Since its introduction, anaesthetists have devised ways of using the laryngeal mask airway to facilitate tracheal intubation, either by passing an endotracheal tube blindly down the lumen of a correctly positioned layrngeal mask airway or by first using it as a guide for the passage of a fibreoptic laryngoscope. Recently a purpose designed intubating laryngeal mask airway has been described, which allows blind successful placement of endotracheal tubes up to 8. The McCoy laryngoscope is a recent aid for difficult intubations. Use of this hinged tip has been shown to improve the view of the larynx in a substantial proportion of difficult laryngoscopies, 41 and as a result the McCoy laryngoscope has become popular.

DJR has been reimbursed for attending several conferences and has received lecture fees from GlaxoWellcome manufacturer of remifentanil. National Center for Biotechnology Information , U.

Anaesthesia

Journal List BMJ v. Author information Copyright and License information Disclaimer. D J Rowbotham ku. This article has been cited by other articles in PMC. Methods Although anaesthesia encompasses intensive care medicine and chronic pain management, our review is limited to advances in anaesthesia for surgery and obstetrics. Inhalational anaesthesia Volatile anaesthetics remain the commonest agents for maintenance of anaesthesia but since the introduction of sodium thiopentone, intravenous agents have been used for induction.

A unique opioid, remifentanil, allows fine control of intraoperative analgesia but its effects wear off within minutes of stopping infusion. Mobile epidurals are rapidly gaining popularity in labour wards because they allow normal mobility with high quality pain relief. Neurokinin type 1 receptor antagonists promise to further improve management of postoperative nausea and vomiting. Desflurane Desflurane was also developed in the s and has been only recently introduced into clinical practice.

Xenon Xenon is an inert gas with anaesthetic properties but until recently its cost has been prohibitive. Intravenous anaesthesia Total intravenous anaesthesia Propofol Since the introduction of propofol in no new intravenous anaesthetic agents have been introduced. Target controlled infusion Target controlled infusion systems allow the anaesthetist to set a desired plasma concentration, which the software inside the pump produces rapidly but safely by controlling the infusion rate according to complex but standard pharmacokinetic equations.

Open in a separate window. Remifentanil Remifentanil is a new potent synthetic opioid ideally suited for infusion often with a target controlled infusion system during anaesthesia. Local anaesthetics Bupivacaine Bupivacaine is the most frequently used local anaesthetic for perioperative and postoperative pain relief in many countries. Mobile epidurals A recent advance in obstetric anaesthesia has been the introduction of mobile epidurals. Postoperative emesis Postoperative nausea and vomiting remains a significant morbidity problem after general anaesthesia and the 5-HT 3 antagonists have been shown to be at least as effective as standard antiemetics but with an improved side effect profile.

Equipment Laryngeal mask airway One of the most significant advances in anaesthesia in recent years has been the laryngeal mask airway.

McCoy laryngoscope The McCoy laryngoscope is a recent aid for difficult intubations. Comparison of sevoflurane and halothane for outpatient dental anaesthesia in children. Sevoflurane—a long-awaited volatile anaesthetic. Clinical impressions and cardiorespiratory effects of a new fluorinated inhalational anaesthetic, desflurane I , in volunteers. Induction and maintenance characteristics of anaesthesia with desflurane and nitrous oxide in infants and children. Desflurane—a review of its pharmacodynamic and pharmacokinetic properties and its efficacy in general anaesthesia.

Recovery profile after desflurane-nitrous oxide versus isoflurane-nitrous oxide in outpatients. Efficiency of a circle system for short surgical cases: Xenon provides faster emergence from anaesthesia than does nitrous oxide-sevoflurane or nitrous oxide-isoflurane. Comparison of the analgesic potency of xenon and nitrous oxide in humans evaluated by experimental pain. Mirakhur RK, Morgan M. Manual compared with target controlled infusion of propofol.

Auditory evoked potential index: Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia: Closed-loop control of anaesthesia. Remifentanil pharmacokinetics and pharmacodynamics. Remifentanil—an opioid for the 21st century.

Cardiac arrest following regional anaesthesia with etidocaine or bupivacaine. Acute bupivacaine toxicity as a result of venous leakage under the tourniquet cuff during a Bier block. Myocardial uptake of bupivacaine: Expert Opinion Invest Drugs. Central nervous and cardiovascular effects of intravenous infusion of ropivacaine, bupivacaine and placebo in healthy volunteers. Comparison of extradural ropivacaine and bupivacaine. Randomised comparison of combined spinal-epidural and standard epidural analgesia in labour.

Cochrane Collaboration; Issue 1. Epidural versus non-epidural analgesia for pain relief in labour. Cochrane Database of Systematic Reviews. Shende D, Mandal NG. Efficacy of ondansetron and metoclopramide for preventing postoperative emesis following strabismus surgery in children.

Antiemetic activity of the NK 1 receptor antagonist GR in the treatment of established postoperative nausea and vomiting after major gynaecological surgery. Large clinical trials are needed to provide the greatest level of evidence and safety prior to widespread clinical implementation.


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How to cite this article. Close Copy Citation Details. Recent advances in intravenous anesthesia and anesthetics [version 1; referees: Anesthesiology, as a field, has made promising advances in the discovery of novel, safe, effective, and efficient methods to deliver care. This review explores refinement in the technology of soft drug development, unique anesthetic delivery systems, and recent drug and device failures. The author s declared that no grants were involved in supporting this work.

