Controversies in anaesthesia--designer drugs

In the past, the discovery of new drugs often occurred by chance. Over recent years, an increasing knowledge of the mode of drug action and receptor sites has improved our ability to design new drugs. While the mode of action of volatile and intravenous anaesthetic agents remains unclear, neuromuscular blocking agents and opioids have undergone considerable development and design. Drugs are being tailored to produce fewer side effects and to improve desirable properties. As a result, the introduction of new drugs has helped to improve techniques in anaesthesia. The development of remifentanil is an example of this which is discussed. The application of modern technology with target controlled infusions (TCI) for the administration of remifentanil represents further advancement in techniques which may become available to anaesthetists in the future.