Can you explain a few different types of sedatives? I know ketamine is your favorite, but what are some other options?
Hey there nonny! Congrats on being the first in the inbox for July!!
Okay. Sedatives. This is an entire monumental class of medications, so you’ll forgive me if I have to be fairly brief about each type.
There are more than a few sedatives and anesthetics that have been used throughout history. In this day and age, the most common are the benzodiazepines, which I have [a full post on here].
Basically, benzos work by hitting GABA receptors and suppressing brain activity, which is also why they work so well for seizures. Benzos can be given as an injection in the muscle (IM), in the vein (IV), orally (PO), and some can be given via the nose (IN, intranasally). How long they take to kick in will depend on the medication.
In terms of anesthetics, the next big one is propofol, AKA Milk of Amnesia, AKA Jackson Juice if your character is a bit of a cynic. Propofol is a milky-white medicine which MUST be given by IV. Propofol is basically instant unconsciousness in a glass vial. Anesthesiologists love this crap, because it’s literally dial-a-brain: turn on the medicine and the brain shuts down, turn off the medicine the person wakes up with minimal effects. Having had propofol, I can say it’s absolutely magical. Outpatient procedures basically depend on it.
The downside of propofol is that it can cause severe drops in blood pressure, which makes it less than ideal for emergency uses, and that it must go by IV.
Next up are the barbiturates, such as phenobarbital, thiopental, and secobarbital. These are an older class of meds who have fallen out of favor as sedatives but retain a role for seizure prevention and management, and were initially investigated as potential [truth serums].
These tend to be fairly long-acting and relatively unpredictable in their effects (compared to benzos and propofol), and can be given as pills (PO), intravenously (IV) or in the muscle (IM), depending on the specific med. These last anywhere from 4-6 hours, and can cause respiratory depression in overdose (just like almost all benzos).
Sleep aids like Ambien (zolpidem) technically fall into the sedative category as well. Diphenhydramine is typically sold over-the-counter as a sleep aid… but is better known by its trade name, Benadryl. It’s sold OTC in the same doses for both indications but often at wildly different prices, so a smart character might take the same med for both indications, while a less-observant character might accidentally overdose if they take it for their allergies (Benadryl) and to help them sleep (Unisom).
As for inhaled sedation, ether and chloroform are both historical inhaled anesthetics, but the difficulty with them is dosing. Both drugs have a fairly narrow therapeutic index; that is, the difference between a dose that’s safe and healthy and a dose that could kill your character is very small. They both also take a few minutes to kick in, meaning that the old ”Hey, does this smell like chloroform to you?” method of subduing characters isn’t realistic.
In fact, all sedatives take between 1 and 5 minutes to kick in, meaning that your character may still have to struggle with the subdued before the meds kick in.
Nitrous oxide is another inhaled anesthetic, AKA laughing gas, with a sweet odor. Its half-life is about 5 minutes, so characters who need to remain sedated will need the nitrous to continue to be on. It typically doesn’t produce general anesthesia, but is used as an anxiolytic (ie to reduce anxiety) and for partial sedation. Interestingly enough, some ambulances in this world carry nitrous oxide. (Note: not to be confused with inhaled nitric oxide, which is a pulmonary antihypertensive gas.)
Other anesthetic gasses still in use include desflurane, isoflurane, and sevoflurane. These require an anesthesia machine to deliver, partially because many of them are liquid at room temperature and must be heated to become gasses.
Etomidate is an anesthetic that’s used almost exclusively for intubation; it must go IV, it only works for a few minutes, which means it needs another sedative to go with it. That makes it ideal for putting tubes in people.
I’ve struggled with whether or not to include opiates in this list. The thing about opiates, such as morphine, methadone, meperidine, and heroin, is that while they do make characters sleepy, it’s not their primary effect. (Then again, doctors don’t always get this right; you would be appalled by the number of ICUs who believe that using fentanyl as a “sedative” is an appropriate course of action.) These work by acting on opioid receptors, which manage pain but also help make someone very drowsy. The danger with opioid overdose is respiratory depression, to one degree or another.
You mentioned ketamine. Ketamine is the anesthetic I think works best in most situations in which writers use sedatives; it reliably produces unconsciousness, it’s relatively safe when administered properly, doesn’t tank blood pressure, typically leaves breathing reflexes intact, etc. However, it’s not perfect, and it’s a bad idea to use recreationally, as is literally every drug in this post.
I hope this helped!!