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March 2012
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Introduction ......................................................................................................................... 1
Scope and Methodology ...................................................................................................... 1
Size and Growth of the Market .......................................................................................... 3
Issues and Trends Affecting Market.................................................................................. 6
Leading Competitors ........................................................................................................... 6
TWO: INTRODUCTION THE WORLD ANESTHESIA DRUG MARKET .................................. 9
Intravenous ...................................................................................................................... 16
Topical Application ......................................................................................................... 17
Transdermal/Transmucosal Application ......................................................................... 17
Distribution Channels ....................................................................................................... 18
Demographics and Statistics ............................................................................................. 19
Medical Procedures by Type ........................................................................................... 21
Complications in Anesthesia ........................................................................................... 25
AnesthesiologyWork Force ......................................................................................... 25
THREE: GENERAL ANESTHESIA ................................................................................................. 29
Overview............................................................................................................................. 29
Stages of General Anesthesia .......................................................................................... 30
Induction ................................................................................................................................. 30
Excitement .............................................................................................................................. 30
Surgical Anesthesia ................................................................................................................. 30
Overdose ................................................................................................................................. 31
Table of Contents
ii
Description of Products ..................................................................................................... 31
Brevital.................................................................................................................................... 31
Diprivan .................................................................................................................................. 31
Ethrane .................................................................................................................................... 31
Forane ..................................................................................................................................... 32
Halothane ................................................................................................................................ 32
Ketalar ..................................................................................................................................... 32
Lusedra.................................................................................................................................... 33
Pentothal ................................................................................................................................. 33
Suprane ................................................................................................................................... 33
Ultane/Sevorane ...................................................................................................................... 33
Overview............................................................................................................................. 45
Techniques of Administration ......................................................................................... 47
Topical Application................................................................................................................. 47
Transdermal/Transmucosal ..................................................................................................... 47
Simple Local Infiltration ......................................................................................................... 48
Regional Injections ................................................................................................................. 48
Esters ............................................................................................................................... 55
Cocaine Hydrochloride ........................................................................................................... 55
Nesacaine ................................................................................................................................ 55
Novocaine ............................................................................................................................... 55
Pontocaine ............................................................................................................................... 56
Combinations .................................................................................................................. 56
EMLA ..................................................................................................................................... 56
Pliaglis .................................................................................................................................... 56
Synera ..................................................................................................................................... 56
Copyright 2012 Kalorama Information
Reproduction without written permission, in any media now in existence or hereafter developed,
in whole or in any part, is strictly prohibited
Table of Contents
iii
Generic Drug Impact and Availability ............................................................................ 58
Research and Development .............................................................................................. 60
Market Size and Growth................................................................................................... 63
Total Market .................................................................................................................... 63
Market by Delivery Method ............................................................................................ 66
Market by Geographical Region ..................................................................................... 67
Competitive Analysis ......................................................................................................... 68
FIVE: ADJUNCTIVE THERAPIES IN ANESTHESIA .................................................................. 71
Overview............................................................................................................................. 71
Description of Products ..................................................................................................... 72
Neuromuscular Blocking Agents ............................................................................................ 72
Preanesthetic Sedation and Anesthesia Maintenance .............................................................. 75
Precedex/dexdor ...................................................................................................................... 77
Anesthesia Reversal Agents .................................................................................................... 78
Table of Contents
iv
Anesthesia and the Benefits to Depression Patients ..................................................... 111
