Intended for healthcare professionals

Clinical Review Recent advances


BMJ 1999; 319 doi: (Published 28 August 1999) Cite this as: BMJ 1999;319:557
  1. Andrew J Fox, lecturer,
  2. David J Rowbotham, professor (
  1. University Department of Anaesthesia, University of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW
  1. 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.


    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


    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 …

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