Nanotechnology in anesthesia

Nanotechnology is defined as the art and science of assembling objects on a scale under 100 nanometers in length.

The concept of nanotechnology was first propounded by Nobel Laureate Richard Feynman in 1959.

Use in anesthesia: Functionalities can be added to nanomaterials by interfacing them with biological molecules. Once injected, the nanorobots would freely float inside the body, detecting and attaching to very specific receptors, for example, gamma-aminobutyric acid (GABA), opioid and neuromuscular junction receptors.Thus, they would perform a highly focussed task:

·  In the brain, by attaching to GABA receptors they produce loss of consciousness and amnesia,

· At the neuromuscular junction they provide full muscle relaxation giving good intubating conditions

· Activation of opioid receptors causing profound analgesia.

The desirable characteristics of a nanorobot are an optimal size of 0.5–3 μm to enable passage through capillaries, non-agglutinability with blood cells and recognisability of very specific receptors only.

POSSIBLE ADVANCES OF NANOTECHNOLOGY IN ANAESTHESIOLOGY

1. General anaesthesia

• Administration, regulation and monitoring of GAà Neuroelectronic interfacing will allow nanodevices to be linked to the human nervous system. This would permit control and detection of nerve impulses to be interpreted by an external computerà computer-controlled GA (researchers from Canary Islands have developed a technique for automatically controlling anaesthesia)
•  Effects of coexisting diseases and injuries impairing anaesthesia could be overcome through using neuroelectronic interface

2. Regional anaesthesia

Bupivacaine overdoseà antidote of bupivacaine with nanotechnology. There is a formation of pi–pi complexes between bupivacaine and a pi-electron–rich injectable nanoparticle. This complex is devoid of the clinical effects of bupivacaineàrapid and easy management of high spinal anesthesia

3. Local anaesthesia

Rapid local transdermal anaestheticà lidocaine-loaded (PCL–PEG–PCL) nanoparticles.

Tested in ratsàsuperior in terms of onset of anaesthesia and efficacy. Further research awaited.

4. Future advances in superspecialities of anaesthesiology

• Chronic Pain and palliative careà saxitoxin, a potent anaesthetic, bundled with liposomes. This is a slow- release formulation can produce a nerve block lasting from days to weeks and even months, at the same time being nontoxic to the nerves or the surrounding tissue.

• Critical care:

1.  Vasculoidsà circulatory system in the  form of artificial blood which transports resources around the body without the need for a heart or other pump àserves as a complete replacement for natural blood.
2. Respirocytesà hypothetical, microscopic, artificial red blood cells that can emulate the function of natural RBC  with 200 times the efficiency. Respirocytes would also speed up weaning from ventilators.
3. Clottocytesà artificial mechanical plateletsà The response time of a clottocyte would be on the order of 100-1000 times quicker than nature's platelets, achieving complete hemostasis in as short as one second.
4. Nanoatropine: In Organophosphorus poisoningà inhaled atropine (dry powder which can be inhaled quickly by the time other therapeutic options are arranged).
5. Microbivoresàmimic white cells and perform phagocytosis of specific bacteria, viruses or fungi. Control of drug resistant infections.

Advantages of Nanorobots:

1. As the nanorobots are nonbiological entities and do not generate any harmful activities, there shall be no side effects
2. They are useful in both general as well as regional anaesthesia
3. Being highly specific and target oriented, they reduce the anaesthesia-associated mortality and morbidity
4. Since they reach specific receptors, lesser drug dosage is required, limiting the side effects
5. As they bind the terminal receptors, there shall be no peaks and troughs in effect.

Disadvantage: high cost and complicated fabrication

Further Reading:

1.	Drexler KE. Nanosystems: Molecular Machinery, Manufacturing, and Computation. 1992..
2.	Kaira L, Singh R. Nanotechnology : the new era of technology. Nitte University Journal of Health Science. 2012 December ; 2(4).
3.	Agarwal A. The future of anaesthesiology. IJA. 2012; 56(6): p. 524-528.
4.	Iliades C, Jon N. everydayhealth.com. [Online]. [cited 2015 may. Available from: http://www.everydayhealth.com/pain-management/nanoparticles-the-high-tech-way-to-treat-pain.aspx.

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Awake Intubation (procedure in brief)