What’s new in intravenous anaesthesia?

PURPOSE OF REVIEW: Advances in intravenous anaesthesia are driven by the need for agents with improved safety, enhanced hemodynamic stability, predictable recovery profiles, and overall patient safety. This review summarizes recent advances in intravenous anaesthesia with a particular focus on remimazolam, ciprofol, novel etomidate analogues, and neurosteroid anaesthetics and contemporary approaches to monitoring depth of anaesthesia. RECENT FINDINGS: New agents aim to overcome limitations associated with traditional drugs such as propofol and etomidate. Remimazolam, an ultra-short-acting benzodiazepine provides effective hypnosis with reduced cardiovascular depression and the advantage of pharmacological reversibility. Ciprofol, a propofol analogue, demonstrates high potency, improved injection tolerability, and potentially more favorable hemodynamic profile. Etomidate analogues have been developed to retain anaesthetic efficacy, while minimizing adrenal suppression. Neurosteroid anaesthetics have reemerged as promising compounds due to rapid onset, stable cardiovascular effects, and favorable pharmacokinetics. Advances in target-controlled infusion and algorithm-driven automated drug delivery systems are enhancing precision and responsiveness of anaesthesia administration. Integrative technologies, including real-time monitoring and artificial intelligence support, are increasingly applied to optimize dosing and depth of anaesthesia. SUMMARY: Over the recent half-decade, the field of intravenous anaesthesia reflects a shift toward personalized, computer-assisted delivery and novel agents with favorable pharmacokinetics. These trends point toward safer, more effective anaesthesia management while paving the way for continued innovation in clinical practice.