What are the current practices in anesthesia?

From the Guidelines

The current best practice in anesthesia emphasizes a multimodal approach to pain management, enhanced recovery protocols, and patient safety, with a focus on minimizing opioid use and promoting early mobilization and oral intake, as recommended by the most recent guidelines 1.

Key Components of Current Anesthesia Practice

• Preoperative optimization, including carbohydrate loading and minimal fasting periods
• Intraoperative use of low-flow anesthesia with desflurane or sevoflurane, and total intravenous anesthesia (TIVA) with propofol and remifentanil in certain cases
• Regional anesthesia techniques, such as ultrasound-guided peripheral nerve blocks, to reduce opioid requirements and enhance recovery
• Multimodal pain management, combining acetaminophen, NSAIDs, gabapentinoids, and limited opioids to minimize side effects and promote patient satisfaction
• Postoperative care, including early mobilization, early oral intake, and goal-directed fluid therapy to enhance recovery and reduce complications

Rationale for Current Practice

The current practice in anesthesia is based on the latest evidence and guidelines, which emphasize the importance of minimizing opioid use and promoting early mobilization and oral intake to enhance recovery and reduce complications 1. The use of low-flow anesthesia and TIVA can reduce environmental impact and minimize side effects, while regional anesthesia techniques can reduce opioid requirements and enhance recovery 1. Multimodal pain management can promote patient satisfaction and reduce side effects, while postoperative care can enhance recovery and reduce complications 1.

Evidence-Based Recommendations

• Use multimodal analgesia techniques, including local anesthesia, to enable opioid sparing and enhance recovery 1
• Use low-flow anesthesia with desflurane or sevoflurane, and TIVA with propofol and remifentanil in certain cases 1
• Use regional anesthesia techniques, such as ultrasound-guided peripheral nerve blocks, to reduce opioid requirements and enhance recovery 1
• Promote early mobilization, early oral intake, and goal-directed fluid therapy to enhance recovery and reduce complications 1

From the FDA Drug Label

2.2 General Anesthesia 2.3 Continuation as an Analgesic into the Immediate Postoperative Period Under the Direct Supervision of an Anesthesia Practitioner 2.4 Analgesic Component of Monitored Anesthesia Care 14.1 Induction and Maintenance of General Anesthesia - Inpatient/Outpatient 14.3 Spontaneous Ventilation Anesthesia 14.8 Monitored Anesthesia Care

The current practices in anesthesia include:

• General Anesthesia: used for induction and maintenance of anesthesia in inpatient and outpatient settings 2
• Monitored Anesthesia Care: used as an analgesic component, with the patient under the direct supervision of an anesthesia practitioner 2
• Continuation of analgesic use into the immediate postoperative period: under the direct supervision of an anesthesia practitioner 2
• Spontaneous Ventilation Anesthesia: a technique used in certain anesthesia procedures 2

From the Research

Current Practices in Anesthesia

The current practices in anesthesia involve the use of various anesthetic agents, including desflurane, sevoflurane, and propofol.

• Desflurane and sevoflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia 3.
• These agents are thought to enhance inhibitory postsynaptic channel activity and inhibit excitatory synaptic activity, although the mechanism of action has not been completely defined 4.
• The choice of anesthetic agent depends on various factors, including patient characteristics, duration and type of procedure, and type of breathing system 5.

Comparison of Anesthetic Agents

Studies have compared the effects of different anesthetic agents on recovery profiles.

• One study found that desflurane led to a more rapid emergence and shorter time to extubation compared to sevoflurane 6.
• Another study found that coadministration of propofol and sevoflurane provided faster awakening and extubation with a low incidence of emergence coughing and agitation compared to sevoflurane alone 7.
• The use of desflurane was not associated with reduced postoperative respiratory complications when compared with sevoflurane 3.

Factors Influencing Anesthetic Choice

Several factors can influence the choice of anesthetic agent, including:

• Patient characteristics, such as age and medical history 4, 5
• Duration and type of procedure 5
• Type of breathing system 5
• Cost and environmental concerns 3, 4