I. Anesthesia / Analgesia Concepts
a) Anesthesia should be thought of as 4 distinct and equally important periods: 1) preparation/premedication; 2) induction; 3) maintenance and 4) recovery. We tend to diminish the importance of the phases of preparation/premedication and recovery and yet these phases contribute as much to successful anesthesia as the phases of induction and maintenance.
b) No matter what anesthetic protocol is chosen, safe and successful anesthesia will be enhanced by the use of pre-anesthetic tranquilizers. This is evidenced by two facts:
• Stress in the perioperative period is extremely dangerous physiologically. (Think about capture deaths that occur in wild animals.)
• Tranquilizers allow reduction in the dose of both induction and maintenance drugs, thus increasing the distance between 'effective dose' and 'dangerous or toxic dose' of drugs.
c) Also, no matter what anesthetic protocol is chosen, analgesia is imperative. Perioperative analgesia has two monumental advantages: 1) analgesia increases anesthetic safety by decreasing the necessary dosages of anesthetic drugs and 2) analgesia improves our medical success rate because adequate analgesia improves healing and allows a decreased incidence of postoperative stress-related complications. Regardless of which analgesic drugs are chosen, 3 basic tenets of pain management should always be followed: 1) analgesic drugs should be administered preemptively; 2) multimodal analgesia should be used whenever possible; and 3) analgesia should continue as long as pain affects the quality of life of the patient.
d) Along with multi-modal or balanced analgesia, we should be providing multimodal or balanced anesthesia. Again, using a variety of drugs allows us to capitalize on the synergism between the drugs while decreasing the dose of each drug. With our current knowledge of pharmacology and the availability of safe, effective anesthetic and analgesic drugs, anesthetizing a patient with a single agent (eg, no premedicant, inhalant induction, inhalant maintenance) is no longer appropriate. Nor is it safe.