Abstract
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.
Highlights
The first generation of intravenous (IV) agents for anesthesia induction and maintenance, as an alternative to volatile agents, dates back to the introduction of thiopental in the 1930’s
1 in 10 drugs in phase I development will go on to obtain Food and Drug Administration (FDA) approval[2], and some drugs are withdrawn from the market, even after approval, because of unanticipated limitations and drawbacks
Not occur after infusion of remimazolam because it is primarily cleared by unique tissue esterase enzymes, which convert it into an inactive carboxylic acid metabolite (CNS7054)[7,8]
Summary
The first generation of intravenous (IV) agents for anesthesia induction and maintenance, as an alternative to volatile agents, dates back to the introduction of thiopental in the 1930’s. While remimazolam was initially developed for use as a drug for procedural sedation, more studies are currently focused on utilizing this agent for the induction and maintenance of general anesthesia. Remimazolam is a new, short-acting, ester-based anesthetic agent that allows for rapid esterase-mediated metabolism independent of hepatic or renal enzymes and function[3,4] It is currently in phase III clinical development for procedural sedation in the USA. There may be significant pain upon IV injection and a potentially fatal risk of propofol infusion syndrome (PIS) With these challenges, attention has shifted to the development of new formulations and alternatives to improve the pharmacologic profile and overcome some of the disadvantages. Fospropofol was recently discontinued in the USA; the likely reasons include 1) its delayed onset of effect (peak effect is in 8 minutes with clinical effect in 4–13 minutes)[62] and slower recovery compared to propofol and 2) its significant associated perineal paresthesia and pruritus
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