[Therapeutic impoverishment in modern anesthesiology-Between safety culture, regulations and loss of clinical diversity : A critical analysis].

Abstract

Traditionally, anesthesiology has been a discipline with a broad pharmacological spectrum. In recent years, however, there has been a clear trend toward reducing this range of therapeutic options. Numerous well-established agents have lost importance in many hospitals or have disappeared entirely from the routine clinical practice. This decline is only partly based on new evidence, more often, didactic simplification, cultural standardization, ecological discussions and regulatory interventions by authorities play a decisive role. This article analyzes the causes and mechanisms of this therapeutic impoverishment and compares these developments with other medical disciplines. Finally, it outlines ways in which indication-based, evidence-oriented and differentiated pharmacotherapy in anesthesiology can be strengthened once again.