Opioids surgical patients

Peri-operative use of celecoxib in a structured multimodal anesthetic regimen provides both analgesic and opioid-sparing effects for the post-surgical patient resulting in improved patient outcomes [1]. 

Pentazocine is indicated for relief of moderate pain in patients not receiving large doses of opioids. It is also used as premedication for anesthesia and as a supplement to surgical anesthesia. 

Deep sedation is similar to a light state of general (intravenous) anesthesia involving decreased consciousness from which the patient is not easily aroused. Because deep sedation is often accompanied by a loss of protective reflexes, an inability to maintain a patent airway, and lack of verbal responsiveness to surgical stimuli, this state may be indistinguishable from intravenous anesthesia. Intravenous agents used in deep sedation protocols include the sedative-hypnotics thiopental, methohexital, midazolam, or propofol, the potent opioid analgesics, and ketamine. 

PCA allows the patient to self-administer a small amount of analgesic medication on a relatively frequent basis. This technique has been used to administer drugs such as opioids and local anesthetics. PCA can often provide better pain control with smaller quantities of the drug and a lower incidence of side effects. The patient is allowed to self-administer a small dose of the drug by pressing a button that is connected to some type of pump. These PCA pumps vary in cost, level of sophistication, and location (external versus surgically implanted), but all pumps... 

Anaesthesia in MH-susceptible patients is achieved safely with total intravenous anaesthesia using propofol and opioids. Dantrolene for intravenous use must be available in every surgical theatre. The relation of malignant hyperthermia syndrome with neuroleptic malignant syndrome (for which dantrolene may be used as adjunctive treatment, see p. 388) is uncertain. 

Current anesthesia protocols usually include several agents in combinations that vary according to the depth of anesthesia required for specific procedures. Inhalational anesthetics, which include nitrous oxide and six halogenated hydrocarbons, have varying potency in proportion to their lipid solubilities. MAC value, a measure of anesthetic potency, is defined as the minimal alveolar anesthetic concentration (% of inspired air) at which 50% of patients do not respond to a surgical stimulus. MAC values are additive, lower in elderly patients, and lower in the presence of opioid analgesics and sedative hypnotics. 

Sufentanil, an opioid analgesic (8 mcg/kg IV administered with nitrous oxide and oxygen), is indicated in patients undergoing major surgical procedures, such as cardiovascular surgery or neurosurgical procedures in the sitting position, in order to provide favorable myocardial and... 

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