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dc.contributor.authorBrown, Emery Neal
dc.contributor.authorPavone, Kara
dc.contributor.authorNaranjo, Marusa
dc.date.accessioned2020-08-20T13:53:03Z
dc.date.available2020-08-20T13:53:03Z
dc.date.issued2018-11
dc.identifier.issn0003-2999
dc.identifier.urihttps://hdl.handle.net/1721.1/126701
dc.description.abstractBalanced general anesthesia, the most common management strategy used in anesthesia care, entails the administration of different drugs together to create the anesthetic state. Anesthesiologists developed this approach to avoid sole reliance on ether for general anesthesia maintenance. Balanced general anesthesia uses less of each drug than if the drug were administered alone, thereby increasing the likelihood of its desired effects and reducing the likelihood of its side effects. To manage nociception intraoperatively and pain postoperatively, the current practice of balanced general anesthesia relies almost exclusively on opioids. While opioids are the most effective antinociceptive agents, they have undesirable side effects. Moreover, overreliance on opioids has contributed to the opioid epidemic in the United States. Spurred by concern of opioid overuse, balanced general anesthesia strategies are now using more agents to create the anesthetic state. Under these approaches, called "multimodal general anesthesia," the additional drugs may include agents with specific central nervous system targets such as dexmedetomidine and ones with less specific targets, such as magnesium. It is postulated that use of more agents at smaller doses further maximizes desired effects while minimizing side effects. Although this approach appears to maximize the benefit-to-side effect ratio, no rational strategy has been provided for choosing the drug combinations. Nociception induced by surgery is the primary reason for placing a patient in a state of general anesthesia. Hence, any rational strategy should focus on nociception control intraoperatively and pain control postoperatively. In this Special Article, we review the anatomy and physiology of the nociceptive and arousal circuits, and the mechanisms through which commonly used anesthetics and anesthetic adjuncts act in these systems. We propose a rational strategy for multimodal general anesthesia predicated on choosing a combination of agents that act at different targets in the nociceptive system to control nociception intraoperatively and pain postoperatively. Because these agents also decrease arousal, the doses of hypnotics and/or inhaled ethers needed to control unconsciousness are reduced. Effective use of this strategy requires simultaneous monitoring of antinociception and level of unconsciousness. We illustrate the application of this strategy by summarizing anesthetic management for 4 representative surgeries.en_US
dc.description.sponsorshipNational Institutes of Health (Grants R01 GM104948 and P01GM118269)en_US
dc.language.isoen
dc.publisherOvid Technologies (Wolters Kluwer Health)en_US
dc.relation.isversionofhttp://dx.doi.org/10.1213/ane.0000000000003668en_US
dc.rightsCreative Commons Attribution-NonCommercial-NoDerivs Licenseen_US
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en_US
dc.sourceAnesthesia & Analgesiaen_US
dc.titleMultimodal General Anesthesia: Theory and Practiceen_US
dc.typeArticleen_US
dc.identifier.citationBrown, Emery N. et al. "Multimodal General Anesthesia: Theory and Practice." Anesthesia and Analgesia 127, 5 (November 2018): 1246-1258. © 2018 The Author(s)en_US
dc.contributor.departmentMassachusetts Institute of Technology. Institute for Medical Engineering & Scienceen_US
dc.contributor.departmentPicower Institute for Learning and Memoryen_US
dc.contributor.departmentMassachusetts Institute of Technology. Department of Brain and Cognitive Sciencesen_US
dc.contributor.departmentMassachusetts Institute of Technology. Institute for Data, Systems, and Societyen_US
dc.relation.journalAnesthesia and Analgesiaen_US
dc.eprint.versionFinal published versionen_US
dc.type.urihttp://purl.org/eprint/type/JournalArticleen_US
eprint.statushttp://purl.org/eprint/status/PeerRevieweden_US
dc.date.updated2019-09-30T15:36:21Z
dspace.date.submission2019-09-30T15:36:24Z
mit.journal.volume127en_US
mit.journal.issue5en_US
mit.metadata.statusComplete


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