Emerging horizons in anaesthetic practice: a pharmacological update

Abstract

Anesthesiologists are in search for new drugs possessing properties like rapid onset of action, minimal residual effects, better hemodynamic stability, organ independent metabolism and cost effective. Structural alterations of the currently available compounds or newer formulations of the older ones or newer anaesthetic drug delivery system will be an useful alternative to newer discovery by reducing the cost and time. Tapentadol is a centrally acting µ opioid receptor (MOR) agonist with selective norepinephrine reuptake inhibition, approved by US FDA for treating moderate to severe acute pain in adults more than 18 years of age. Sugammadex, a novel selective relaxant binding agent to reverse steroidal neuromuscular blockers is recently approved by the European Union. Gantacurium, a rapid and ultra short acting non depolarizing neuromuscular blocker, inactivated rapidly by the adduction of non essential amino acid cysteine to the gantacurium molecule is in clinical trials. Remimazolam is a new drug in clinical trials that has a rapid onset of action like midazolam and is metabolized by non specific tissue esterases like remifentanil and expected to have a promising future. Liposomal Bupivacaine is approved by FDA in October 2011 that uses bupivacaine in liposomal vesicles to extend the duration of analgesia upto 72 hours and reduces the opioid use in the post operative period. Methoxy carbonyl carboetomidate is in clinical trials that combines the advantages of MOC etomidate and carboetomidate. Hence anaesthesiology is marching towards a bright pathway with new soft drugs coming up making not only anaesthesiology soft but also pharmacology.