TABLE 2.

Novel drugs aimed at improving anesthesia management, specifically in patients with cardiovascular disease.

Anesthesia drug	Mechanism	Function in the cardiovascular system	Advantages in cardiac patients	Reference
Cleviprex (Clevidipine)	An ultrashort-acting third-generation dihydropyridine, clevidipine butyrate preferentially reduces peripheral vascular resistance by blocking calcium influx in arterial smooth muscles, thus exhibiting selectivity for arteriolar vasodilatation	The third-generation intravenous dihydropyridine calcium channel blocker clevidipine has a very short half-life and reduces arterial blood pressure (BP) quickly, to a titratable degree; its effects are eliminated rapidly from the body as a result of metabolism by tissue and blood esterases. Clevidipine, an arterial-selective vasodilator, removes the need to widen the venous capacitance bed to lower peripheral vascular resistance	In patients slated for cardiac surgery, clevidipine was well-tolerated and effective in quickly lowering BP to goal levels prior to operation	Levy et al. (2007)
Sugammadex (SG)	The first of a new family of selective relaxant binding agents, SG (ORG 25969) is a novel cyclodextrin that reverses neuromuscular blockade (NMB) with the aminosteroid non-depolarizing muscle relaxants rocuronium and vecuronium. If you have mild or profound NMB, SG may reverse it	More severe cardiovascular side effects, such as hypotension, third-degree atrioventricular block, and persistent bradycardia, have been highlighted in recent case reports. Patients have had a cardiac arrest after the SG injection, which was caused by coronary vasospasm. Both victims of the cardiac arrest had normal coronaries, although one had non-obstructive lesions	Faster and safer recovery is possible, which is especially helpful for cardiovascular patients who could have trouble with chronic muscular weakness or ventilation	Kapoor (2020)
Landiolol	The β1 selective adrenoceptor antagonist landiolol has a very short half-life. The negative chronotropic impact is more substantial, and the effect on BP is less pronounced compared to other β blockers. Landiolol improved hemodynamics in this trial while dramatically lowering the HR.	Landiolol is a very cardioselective, super short-acting beta-blocker with a half-life (t1/2) of 3–4.5 min that regulates the HR in critical care, emergencies, and perioperative settings	This medication is beneficial for people with tachyarrhythmias, such as atrial fibrillation, because it allows for precise regulation of the HR without significantly lowering BP or airflow	Bezati et al. (2023)
Dexmedetomidine	Dexmedetomidine is an effective non-opioid medication for pain management and sedation in the ICU and during surgery. Despite the drug’s efficacy, vital signs must be monitored while using it. The correct dosage must be administered to avoid side effects, a responsibility shared by both the pharmacist and the doctor	The primary adverse effect of dexmedetomidine is hemodynamic changes. These symptoms include high BP, slow HR, and low BP, which result from the activation of α2-receptors before and after synapses. This leads to the narrowing and widening of blood vessels and reflex bradycardia	It has little impact on respiration, stabilizes the circulatory system, and reduces the need for sedatives and opioids. Additionally, it may reduce stress and myocardial oxygen demand	Chen et al. (2022)
Oliceridine	Opioid medicine oliceridine, marketed as Olinvyk, is prescribed to individuals suffering from moderate to severe acute pain. The injection is administered intravenously (IV)	Utilized for the management of pain in individuals with CVD who exhibit sensitivity to conventional opioids	Even at dosages more significant than their antinociceptive effects, oliceridine’s antinociception is robust and maximum	Burashnikov et al. (2021)
Remimazolam	Remimazolam, sold under the brand name Byfavo, induces and sustains procedural sedation for invasive diagnostic or surgical procedures that last 30 min or less	It is used as a sedative for individuals who need quick surgical recovery and cardiovascular stability	With an incidence of perioperative adverse events similar to other drugs, the data demonstrates that remimazolam provides anesthesia without causing considerable hemodynamic instability and with a decreased requirement for vasopressors	Ripoll et al. (2024)
Volatile anesthetic with cardioprotective effects	Volatile anesthetics enhance recovery after ischemia. Heart surgery patients may have less risk of death and cardiac complications due to desflurane’s and sevoflurane’s cardioprotective characteristics, according to a meta-analysis	Medicated to lessen the risk of myocardial injury during cardiac operations, such as CABG	Among the anesthetic medications that lessen the risk of death and morbidity in surgical patients, desflurane and sevoflurane stand out as having the most significant cardioprotective effects in experimental trials	Lin et al. (2021)
P2Y12 inhibitors	Compared to oral P2Y12 inhibitors, cangrelor, an intravenous (IV) P2Y12 receptor inhibitor, has a faster start and end of the pharmacological activity and is very potent	Cangrelor, prasugrel, and ticagrelor are potent P2Y12 inhibitors that increase the risk of serious bleeding but drastically reduce the risk of composite severe cardiovascular ischemic events	Patients at risk of thrombotic events may be more effectively managed with rapid and reversible platelet inhibition, as opposed to the long-lasting effects of oral P2Y12 inhibitors such as clopidogrel	Occhipinti et al. (2024)
Milrinone derivatives	Over a therapeutic range of 100–300 ng/mL, milrinone—a bipyridine derivative—has sound inotropic and lusitropic effects, as well as peripheral vasodilation and mild chronotropic effects. Decompensated congestive heart failure is a condition that milrinone is used to treat	Milrinone, a bipyridine derivative, mainly inhibits type III phosphodiesterase, preventing the catabolization of cyclic AMP. Its principal cardiovascular effects include the direct stimulation of cardiac contractility and dilatation of arteries and veins	Help high-risk cardiac patients with inotropic assistance without significantly increasing the demand for oxygen by the heart, as is the case with conventional inotropes	Pietrangelo et al. (2010)
Liposomal bupivacaine (LB)	The Food and Drug Administration has authorized the use of LB for transversus abdominis plane (TAP) blocks as part of this expansion. Bupivacaine, in its extended-release liposomal form, may continue to work for up to 3 days after an infiltration	The extended duration of action of multivesicular liposomes containing bupivacaine has led to their greater use. Research has shown that the local infiltration of LB extends the duration of action and delays peak plasma concentration compared to bupivacaine hydrochloride. Because LB lasts longer than conventional bupivacaine, it can more effectively regulate postoperative pain	Patients who are administered LB showed a considerable improvement in their nausea ratings, a reduction in their maximum pain scores across all time points examined, and a marked decrease in their overall opioid use within 72 h after injections	Song et al. (2021); Tong et al. (2014)