Think twice before you go into anesthesia!

Those were the cautionary words Dr. John Redpath shared with me during my anesthesia rotation in my third year at Stanford Medical School. Fentanyl, blithely named “Sublimase,” had completely replaced other opioids in anesthesia practice. Sufentanil and alfentanil were rumored to be even safer opioids. Gavril Pasternak was reporting distinct opioid receptor subtypes for analgesia and respiratory depression (Neurology 1981;31:1311-5). Dr. Redpath anticipated the discovery of an opioid as potent as fentanyl that didn't depress ventilation. “If that happens, there will be no need for anesthesiologists.”

It didn't happen, and anesthesiologists have remained gainfully employed. The discovery of “biased opioids” offered the possibility of such an opioid (Science 1999;286:2495-8), and the recently introduced oliceridine may deliver somewhat on the promise (Anesthesiology 2020;133:559-68). (So far,...

You do not currently have access to this content.