[Nociceptive modulation during intravenous anesthesia]

The surgical stress can be defined as a complex array of neuroendocrine, haemodynamic, metabolic and inflammatory changes following surgical injury. These responses, when excessive, may contribute to increased postoperative morbidity and mortality. Thus a major endpoint of general anaesthesia is to protect the patient against the noxious stress response components. The different classes of anaesthetic or associated drugs are reviewed in this respect: sedative/hypnotics (barbiturates, etomidate, propofol, benzodiazepines), opioids, alpha-2 adrenergic agonists (clonidine), non-steroidal antiinflammatory drugs, intravenous local anaesthetics. Central and peripheral sensitization phenomenons--ie the sympathoadrenal response to surgery--might likely be efficiently attenuated by preemptive analgesia, and/or well-designed computer-guided total intravenous anaesthesia. 119 references complete this review.