Propofol. Neuroimaging Pharmacopoeia, Second Ed. 281–283 (2023). doi:10.1007/978-3-031-08774-5_40
7. Top 3 Benefits Of Oral And IV Sedation. Available at: https://ormondperio.com/blog/top-3-benefits-of-oral-and-iv-sedation.
8. Advantages and Disadvantages of Oral Sedation | Jenison Sedation Dentists. Available at: https://www.gdpsmiles.com/advantages-disadvantages-of-oral-sedation.php.