Topic
Balanced Anesthesia
About: Balanced Anesthesia is a research topic. Over the lifetime, 212 publications have been published within this topic receiving 2226 citations.
Papers published on a yearly basis
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Papers
TL;DR: In this paper, the authors investigated the effect of balanced anesthetic on postoperative opioid-related adverse events, and concluded that it did not result in a greater incidence of serious adverse events such as hypoxemia and bradycardia.
Abstract: Background: It is speculated that opioid-free anesthesia may provide adequate pain control while reducing postoperative opioid consumption. However, there is currently no evidence to support the speculation. The authors hypothesized that opioid-free balanced anesthetic with dexmedetomidine reduces postoperative opioid-related adverse events compared with balanced anesthetic with remifentanil.Methods: Patients were randomized to receive a standard balanced anesthetic with either intraoperative remifentanil plus morphine (remifentanil group) or dexmedetomidine (opioid-free group). All patients received intraoperative propofol, desflurane, dexamethasone, lidocaine infusion, ketamine infusion, neuromuscular blockade, and postoperative lidocaine infusion, paracetamol, nefopam, and patient-controlled morphine. The primary outcome was a composite of postoperative opioid-related adverse events (hypoxemia, ileus, or cognitive dysfunction) within the first 48 h after extubation. The main secondary outcomes were episodes of postoperative pain, opioid consumption, and postoperative nausea and vomiting.Results: The study was stopped prematurely because of five cases of severe bradycardia in the dexmedetomidine group. The primary composite outcome occurred in 122 of 156 (78%) dexmedetomidine group patients compared with 105 of 156 (67%) in the remifentanil group (relative risk, 1.16; 95% CI, 1.01 to 1.33; P = 0.031). Hypoxemia occurred 110 of 152 (72%) of dexmedetomidine group and 94 of 155 (61%) of remifentanil group patients (relative risk, 1.19; 95% CI, 1.02 to 1.40; P = 0.030). There were no differences in ileus or cognitive dysfunction. Cumulative 0 to 48 h postoperative morphine consumption (11 mg [5 to 21] versus 6 mg [0 to 17]) and postoperative nausea and vomiting (58 of 157 [37%] versus 37 of 157 [24%]; relative risk, 0.64; 95% CI, 0.45 to 0.90) were both less in the dexmedetomidine group, whereas measures of analgesia were similar in both groups. Dexmedetomidine patients had more delayed extubation and prolonged postanesthesia care unit stay.Conclusions: This trial refuted the hypothesis that balanced opioid-free anesthesia with dexmedetomidine, compared with remifentanil, would result in fewer postoperative opioid-related adverse events. Conversely, it did result in a greater incidence of serious adverse events, especially hypoxemia and bradycardia.
214 citations
TL;DR: In this paper, the authors discuss the most recent up-to-date findings focused on the currently available "best clinical practice" regarding perioperative anesthesia care bundle factors and their effect on tumor progression.
Abstract: This narrative review discusses the most recent up-to-date findings focused on the currently available "best clinical practice" regarding perioperative anesthesia care bundle factors and their effect on tumor progression. The main objective is to critically appraise the current literature on local anesthetics, regional outcome studies, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs) and their ability to decrease recurrence in patients undergoing cancer surgery. A brief discussion of additional topical perioperative factors relevant to the anesthesiologist including volatile and intravenous anesthetics, perioperative stress and anxiety, nutrition, and immune stimulation is included. The results of several recently published systematic reviews looking at the association between cancer recurrences and regional anesthesia have yielded inconclusive data and provide insufficient evidence regarding a definitive benefit of regional anesthesia. Basic science data suggests an anti tumor effect induced by local anesthetics. New refined animal models show that opioids can safely be used for perioperative pain management. Preliminary evidence suggests that NSAIDs should be an essential part of multimodal analgesia. Volatile anesthetics have been shown to increase tumor formation, whereas preclinical and emerging clinical data from propofol indicate tumor protective qualities. The perioperative period in the cancer patient represents a unique environment where surgically mediated stress response leads to immune suppression. Regional anesthesia techniques when indicated in combination with multimodal analgesia that include NSAIDs, opioids, and local anesthetics to prevent the pathophysiologic effects of pain and neuroendocrine stress response should be viewed as an essential part of balanced anesthesia.
153 citations
TL;DR: In searching for a nondepolarizing muscle relaxant with intermediate duration but more rapid onset of action than the presently available compounds, the neuromuscular and circulatory effects of ORG9426 were investigated in two studies in humans receiving fentanyl, droperidol, thiopental, and nitrous oxide-oxygen anesthesia.
Abstract: In searching for a nondepolarizing muscle relaxant with intermediate duration but more rapid onset of action than the presently available compounds, the neuromuscular and circulatory effects of ORG9426 were investigated in two studies in humans receiving fentanyl, droperidol, thiopental, and nitrous
143 citations
1 Jan 1997
TL;DR: This chapter presents a comprehensive review of the literature regarding methods to provide anesthesia as well as analgesia to laboratory rodents, focusing primarily on the predominant rodent species used in research, that is, mice and rats.
Abstract: Publisher Summary This chapter presents a comprehensive review of the literature regarding methods to provide anesthesia as well as analgesia to laboratory rodents. It focuses primarily on the predominant rodent species used in research, that is, mice and rats. Rodents require appropriate preoperative evaluation and care when planning experimental manipulations that require anesthesia. Colony history should be carefully reviewed to determine the source and health status of the animals. The age of the animals and the length of time they have been housed in the present facility should be determined, and the most current information available from the serological monitoring of sentinel animals or other available health surveillance should be reviewed. There are basically three methods of anesthetic delivery to rodents—parenteral, inhalation, or a combination of both. Balanced anesthesia is a relatively novel method for producing anesthesia in humans that is becoming popular for use in animals. This format utilizes combinations of drugs, each in a sufficient amount to produce a desired effect(s), yet keeping its undesirable or unnecessary effects to a minimum.
134 citations
TL;DR: The advantages gained by the use of nitrous oxide, continuous opioid infusion, epidural/spinal opioid administration, and transdermal opioid administration are described and are easy to learn, relatively inexpensive, and may decrease patient morbidity and mortality.
112 citations
Related Topics (5)
Performance Metrics
| Year | Papers |
|---|---|
| 2022 | 1 |
| 2021 | 8 |
| 2020 | 6 |
| 2019 | 11 |
| 2018 | 5 |
| 2017 | 13 |