静脉麻醉最新进展英文版和中文翻译.doc

Recent advances in intravenous anaesthesia Efforts to develop new hypnotic compounds continue, although several have recently failed in development. Propofol has been reformulated in various presentations with and without preservatives. Pharmacokinetic and pharmacodynamic differences exist between some of these preparations, and it is currently unclear whether any have substantial advantages over the original presentation. The use of target-controlled infusion (TCI) has been extended to include paediatric anaesthesia and sedation. Application of TCI to remifentanil is now licensed. Linking of electroencephalogram (EEG) monitoring to TCI for closed-loop anaesthesia remains a research tool, although commercial development may follow. The availability of stereoisomer ketamine and improved understanding of its pharmacology have increased non-anaesthetic use of ketamine as an adjunct analgesic. It may be useful in subhypnotic doses for postsurgical patients with pain refractory to morphine administration. Br J Anaesth 2004; 93: 725–36 Keywords: anaesthetics i.v., etomidate; anaesthetics i.v., ketamine; anaesthetics i.v., ORG21465; anaesthetics i.v., ORG25435; anaesthetics i.v., propofol; anaesthetics i.v., THRX-918661; analgesics opioid, remifentanil Intravenous anaesthesia (IVA) is now well established in most areas of anaesthetic provision and is the preferred technique for some. This review assesses the present status of IVA, describes recent and forthcoming developments, and addresses various related controversies and their implications. Intravenous anaesthetics have other uses beyond the induction and maintenance of anaesthesia, and recent developments of relevance to clinicians are also summarized. Material for this review was gathered from literature searching, attendance at meetings and personal communication with experts in the field. Priority has been given to developments since 2000. The content has been constrained to clinical developments and late-stage anim