What is anesthesia?

From the Guidelines

Anesthesia should be administered with careful patient assessment and monitoring, following the most recent guidelines from the Association of Anaesthetists, which recommend minimum monitoring of ECG, SpO2, NIBP, and capnography during general anesthesia. The choice of anesthesia technique depends on the type of procedure, patient's medical history, and current medications. General anesthesia, regional anesthesia, and local anesthesia are the three main types, each with its own indications and contraindications.

• General anesthesia is typically induced with propofol (1.5-2.5 mg/kg) and maintained with sevoflurane (1.5-2.5% concentration) 1.
• Regional anesthesia includes spinal anesthesia with bupivacaine (10-15 mg) or epidural anesthesia with ropivacaine (0.2% solution at 6-14 mL/hour) 1.
• Local anesthesia typically uses lidocaine (1-2% solution) for minor procedures. Some key considerations for anesthesia administration include:
• Patient assessment, including medical history, current medications, and allergies
• Monitoring of vital signs, including ECG, SpO2, NIBP, and capnography
• Use of processed electroencephalogram (pEEG) monitoring during total intravenous anesthesia (TIVA) with neuromuscular blocking (NMB) drugs 1
• Maintenance of adequate gut perfusion and oxygenation during surgery 1
• Avoidance of intraoperative hypotension and hyperglycemia 1 The most recent guidelines from the Association of Anaesthetists provide a comprehensive framework for anesthesia administration, emphasizing the importance of careful patient assessment, monitoring, and adherence to established protocols 1.

From the FDA Drug Label

The decision as to when patients who have received injectable midazolam, particularly on an outpatient basis, may again engage in activities requiring complete mental alertness, operate hazardous machinery or drive a motor vehicle must be individualized. It is recommended that no patient operate hazardous machinery or a motor vehicle until the effects of the drug, such as drowsiness, have subsided or until one full day after anesthesia and surgery, whichever is longer.

Anesthesia with midazolam (IV) requires careful consideration of the patient's recovery time before engaging in activities that require complete mental alertness.

• The patient should not operate hazardous machinery or drive a motor vehicle until the effects of the drug have subsided or until one full day after anesthesia and surgery, whichever is longer.
• Decisions regarding the timing of any elective procedures requiring anesthesia should take into consideration the benefits of the procedure weighed against the potential risks 2.

From the Research

Overview of Anesthesia

• Anesthesia is a medical treatment that prevents patients from feeling pain during surgical procedures 3.
• There are different types of anesthesia, including general anesthesia, which renders the patient unconscious, and regional anesthesia, which numbs a specific area of the body.

Multimodal General Anesthesia

• Multimodal general anesthesia involves the use of multiple agents to create the anesthetic state, rather than relying on a single drug 3.
• This approach aims to maximize the desired effects of anesthesia while minimizing side effects.
• The use of multiple agents at smaller doses can help to reduce the risk of adverse reactions and improve patient outcomes.

Management of Nociception and Pain

• Nociception, or the sensation of pain, is a major concern in anesthesia care 3.
• Multimodal general anesthesia strategies focus on controlling nociception intraoperatively and pain postoperatively.
• The use of agents with specific central nervous system targets, such as dexmedetomidine, and those with less specific targets, such as magnesium, can help to achieve this goal.

Postoperative Nausea and Vomiting (PONV) and Pain

• PONV and pain are two of the major concerns for patients presenting for surgery 4.
• A multimodal approach to PONV and pain management involves the use of multiple therapies, including antiemetics and analgesics.
• This approach can help to reduce the incidence of PONV and pain, and improve patient outcomes.

Comparison of Anesthetic Agents

• Different anesthetic agents, such as propofol and sevoflurane, have been compared in terms of their efficacy and safety 5, 6.
• The use of propofol and sevoflurane in combination has been shown to provide better recovery profiles than sevoflurane alone.
• Remifentanil has been found to have a statistically significant anesthetic profile than fentanyl when combined with propofol.

Multimodal Analgesia

• Multimodal analgesia involves the use of a combination of opioid and non-opioid analgesic drugs to prevent postoperative pain 7.
• This approach aims to minimize opioid use and reduce opioid-related side effects.
• The use of multimodal analgesia has been shown to improve patient outcomes and reduce the risk of postoperative pain.