Waugaman W R, Foster S D
Department of Anesthesiology, UCLA School of Medicine.
Nurs Clin North Am. 1991 Jun;26(2):451-61.
Pharmacologic advances in anesthesia over the last decade have focused on drug safety, shorter durations of action, reversibility, and ease of administration. This is reflective of major changes in the focus of patient care from inpatient to outpatient settings as well as from available risk management data that support the investigation of these new drugs. The pharmacologic advances discussed included those drugs in current practice as well as experimental drugs yet to be released for general clinical use. Inhaled agents, such as isoflurane and perhaps the experimental agent, desflurane, will maintain or achieve their popularity because of the relative ease of administration and wide margins of safety. Propofol, the most recent intravenous anesthetic available for clinical use, has already gained wide acceptance because of its dual function as an induction and maintenance agent and its appropriateness for use in the ambulatory surgical population. The role of midazolam in anesthesia practice has increased to such an extent that it has largely supplanted the use of diazepam (Valium). The introduction of the antagonist, flumazenil, will undoubtedly enhance the safety and efficacy of midazolam as well as broaden its applicability of use across various patient populations. Several of the newer synthetic narcotics, such as alfentanil and sufentanil, have replaced other narcotics formerly used in anesthesia practice, such as meperidine and morphine, primarily because of their short action and lack of significant side effects. The use of muscle relaxants as a critical component of anesthetic management has led to the development of a number of new drugs in this classification. Pharmacologic management of patients under anesthesia will at some future date likely include the administration of alpha 2 agonists. Administration of these drugs can reduce anesthetic requirements of traditional agents by as much as 50%. As research continues, new drugs will be incorporated into the practice of anesthesia, ones that will promote rapid uptake, low toxicity, intense analgesia, easy reversibility, shorter durations, and fewer side effects. One measure of success relative to pharmacologic development in anesthesia is the recent and dramatic decreases in patient morbidity and mortality figures over the last decade. This attests to the rapid growth and development of not only improved patient monitoring systems but also newly improved "agents of sleep."
过去十年间，麻醉学领域的药理学进展主要集中在药物安全性、更短的作用时长、可逆性以及给药便利性上。这反映了患者护理重点从住院环境向门诊环境的重大转变，同时也得益于支持这些新药研究的风险管理数据。所讨论的药理学进展包括当前临床实践中使用的药物以及尚未获批用于一般临床的实验性药物。吸入性麻醉剂，如异氟烷，或许还有实验性麻醉剂地氟烷，因其给药相对简便且安全范围广，将继续受到青睐或愈发普及。丙泊酚是最新可供临床使用的静脉麻醉剂，因其兼具诱导和维持麻醉的双重功能，且适用于门诊手术人群，已获得广泛认可。咪达唑仑在麻醉实践中的作用大幅增强，在很大程度上已取代了地西泮（安定）的使用。拮抗剂氟马西尼的引入无疑将提高咪达唑仑的安全性和有效性，并拓宽其在不同患者群体中的适用范围。几种新型合成麻醉镇痛药，如阿芬太尼和舒芬太尼，已取代了先前麻醉实践中使用的其他麻醉镇痛药，如哌替啶和吗啡，主要是因为它们作用时间短且副作用不明显。肌肉松弛剂作为麻醉管理的关键组成部分，促使该类别中研发出了许多新药。未来，麻醉患者的药理学管理可能会包括使用α2激动剂。使用这些药物可使传统麻醉剂的需求量降低多达50%。随着研究的不断深入，新的药物将被纳入麻醉实践，这些药物将具有吸收迅速、毒性低、镇痛效果强、易于逆转、作用时间短和副作用少等特点。衡量麻醉药理学发展成功与否的一个标准是，过去十年患者发病率和死亡率显著下降。这不仅证明了患者监测系统的快速发展，也证明了新型“睡眠药物”的不断改进。
