Chapter 10
- Intravenous Nonopioid Anesthetics
- J. G. Reves
- Peter S. A. Glass
- David A. Lubarsky
- Matthew D. McEvoy
The introduction of thiopental into clinical practice in 1934
marked the advent of modern intravenous anesthesia. Thiopental and other barbiturates,
however, are not ideal intravenous anesthetics, primarily because they provide only
hypnosis. The ideal intravenous anesthetic drug would provide hypnosis, amnesia,
analgesia, and muscle relaxation without undesirable cardiac and respiratory depression.
Because no single drug is ideal, many other drugs are used, often together, that
offer some or all of the desired effects. These drugs were introduced steadily into
clinical practice with varying degrees of acceptance. With an increasing number
of compounds and superior methods of intravenous anesthetic drug delivery available
(see Chapter 9
), the use
of intravenous anesthetics continues to grow.
The future of anesthetic management involves the simultaneous
use of several drugs, including inhaled anesthetics. A 1988 survey of mortality
in 100,000 anesthesia cases revealed that the practice of combined anesthetic drug
use may be safer than the use of only one or two drugs[1]
;
the relative odds of dying within 7 days was 2.9 times greater when one or two anesthetic
drugs were used than when three or more were used. Although it is exceedingly difficult
to interpret these data, the use of several drugs may be beneficial to anesthetic
care. Thus, the skillful use of multiple intravenous anesthetics is not only possible
but preferable. The purpose of this chapter is to provide information on the major
nonopioid intravenous anesthetic drugs available for clinical use today.
