Decline in the Development of New Anesthetics

The number of new anesthetics approved by the USA FDA over the past 30 years (1985–2014) is much smaller than during the preceding 30 years (1955–1984): four versus ten. Investigational anesthetics clinically tested since 1990 have been almost exclusively intravenous anesthetics (nine compounds), with only one now approved by the FDA. All nine agents represent modifications of anesthetics introduced approximately 40–50 years ago; none demonstrates a truly novel mechanism of action. The apparent drought of novel anesthetics is difficult to explain. While there may be multiple reasons, we believe that one is especially noteworthy: the dramatic improvement in anesthesia safety owing to the context in which anesthetics are administered, effectively decreasing the pressure to develop new drugs with better safety margins.

TrendsThe number of new anesthetics approved by the FDA over the past 30 years is much smaller than during the preceding 30 years.Investigational anesthetics since 1990 represent modifications of drugs introduced approximately 40–50 years ago; none demonstrates a truly novel mechanism of action.Factors contributing to the decline:(i) The mechanism of general anesthesia remains an enigma.(ii) There are insufficient incentives for the pharmaceutical industry to develop new anesthetics.(iii) There has been dramatic improvement in anesthesia safety as a result of the context in which anesthetics are administered: under the direct and constant attention of specialty-trained physician-anesthesiologists with sophisticated methods of anesthesia monitoring. This improvement in patient safety may have effectively decreased the pressure to develop new anesthetics with better safety margins.