• 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.
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