- Sensory
- Absence of intraoperative pain
- Cognitive:
- Absence of intraoperative awareness
- Absence of recall of intraoperative events
- Motor:
- Absence of movement
- Adequate muscular relaxation
- Autonomic:
- Absence of hemodynamic response
- Absence of tearing, flushing, sweating
- Use specific drugs for each component
- Sensory
- N20, opioids, ketamine for analgesia
- Cognitive:
- Produce amnesia, and preferably unconsciousness, with N2O, .25-.5 MAC of an inhaled agent, or an IV hypnotic (propofol, midazolam, diazepam, thiopental)
- Motor:
- Muscle relaxants as needed
- Autonomic:
- If sensory and cognitive components are adequate, usually no additional medication will be needed for autonomic stability. If some is needed, often a beta blocker +/- vasodilator is used.
- Garbage Anesthesia (everything but the kitchen sink)
- LOT2 (Little Of This, Little of That)
- Mixed Technique
- The Usual
- Check out your infusion pump as thoroughly as you check out your anesthesia machine.
- Is your drug dilution correct?
- Is the syringe adequately held?
- Is the syringe plunger properly held in the clamp?
- Are your infusion units correct?
- Is the weight correct (for calculator pumps)?
- Has the dead space been taken out of the line?
- Have the batteries been checked?
- Think of the check out as though you were going to infuse sodium nitroprusside.
- Always infuse drug through a t-piece connected at the IV catheter site.
- Typical IV tubing contains 5-8 mls of dead space between injection ports and catheter.
- Connecting the infusion at the convenient injection port may result in patients receiving 5-8 mls of remifentanil if the IV rate is increased or other drugs are flushed through the line.
- After an unintentional bolus there will be a period of no drug administration while the tubing again fills with remifentanil.