ADVANCES IN ANAESTHETIC PHARMACOLOGY: EXPLORING THE EVOLUTION OF INTRAVENOUS, INHALATIONAL, AND REGIONAL AGENTS FOR ENHANCED PATIENT SAFETY AND CLINICAL OUTCOMES
Main Article Content
Keywords
Intravenous anaesthesia, Inhalational anaesthesia, regional anaesthesia, Pharmacology, Haemodynamic stability, Postoperative recovery
Abstract
Anaesthetic pharmacology is a key to developing or delivering safer, more efficient and patient-centred surgical care. Intravenous, inhalational and regional anaesthetic methods, which apply today, are different in physiological processes and results, but detailed comparisons are still not complete. The goals of the study were to assess and compare the pharmacodynamic performance, intrasurgical stability and postoperative recovery of these three modalities. A prospective comparative study was carried out on 150 adult surgical patients of equal number in three groups namely intravenous, inhalational and regional anaesthesia. Both groups were given routine surveillance during surgery. The onset, duration, change in haemodynamics, postoperative recovery time, postoperative complications, and patient satisfaction were measured and then subjected to one-way analysis of variance and chi-square test with a significance of p < 0.05. The shortest induction (mean onset of 38.6 seconds) and recovery (11.8 minutes) as well as the highest patient satisfaction scores, were found in intravenous anaesthesia. Regional anaesthesia gave better haemodynamic stability with the least difference in mean arterial pressure (4.8 mmHg). The results of inhalational anaesthesia were in between, but were linked more to postoperative nausea and vomiting rates. The correlation analysis showed that the variability in haemodynamics was inversely related to recovery time (r = -0.62, p < 0.01), which proved more stable the faster recovery took place. The different anaesthetic modalities have their benefits. IV anaesthesia is associated with quicker recovery and patient satisfaction, regional anaesthesia is linked to the provision of the best haemodynamic stability, and inhalational one offers the flexibility to prolong surgeries. Individualised choice of the anaesthetic on the basis of the surgical and patient variables is important in increasing safety, recovery effectiveness, and overall perioperative results.
References
2. Coeckelenbergh S, Richebé P, Longrois D, et al. Current trends in anesthetic depth and antinociception monitoring: an international survey. J Clin Monit Comput 2022;36:1407-22.
3. Choi H, Hwang W. Anesthetic approaches and their impact on cancer recurrence and metastasis: a comprehensive review. Cancers 2024;16:4269.
4. Neal JM, Neal EJ, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine local anesthetic systemic toxicity checklist: 2020 version. Reg Anesth Pain Med 2021;46:81-2.
5. Desai N, Albrecht E, El-Boghdadly K. Perineural adjuncts for peripheral nerve block. BJA Educ 2019;19:276-82.
6. Vellinga R, Hannivoort LN, Introna M, et al. Prospective clinical validation of the Eleveld propofol pharmacokinetic-pharmacodynamic model in general anaesthesia. Br J Anaesth 2021;126:386-94.
7. Masui K, Stöhr T, Pesic M, et al. A population pharmacokinetic model of remimazolam for general anesthesia and consideration of remimazolam dose in clinical practice. J Anesth 2022;36:493-505.
8. Sneyd JR, Gambus PL, Rigby-Jones AE. Current status of perioperative hypnotics, role of benzodiazepines, and the case for remimazolam: a narrative review. Br J Anaesth 2021;127:41-55.
9. Stöhr T, Colin PJ, Ossig J, et al. Pharmacokinetic properties of remimazolam in subjects with hepatic or renal impairment. Br J Anaesth 2021;127:415-23.
10. Chae D, Kim HC, Song Y, et al. Pharmacodynamic analysis of intravenous bolus remimazolam for loss of consciousness in patients undergoing general anaesthesia: a randomised, prospective, double-blind study. Br J Anaesth 2022;129:49-57.
11. Kampman JM, Hermanides J, Hollmann MW, et al. Mortality and morbidity after total intravenous anaesthesia versus inhalational anaesthesia: a systematic review and meta-analysis. EClinicalMedicine 2024;72:102268.
12. Park M, Jung K, Cho HS, et al. Renal injury from sevoflurane in noncardiac surgery: a retrospective cohort study. Br J Anaesth 2022;129:182-90.
13. Cai H, Fan X, Feng P, et al. Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and meta-analysis of 57 randomized clinical trials. BMC Anesthesiol 2021;21:233.
14. Albrecht E, Renard Y, Desai N. Intravenous versus perineural dexamethasone to prolong analgesia after interscalene brachial plexus block: a systematic review with meta-analysis and trial sequential analysis. Br J Anaesth 2024;133:135-45.
15. Wang TT, Lu HF, Poon YY, et al. Sevoflurane versus desflurane for early postoperative vomiting after general anesthesia in hospitalized adults: a systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2021;75:110464.
16. Verret M, Le JB, Lalu MM, et al. Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis. Br J Anaesth 2024;133:615-27.
17. Yue Z, Xu Y, Cai M, et al. Floral elegance meets medicinal marvels: traditional uses, phytochemistry, and pharmacology of the genus Lagerstroemia L. Plants 2024;13:3016.
18. Lloyd P, Fowler AJ, Wozniak A, et al. Environmental impact of commonly used anaesthetic agents: systematic literature review with narrative synthesis. BJA Open 2025;13:100362.
19. Khalil R, Ma Z, Lubarsky D, et al. The environmental effects of anesthetic agents and anesthesia practices. J Anesth Transl Med 2024;3:166-70.
20. Kalmar AF, Teunkens A, Vereecke H, et al. The myth of circularity: assessing vapour capture for volatile anaesthetics. Br J Anaesth 2025;135:72-5.
21. Sneyd JR. Avoiding kidney damage in ICU sedation with sevoflurane: use isoflurane instead. Br J Anaesth 2022;129:7-10.
22. Kotani Y, Pruna A, Turi S, et al. Propofol and survival: an updated meta-analysis of randomized clinical trials. Crit Care 2023;27:139.
23. Besnier E, Moussa MD, Thill C, et al. Opioid-free anaesthesia with dexmedetomidine and lidocaine versus remifentanil-based anaesthesia in cardiac surgery: study protocol of the OFACS trial. BMJ Open 2024;14:e079984.
24. Arun F, Arun O. Impact of propofol on gastrointestinal cancer outcomes: a review of cellular behavior, growth, and metastasis. World J Clin Oncol 2025;16:104727.
25. Weibel S, Jelting Y, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst Rev 2018;(6):CD009642.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Avinash Prakash
Associate Professor, department of Anesthesiology and Critical Care, AIIMS Nagpur
Vels Medical College and Hospital, Tiruvallur district, Tamil Nadu, India
GURU K
Assistant professor, Department of Anesthesiology,
Dr. Malyashree Roy
Assistant Professor, West Bengal health university, North Bengal Medical College,