Anesthesia for the 21st Century.
Anesthesiology is on the verge of a major evolution that will involve newer, more specific, and better anesthetic agents and newer, safer, and simpler techniques to deliver these agents. Why we need new drugs is the first question. We need them because the drugs we have today can cause damage and even death if given incorrectly. We need better and safer anesthetics. Our patients should be demanding such agents. So what will anesthetics of the future be like? One possibility is a collection of what we call “magic bullets” (1, 2). These agents are very specific for certain receptors and/or neurotransmitters in the body (3-6). They may, in fact, use the body’s own proteins and peptides (7, 8). We are entering into an era within which doctors can create or mimic the proteins and peptides that our bodies make. At least some of these agents will be endogenous substances that have high safety margins. It is possible that we may be administering agents that are chemicals using physical forces (energies) that stimulate the body’s own neurotransmitters nonchemically and/or receptors noninvasively.