Anaesthesia

doi:10.1136/bmj.319.7209.557

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Andrew J Fox, lecturer,
David J Rowbotham, professor (David.Rowbotham@leicester.ac.uk)

University Department of Anaesthesia, University of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW

Correspondence to: D J Rowbotham

More than 150 years ago William Morton successfully used diethyl ether as general anaesthesia. Advances in anaesthesia have made many new surgical techniques possible, and mortality directly attributable to anaesthesia is now rare. Most recent advances have contributed to an important decrease in morbidity from anaesthesia and to an increase in quality of perioperative management.

Methods

Although anaesthesia encompasses intensive care medicine and chronic pain management, our review is limited to advances in anaesthesia for surgery and obstetrics. We discuss topics that we believe, after canvassing our colleagues, to be the most topical in recent international literature on anaesthesia. Although some of the developments have a long history, they are all recent additions to clinical practice.

Inhalational anaesthesia

Volatile anaesthetics remain the commonest agents for maintenance of anaesthesia but since the introduction of sodium thiopentone, intravenous agents have been used for induction. Induction with volatile agents is often slow, stormy, and unpleasant for the patient. Volatile agents that possessed acceptable induction characteristics lost favour because of their side effects, but the new agent sevoflurane has, to a great extent, improved their popularity.1

Sevoflurane

Although first synthesised in the late 1960s, sevoflurane has only recently been available for general use. Sevoflurane is a methylpropyl ether which, because of its high insolubility—it is more than three times less soluble in blood than halothane—produces both rapid induction and recovery characteristics and easy control of anaesthetic depth.2 Sevoflurane's low solubility enables a faster onset of anaesthesia because the partial pressure of the gas in the brain increases more rapidly than it does with the older agents. Similarly, when administration of sevoflurane ceases, the fall in partial pressure of the gas in the brain is equally rapid, and therefore recovery from anaesthesia is also faster than with the older agents. Importantly, sevoflurane does not irritate the airways …