2/27/2023 0 Comments Multimodal perception definitionAlthough midazolam is often administered before induction to treat anxiety, amnesia is managed implicitly by rendering the patient unconscious. 3 This approach is believed to increase the likelihood of a drug’s desired effects and reduce the likelihood of its side effects.Ĭurrent practice of balanced general anesthesia relies on a hypnotic, such as propofol, for induction and on an inhaled ether or on a hypnotic infusion to maintain unconsciousness. 2 There is evidence that balanced general anesthesia uses less of each drug than if the drug were administered alone. Anesthesiologists developed this approach to avoid sole reliance on ether for maintenance of general anesthesia. 1 Balanced general anesthesia, the most common management strategy used in anesthesia care, entails administering a combination of different agents to create the anesthetic state. General anesthesia is a drug-induced reversible state consisting of unconsciousness, amnesia, antinociception, and immobility, with maintenance of physiological stability. We illustrate the application of this strategy by summarizing anesthetic management for 4 representative surgeries. Effective use of this strategy requires simultaneous monitoring of antinociception and level of unconsciousness. Because these agents also decrease arousal, the doses of hypnotics and/or inhaled ethers needed to control unconsciousness are reduced. We propose a rational strategy for multimodal general anesthesia predicated on choosing a combination of agents that act at different targets in the nociceptive system to control nociception intraoperatively and pain postoperatively. In this Special Article, we review the anatomy and physiology of the nociceptive and arousal circuits, and the mechanisms through which commonly used anesthetics and anesthetic adjuncts act in these systems. Hence, any rational strategy should focus on nociception control intraoperatively and pain control postoperatively. Nociception induced by surgery is the primary reason for placing a patient in a state of general anesthesia. Although this approach appears to maximize the benefit-to-side effect ratio, no rational strategy has been provided for choosing the drug combinations. It is postulated that use of more agents at smaller doses further maximizes desired effects while minimizing side effects. Under these approaches, called “multimodal general anesthesia,” the additional drugs may include agents with specific central nervous system targets such as dexmedetomidine and ones with less specific targets, such as magnesium. Spurred by concern of opioid overuse, balanced general anesthesia strategies are now using more agents to create the anesthetic state. Moreover, overreliance on opioids has contributed to the opioid epidemic in the United States. While opioids are the most effective antinociceptive agents, they have undesirable side effects. To manage nociception intraoperatively and pain postoperatively, the current practice of balanced general anesthesia relies almost exclusively on opioids. Balanced general anesthesia uses less of each drug than if the drug were administered alone, thereby increasing the likelihood of its desired effects and reducing the likelihood of its side effects. Anesthesiologists developed this approach to avoid sole reliance on ether for general anesthesia maintenance. Balanced general anesthesia, the most common management strategy used in anesthesia care, entails the administration of different drugs together to create the anesthetic state.
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