The Legacy of Dr. Albert Szent-Györgyi and the Essence of Innovation

“Innovation is seeing what everybody has seen and thinking what nobody has thought.”

The Nobel prize winning biochemist Dr. Albert Szent-Györgyi is credited with this comment on innovation and how true it is. He was Hungarian and was awarded the Nobel prize in 1937 for first isolating vitamin C, discovering many of the components and reactions of the citric acid cycle and the molecular basis of muscle contraction.

Recent Advancements in Anesthesia

The field of anaesthesia is constantly innovating with many dedicated people thinking what nobody has thought. Here are some recent and promising advancements:

1. New Drugs and Delivery Methods:

Propofol is a widely used intravenous anaesthetic known for its rapid onset and short duration of action. However, it can also cause some unwanted side effects, such as pain on injection, nausea, and vomiting. As a result, researchers are developing new propofol analogues, which are molecules with a similar structure to propofol but potentially fewer side effects.

Here are some promising new propofol analogues:

• Ciprofol: This analogue is 4-6 times more potent than propofol, potentially requiring a lower dose to achieve the same anaesthetic effect. Studies suggest it might also have a lower incidence of injection site pain and respiratory depression compared to propofol.

• AL-121: This analogue is structurally similar to propofol but has a different mechanism of action. Early studies suggest that it might be as effective as propofol but with a reduced risk of nausea and vomiting. However, more research is needed to confirm these findings.

• PF-06650282: This analogue is another promising candidate with a similar potency to propofol. Initial studies suggest that it might have a faster onset and shorter recovery time compared to propofol. However, further research is ongoing.

These are just a few examples, and several other propofol analogues are under development.

2.Target Controlled Infusion (TCI):

Target Controlled Infusion (TCI) is a computer-assisted technique for administering anaesthesia drugs. It differs from traditional methods by focusing on achieving a specific concentration of the drug in the target compartment, typically the brain or the effect site, rather than simply delivering a set dose.

The anaesthetist sets the desired drug concentration (target) based on the patient's age, weight, and other factors. The TCI pump uses a built-in computer model that simulates the drug's distribution and elimination within the body. The computer continuously calculates the required drug infusion rate or bolus dose to achieve and maintain the target concentration. The pump precisely delivers the calculated dose based on the real-time calculations, adjusting for individual patient variables. By aiming for a specific drug concentration at the effect site, TCI can potentially provide more consistent and predictable anaesthesia, reducing the risk of under or overdosing. TCI allows for tailoring the drug delivery to individual patient characteristics, leading to potentially faster recovery and fewer side effects. TCI automates some of the calculations and adjustments, freeing up the anaesthetist to focus on other aspects of patient care.

3.Novel Inhalation Anaesthetics:

Research is ongoing to find new inhalational anaesthetics with faster onset and recovery times, potentially leading to shorter hospital stays. While the current lineup of inhalational anaesthetics like sevoflurane and desflurane are effective, researchers are actively exploring new options for potential improvements.

Xenon is a naturally occurring gas that has shown promise as an inhalational anaesthetic with a rapid onset and offset, minimal side effects, and no known environmental impact. However, its high cost and limited availability currently pose significant challenges.

Vortioxetine is primarily used as an antidepressant that shows potential as an inhalational anaesthetic with rapid onset and recovery times. However, further research is needed to assess its safety and efficacy for this use.

Researchers are studying novel fluoroethers with similar properties to existing options like sevoflurane but aiming for faster onset and recovery times and potentially fewer side effects.

4. Technological Advancements:

Closed-Loop Anaesthesia is a system that utilises automated feedback mechanisms to adjust anaesthetic delivery based on real-time patient data, potentially reducing the workload on anaesthetists, and improving patient outcomes. This stands in contrast to the traditional method, where anaesthetists manually adjust dosages based on their observations and patient responses. The system continuously monitors various patient parameters, such as heart rate, blood pressure, brain activity (EEG), and muscle relaxation. The anaesthetist sets a desired target for a specific parameter, such as a specific level of brain activity indicating adequate anaesthesia depth. The system uses advanced algorithms to analyse the incoming data from the monitors and compare it to the set target. Based on the difference between the measured value and the target, the system automatically calculates and delivers the necessary adjustments to the anaesthetic drug infusion rate. The system continuously re-evaluates the patient's condition and adjusts the drug delivery, accordingly, creating a closed-loop feedback system.

By continuously adjusting drug delivery, the system can potentially maintain a more stable and consistent level of anaesthesia, reducing the risk of under or overdosing. Automation of dosage adjustments can free up the anaesthetist to focus on other aspects of patient care, such as airway management and pain control. The system can be customised based on individual patient characteristics, potentially leading to a more personalised approach to anaesthesia delivery.

While the technology holds potential for the future of anaesthesia delivery, it's crucial to remember that anaesthetists remain irreplaceable in ensuring patient safety and providing comprehensive care during surgery. Closed-loop systems are envisioned as supportive tools to enhance precision and free up anaesthetists for higher-level decision-making.

Telemedicine in Anaesthesia involves using telecommunication technology for pre-operative consultations, remote monitoring during surgery, and post-operative follow-up, improving access to care in remote areas.

Artificial intelligence is being explored for various applications, such as predicting potential complications, optimising drug dosage adjustments, and assisting with anaesthesia decision-making.

5. Focus on Personalised Medicine:

Pharmacogenomics aims to tailor anaesthetic drugs and techniques based on a patient's individual genetic makeup, potentially improving efficacy, and reducing the risk of side effects.

Minimally invasive monitoring techniques such as non-invasive blood pressure monitoring or brain activity monitoring, can provide valuable information about a patient's condition without causing discomfort or requiring invasive procedures.

It's important to note that these are just some of the ongoing efforts in anaesthesia development. Innovation in medicine is focused on improving patient safety, comfort, and recovery. While some are still in research phases, they hold the potential to significantly improve the future of anaesthesia care.

Innovgas: Pioneering Future Anesthesia Solutions

Here at Innovgas, our founder Dr. Andrew Wallis not only thinks what nobody has thought, he then does what nobody has done. Why don’t you request a sample of our products and find out for yourself.

Author: Niall Shannon, European Business Manager, Innovgas

This article is based on research and opinion available in the public domain.

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