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Preterm EEG: A Multimodal Neurophysiological Protocol

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Published on: February 18, 2012

Multimodal General Anesthesia: Theory and Practice.

Emery N Brown^1,2,3,4,5, Kara J Pavone¹, Marusa Naranjo⁶

¹From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Anesthesia and Analgesia

|September 26, 2018

Summary

Multimodal general anesthesia uses multiple drugs at lower doses to manage surgical pain and reduce opioid reliance. This strategy targets nociception and arousal pathways for improved safety and efficacy.

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Area of Science:

Anesthesiology and Pain Management
Neuroscience
Pharmacology

Background:

Balanced general anesthesia is the standard, but overreliance on opioids for pain control has risks.
Opioid overuse contributes to the national opioid epidemic and carries significant side effects.
Multimodal general anesthesia emerges as a strategy to mitigate opioid risks by using diverse agents.

Purpose of the Study:

To propose a rational strategy for multimodal general anesthesia.
To optimize intraoperative nociception control and postoperative pain management.
To reduce reliance on opioids by targeting multiple pain and arousal pathways.

Main Methods:

Review of nociceptive and arousal circuit anatomy, physiology, and anesthetic mechanisms.
Development of a strategy based on combining agents with different targets in the nociceptive system.
Application of the strategy to anesthetic management in four representative surgical cases.

Main Results:

The proposed strategy aims to maximize desired effects (analgesia, reduced arousal) while minimizing side effects.
Using agents with diverse targets allows for reduced doses of hypnotics and inhaled anesthetics.
Simultaneous monitoring of antinociception and consciousness level is crucial for effective implementation.

Conclusions:

A rational strategy for multimodal general anesthesia can be based on targeting distinct sites within the nociceptive system.
This approach offers a promising alternative to traditional balanced anesthesia, particularly concerning opioid use.
Further research and clinical application are needed to validate and refine this strategy for optimal patient outcomes.