New Anesthesia Drugs Developed to Be Better and Faster

Sophisticated and powerful new tools are being used to develop and evaluate new anesthetic agents with important advantages over current drugs, according to new studies.

Researchers at Massachusetts General Hospital (MGH; Boston, USA) have reported on the development of an improved version of etomidate, a sedative commonly used to induce general anesthesia (GA) in patients who are elderly, critically ill, or in unstable condition. One of the dangers of etomidate is that it also causes suppression of adrenocortical function, which can interfere with production of steroid substances that play an important role in immunity and other key functions.

The researchers identified a specific feature of the etomidate molecule--called a pyrrole ring--that is responsible for blocking adrenocortical function. They then modified the pyrrole ring to created new versions of etomidate. Initial pharmacological studies of the MOC-carboetomidate that combines the potent sedative activity with rapid metabolism and clearance from the brain have shown that the new drug promotes hemodynamic stability, without suppressing adrenocortical function.

A second group of researchers from Paion (Cambridge, United Kingdom) and Johns Hopkins University (JHU; Baltimore, MD, USA) reported on the development a new benzodiazepine-type sedative drug called remimazolam. Again, molecular-level techniques were used to create a new drug that demonstrated fast onset, a short, predictable duration of sedative action, and a more rapid recovery profile than currently available drugs. The use of computerized models and simulation techniques to explore the basic properties of the remimazolam may also facilitate drug evaluation from initial human studies to final clinical trials. Both studies were published in the August 2012 issue of Anesthesia & Analgesia.

“Some of the simulation techniques used in the studies provide useful and detailed information for anesthesiologists to use in comparing the effects of different anesthetics,” commented Ken Johnson, MD, of the University of Utah (Salt Lake City, USA), in an accompanying editorial. “Through their efforts, remimazolam and the MOC etomidate analogs will likely bring interesting advances to our specialty in the coming years.”

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Massachusetts General Hospital
Paion
Johns Hopkins University