Clinical pharmacology and anesthetic techniques

The administration of an appropriate dose of an intravenous anesthetic results in the pleasant, rapid, and reliable induction of general anesthesia.This fact is taken for granted by patients, and those anesthesiologists who adopt a “cookbook” approach to clinical pharmacology. However, the optimal choice and safe use of intravenous anesthetics, particularly for the maintenance of anesthesia, requires a deeper understanding of the pharmacologic properties that characterize this group of drugs, and the specific peculiarities which differentiate them. The pharmacologic issues are: • pharmaceutics, including the formulation, stability, and solubilizing agents and preservatives; • pharmacokinetics, drug distribution, metabolism and elimination over time, and the variability in drug concentrations that occur between individuals and in disease states; • pharmacodynamics, defining the range of effectivedrug concentrations for sedation and anesthesia, and noting the wide range of additional drug effects, synergism with other drugs, and adverse effects.