Pediatric Studies in Bipolar Disorders ...................................................................................112
Table of Contents
v
L
Table of Contents
vi
Figure 3-1
The Market for General Anesthesia Drugs 2007-2016 ................................................... 39
Figure 3-2
The Market for General Anesthesia Drugs Market Share by Delivery Method, 2011 .... 40
Table 3-5
The Market for General Anesthesia Drugs Estimated Products Sales by Geographic
Region, 2011 ................................................................................................................... 41
Figure 3-3
The Market for General Anesthesia Drugs Market Share by Geographic Region, 2011...... 41
Table 3-6
The Market for General Anesthesia Drugs Estimated Revenues and Market Share of
Leading Suppliers 2009-2011 ......................................................................................... 43
Figure 3-4
The Market for General Anesthesia Drugs Estimated Market Share by Leading
Suppliers 2011 ................................................................................................................. 43
LOCAL ANESTHESIA
Table 4-1
Selected Marketed Local Anesthesia Drugs (Brand Name, Generic Name and Supplier) .. 57
Table 4-2
Selected Generic Drug Manufacturers and Products for Local Anesthesia .................... 59
Figure 4-1
Brand vs. Generic Local Anesthetic Market 2007-2011 ................................................. 60
Table 4-3
Local Anesthesia Drugs in Development ........................................................................ 62
Table 4-4
The Market for Local Anesthesia Drugs 2007-2016 ....................................................... 64
Figure 4-2
The Total Market for Local Anesthesia Drugs 2007-2016 ............................................. 65
Figure 4-3
The Market for Local Anesthesia Drugs Market Share by Delivery Method, 2011 ....... 66
Table 4-5
The Market for Local Anesthesia Drugs Estimated Products Sales by Geographic
Region, 2011 ................................................................................................................... 67
Figure 4-4
The Market for Local Anesthesia Drugs Market Share by Geographic Region, 2011 ......... 68
Table 4-6
The Market for Local Anesthesia Drugs Estimated Revenues and Market Share of
Leading Suppliers 2009-2011 ......................................................................................... 69
Table of Contents
vii
Figure 4-5
The Market for Local Anesthesia Drugs Estimated Market Share by
Leading Suppliers 2011................................................................................................... 70
FIVE: ADJUNCTIVE THERAPIES IN ANESTHESIA
Table 5-1
Selected Marketed Adjunctive Therapies in Anesthesia (Type, Brand Name, Generic
Name, and Supplier)........................................................................................................ 82
Table 5-2
Selected Generic Drug Manufacturers and Products for Adjunctive Therapies in
Anesthesia ....................................................................................................................... 82
Figure 5-1
Brand vs. Generic Adjunctive Therapies in Anesthesia Market 2007-2011 ................... 85
Table 5-3
Adjunctive Therapies in Anesthesia in Development ..................................................... 87
Table 5-4
The Market for Adjunctive Therapies in Anesthesia 2007-2016 .................................... 89
Figure 5-2
The Market for Adjunctive Therapies in Anesthesia 2007-2016 .................................... 90
Table 5-5
The Market for Adjunctive Therapies in Anesthesia Estimated Products Sales by
Geographic Region, 2011................................................................................................ 91
Figure 5-3
The Market for Adjunctive Therapies in Anesthesia Market Share by Geographic
Region, 2011 ................................................................................................................... 91
Table 5-6
The Market for Adjunctive Therapies in Anesthesia Estimated Revenues and Market
Share of Leading Suppliers 2009-2011 ........................................................................... 93
Figure 5-4
The Market for Adjunctive Therapies in Anesthesia Estimated Market Share by Leading
Suppliers 2011 ................................................................................................................. 93
SIX: ANESTHESIA DRUGS: TOTAL MARKET SIZE AND FORECAST
Table 6-1
The Total World Market for Anesthesia Drugs 2007-2016 ............................................ 96
Figure 6-1
The Total Market for Anesthesia Drugs 2007-2016 ....................................................... 97
Table 6-2
Anesthesia Drug Market by Type 2007-2016 ................................................................ 99
Figure 6-2
Anesthesia Drug Market by Type 2007-2016 .............................................................. 100
Copyright 2012 Kalorama Information
Reproduction without written permission, in any media now in existence or hereafter developed,
in whole or in any part, is strictly prohibited
Table of Contents
viii
Figure 6-3
Anesthesia Drug Market by Type 2011 ....................................................................... 101
Figure 6-4
Anesthesia Drug Market by Type 2016 ....................................................................... 101
Table 6-3
Anesthesia Drug Market Estimated Products Sales by Geographic Region, 2011 ....... 103
Figure 6-5
Anesthesia Drug Market Market Share by Geographic Region, 2011 .......................... 103
Table 6-4
Leading Suppliers Anesthesia Revenues and Significant Segments of Participation,
2011 ............................................................................................................................... 105
Figure 6-6
Leading SuppliersAnesthesia Revenues, 2011 .......................................................... 105
Two: Introduction
16
for Eisais Lusedra (fospropofol). By 2016, the general anesthesia market is expected
to display an increase in sales of XX% due to factors mentioned above. Revenues in
2016 are expected to increase to $XX xxxx.
Table 3-4
The Market for General Anesthesia Drugs
2007-2016
Year
Segment
Alkyphenols
Other Products
Total Revenues
(in millions)
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Segment
Alkyphenols
Other Products
Total
2007-2011
2012-2016
2007-2016
Source: Kalorama Information
Percent Change
Nondepolarizing
Depolarizing
Both effectively induce paralysis, but produce this effect through different
mechanisms of action.
Neuromuscular blocking agents work by interrupting or preventing the
electrochemical transfer of information at the point at which the axon of a neuron
meets a muscle fiber, that is, at the neuromuscular junction. At this junction, the axon
of the motor neuron divides to form branching terminals that are enfolded in muscle
fibers. These axon terminals are separated from the fibers by the synaptic cleft or
synapse. Impulses do not jump across these synapses. Instead, the electrical
conduction of a signal down the axon occurs as an action potential. As the action
potential invades the nerve ending, a chemical presynaptic neurotransmitting
substance, acetylcholine, is released into the synapse. The acetylcholine diffuses
across the synapse to act on the post synaptic membrane to produce a new action
potential or modulate a preexisting action. Neuromuscular blocking agents act at the
neuromuscular junction by competing with acetylcholine for the receptor sites or by
blocking depolarization.
Because neuromuscular blocking agents cannot readily cross membranes, they
must always be administered parenterally. And, because of their inability to cross the
blood brain barrier, they have no effect on the central nervous system. Thus,
neuromuscular blocking agents do not diminish consciousness or the perception of
pain.
These drugs must be accompanied by adequate anesthesia during surgery to
prevent patient distress. Neuromuscular blocking agents are administered after
unconsciousness is induced.
Neuromuscular blocking agents are used to induce sufficient muscle
relaxation to assist with various surgical procedures. As an adjunct to anesthesia,
neuromuscular blockers can decrease the dosage of the general anesthetic, providing a
greater margin of safety for the patient. There is less risk of respiratory depression,
and recovery from anesthesia occurs more quickly. Neuromuscular blockers also help