New innovations in drug development Recent and evolving drug innovations are primarily focused on modifying the chemical structures of existing drugs or drug classes with intent to improve their pharmacodynamic, pharmacokinetic, and side effect properties. Remimazolam and ADV Midazolam is a widely used sedative and anxiolytic administered as a popular sedation choice and is used for patient care in a variety of inpatient and outpatient settings.

Etomidate derivatives Etomidate is a highly potent hypnotic agent which was introduced into clinical practice in and gained popularity largely because of its relatively benign cardiovascular and respiratory effects. Structures of parent hypnotics and their carboxylic acid metabolites.

New propofol derivatives and alternatives Propofol has been a transformative anesthetic agent since its introduction 40 years ago and is still considered to be a near-ideal anesthetic agent. Xenon Xenon was first administered to humans in New innovations in drug delivery Target-controlled infusion Innovations in computer technology, pharmacokinetic modeling, and IV infusion delivery devices have fostered the development of TCIs.

Closed-loop system for hypnosis. Failure of new innovations Some technological innovations initially offered promise. Computer-assisted personalized sedation system Initially, there was optimism that Sedasys could revolutionize the field of non-operating room sedation by integrating continuous physiologic monitoring with patient feedback response to auditory stimuli to control the depth of sedation. Fospropofol Fospropofol Lusedra Eisai Inc.

Conclusion New innovations in drug development and delivery contribute to continued improvement in anesthesia. Competing interests No competing interests were disclosed.

Introduction

Grant information The author s declared that no grants were involved in supporting this work. Acknowledgements The authors would like to thank Kevin Gribaudo Administrative Associate for his help and support. F recommended References 1. Innovation in the pharmaceutical industry: Clinical development success rates for investigational drugs.

Pharmacokinetics and pharmacodynamics of the short-acting sedative CNS in sheep. Human carboxylesterases and their role in xenobiotic and endobiotic metabolism. J Biochem Mol Toxicol. A placebo- and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam CNS Population pharmacokinetic and pharmacodynamic modeling and simulation. Safety, efficacy, and basic pharmacokinetics. A Phase IIa, randomized, double-blind study of remimazolam CNS versus midazolam for sedation in upper gastrointestinal endoscopy.

A phase IIb study comparing the safety and efficacy of remimazolam and midazolam in patients undergoing colonoscopy. A phase Ib, dose-finding study of multiple doses of remimazolam CNS in volunteers undergoing colonoscopy. Development and formulation of a 0. Benefits of methylated cyclodextrins in the development of midazolam pharmaceutical formulations.

Population pharmacokinetic evaluation of ADV, an innovative oral solution of midazolam containing cyclodextrin. Eur J Pharm Sci. The Role of the Metabolite. Pharmacological studies of methoxycarbonyl etomidate's carboxylic acid metabolite. Differential effects of etomidate and its pyrrole analogue carboetomidate on the adrenocortical and cytokine responses to endotoxemia. In vivo and in vitro pharmacological studies of methoxycarbonyl-carboetomidate.

Prevention of pain on injection with propofol: Prevention of pain on injection of propofol: Influence of polyvinyl chloride infusion extension tube on propofol injection pain: Damitz R, Chauhan A: A comparison of pain on intravenous injection between two preparations of propofol.

Inhalational anaesthesia

Publisher Full Text The anesthetic properties of xenon in animals and human beings, with additional observations on krypton. Neuroprotective effects of the inhalational anesthetics isoflurane and xenon after cardiac arrest in pigs. Xenon offers stable haemodynamics independent of induced hypothermia after hypoxia-ischaemia in newborn pigs. Minimum alveolar concentration MAC of xenon with sevoflurane in humans. Neuroprotection and neurotoxicity in the developing brain: Safety and feasibility of xenon as an adjuvant to sevoflurane anaesthesia in children undergoing interventional or diagnostic cardiac catheterization: Pharmacokinetics as applied to total intravenous anaesthesia.

Intravenous anesthesia and analgesia: The History of Target-Controlled Infusion. Evaluation of a novel closed-loop total intravenous anaesthesia drug delivery system: Model-driven closed-loop feedback infusion of atracurium and vecuronium during hypothermic cardiopulmonary bypass. J Cardiothorac Vasc Anesth. Closed-loop double-vasopressor automated system to treat hypotension during spinal anaesthesia for caesarean section: Intraoperative stroke volume optimization using stroke volume, arterial pressure, and heart rate: Dexmedetomidine pharmacokinetic-pharmacodynamic modelling in healthy volunteers: Influence of arousal on bispectral index and sedation.

Titration of propofol for anesthetic induction and maintenance guided by the bispectral index: Statement on Nonoperating Room Anesthetizing Locations. Practice guidelines for sedation and analgesia by non-anesthesiologists. Computer-assisted personalized sedation for upper endoscopy and colonoscopy: Goudra B, Singh PM: Destiny or Poor Design? An improved design of water-soluble propofol prodrugs characterized by rapid onset of action.

Article Versions 1 version 1. This is an open access article distributed under the terms of the Creative Commons Attribution Licence , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mahmoud M and Mason KP. Track an article to receive email alerts on any updates to this article. Approved with reservations Key revisions are required to address specific details and make the paper fully scientifically sound. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions.

Editorial Note on the Review Process F Faculty Reviews are commissioned from members of the prestigious F Faculty and are edited as a service to readers. No competing interests were declared. Comments on this article Comments 0. F Faculty Reviews are commissioned from members of the prestigious F Faculty. In order to make these reviews as comprehensive and accessible as possible, peer review takes place before publication; the referees are listed below, but their reports are not formally published.

Wensheng Zhang , Sichuan University, China. Comments on this article.

Recent advances: Anaesthesia

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