The Advances in Anesthesiology During My Time at Juntendo University

Over the course of my anesthesiology career, I have noticed that volatile anesthetics have shown remarkable improvement with the introduction of sevoflurane. Inhaled sevoflurane allows a particularly smooth and quick induction, in addition to providing stable anesthetic maintenance. Another improvement has been the development of the synthetic opioid remifentanil. Because it undergoes degradation within a few minutes, there is no risk of respiratory depression after discontinuing drug administration. Remifentanil also depresses sympathetic activity centrally, which provides cardiovascular stability during anesthesia, and as a result, it is utilized in many different surgeries. For patients with a difficult airway, the development of the laryngeal mask airway has proven to be quite useful as it greatly eases management. Several types of laryngeal mask airway have been investigated and, with a few notable contraindications such as a full stomach and severe obesity, it is widely employed worldwide. In pediatric anesthesia, the most interesting advance has been the use of caudal anesthesia employing local anesthetics and select analgesics. Combining dexmedetomidine or clonidine rather than morphine with the caudal anesthetic agent prolongs the analgesic duration without generating major adverse effects.