University Hospital Ghent, Belgium, Faculty of Medicine and Health Sciences, Department of Basic and Applied Medical Sciences, University Ghent, Belgium.
Department of Anesthesiology and Perioperative Medicine, University Hospital, Ghent, Belgium.
Best Pract Res Clin Anaesthesiol. 2023 Sep;37(3):409-420. doi: 10.1016/j.bpa.2022.12.003. Epub 2023 Jan 4.
Balanced anesthesia relies on the simultaneous administration of different drugs to attain an anesthetic state. The classic triad of anesthesia is a combination of a hypnotic, an analgesic, and a neuromuscular blocker. It is predominantly the analgesic pillar of this triad that became more and more supported by adjuvant therapy. The aim of this approach is to evolve into an opioid-sparing technique to cope with undesirable side effects of the opioids and is fueled by the opioid epidemic. The optimal strategy for balanced general anesthesia in ambulatory surgery must aim for a transition to a multimodal analgesic regimen dealing with acute postoperative pain and ideally reduce the most common adverse effects patients are faced with at home; sore throat, delayed awakening, memory disturbances, headache, nausea and vomiting, and negative behavioral changes. Over the years, this continuum of "multimodal general anesthesia" adopted many drugs with different modes of action. This review focuses on the most recent evidence on the different adjuvants that entered clinical practice and gives an overview of the different mechanisms of action, the potential as opioid-sparing or hypnotic-sparing drugs, and the applicability specifically in ambulatory surgery.
平衡麻醉依赖于同时使用不同的药物来达到麻醉状态。麻醉的经典三联症是催眠药、镇痛药和神经肌肉阻滞剂的组合。正是这种三联疗法中的镇痛支柱越来越多地得到辅助治疗的支持。这种方法的目的是演变成一种阿片类药物节约技术，以应对阿片类药物的不良副作用，这是由阿片类药物流行所推动的。门诊手术中平衡全身麻醉的最佳策略必须旨在转向多模式镇痛方案，以处理急性术后疼痛，并理想地减少患者在家中面临的最常见的不良反应；喉咙痛、苏醒延迟、记忆障碍、头痛、恶心和呕吐以及负面行为变化。多年来，这种“多模式全身麻醉”的连续体采用了许多具有不同作用模式的药物。这篇综述重点介绍了最近进入临床实践的不同佐剂的证据，并概述了不同的作用机制、作为阿片类药物节约或催眠药物节约的潜力，以及在门诊手术中的适用性。
