Recent Advances in Anesthesia

Esketamine (S-Ketamine) Introduction S(+) enantiomer of racemic ketamine Non-barbiturate, non-opioid dissociative anaesthetic Produces hypnosis, profound somatic analgesia, amnesia, dissociation 2 times more potent than racemic ketamine 3 times more potent than R-ketamine Available as: IV/IM injection anaesthetic use Intranasal spray for depression Trade names: Ketanest-S, Spravato Mechanism of action Anaesthetic and analgesic action Esketamine → […]

Remimazolam  Introduction Ultra-short-acting intravenous benzodiazepine Structurally related to midazolam Rapid, predictable metabolism resembles the pharmacokinetic concept of remifentanil Available as remimazolam besylate Water-soluble formulation Trade name: Byfavo Chemistry Imidazobenzodiazepine containing a metabolically labile carboxylic ester linkage Molecular formula: C₂₁H₁₉BrN₄O₂ Molecular weight: approximately 439.3 Da The ester linkage permits rapid hydrolysis to an inactive metabolite Mechanism

Apnoeic Oxygenation Definition Apnoeic oxygenation is the continuous delivery of oxygen to the airway during apnoea, allowing ongoing alveolar oxygen uptake without spontaneous breathing or positive-pressure ventilation. It delays desaturation and prolongs safe apnoea time during airway management. Important: It maintains oxygenation but does not provide adequate ventilation. Mechanism O₂ continues to diffuse from alveoli