Inhaled Anesthetics. Fluorinated hydrocarbons revolutionized inhalation anesthesia (halothane in 1956, methoxyflurane in 1960, enflurane and isoflurane in the 1970s, desflurane in 1992, and sevoflurane in 1994).
Intravenous Anesthetics. Thiopental was first administered to a patient at the University of Wisconsin in March 1934 followed by ketamine (1960s), etomidate, and most recently propofol.
Local Anesthetics. Amino esters (procaine in 1905, tetracaine) were commonly used for local infiltration and spinal anesthesia despite their low potency and high likelihood to cause allergic reactions. Lidocaine, an amino amide local anesthetic, was developed in 1944 and gained immediate popularity because of its potency, rapid onset, decreased incidence of allergic reactions, and overall effectiveness for all types of regional anesthetic blocks. Since the introduction of lidocaine, all local anesthetics developed and marketed (mepivacaine, bupivacaine, ropivacaine, levobupivacaine) have been of the amino amide variety.
Opioids are used routinely in the perioperative period, in the management of acute pain, and in a variety of terminal and chronic pain states. Meperidine, the first synthetic opioid, was developed in 1939 followed by fentanyl in 1960 and sufentanil, alfentanil, and remifentanil. Ketorolac, a nonsteroidal antiinflammatory drug (NSAID) approved for use in 1990, was the first parenteral NSAID indicated for postoperative pain.
Muscle relaxants entered anesthesia practice nearly a century after inhalational anesthetics. Curare, the first known neuromuscular blocking agent, was originally used in hunting and tribal warfare by native peoples of South America. Clinical application had to await the introduction of tracheal intubation and controlled ventilation of the lungs. On January 23, 1942, Griffith and his resident, Enid Johnson, anesthetized and intubated the trachea of a young man before injecting curare early in the course of an appendectomy. Satisfactory abdominal relaxation was obtained, and the surgery proceeded without incident. Griffith and Johnson's report of the successful use of curare in a series consisting of 25 patients launched a revolution in anesthetic care. Succinylcholine was prepared by the Nobel laureate Daniel Bovet in 1949 and was in wide international use before historians noted that the drug had been synthesized and tested in the early 1900s. Recognition that atracurium and cis-atracurium undergo spontaneous degradation by Hoffmann elimination has defined a role for these muscle relaxants in patients with liver and renal insufficiency.
Antiemetics. Effective treatment of patients with postoperative nausea and vomiting (PONV) evolved relatively recently and has been driven by incentives to limit hospitalization expenses and improve patient satisfaction. The antiemetic effects of corticosteroids were first recognized by oncologists treating patients with intracranial edema from tumors. Recognition of the role of the serotonin 5-HT3 pathway in PONV has led to a unique class of drugs (including ondansetron in 1991) devoted only to addressing this particular problem.