Considerations for the use of

short-acting opioids in
general anesthesia
Pembimbing
Dr. Susana Sitaresmi K. W., Sp. An.
Disusun Oleh :
Putri Retno Intan
1161050236

KEPANITERAAN KLINIK ILMU ANESTESI

Periode 25 Juli 27 Agustus 2016
RUMAH SAKIT MARDI WALUYO LAMPUNG
 INTRODUCTION
Managemen airway
Amnesia
In current fast-track surgery environment
Analgesia safe and comfortable
General
Anesthesia Side effects general anesthesia
Immobility
The anesthesia provider monitors
sedation
Challenges Choosing an anesthesia regimen
 Clinical considerations in
anesthesiology practice
planning the anesthetic affects patient outcomes

Factors that affect the choice of anesthetic regimen

anesthesia history lung function
medical comorbidities type and length of surgery
Anatomical

Factor increase the risk of complications with general anesthesia

Smoking Diabetes,
Obesity High blood pressure (BP)
 Risk of intraoperative
complications
Wakefulness
One important consideration is the depth of anesthesia to be
achieved for the intervention.
Inappropriate doses of the principal anesthetic use of certain drugs
Depression iatrogenic errors
daily alcohol use

Hemodynamic changes
decreased or increased heart rate and/or BP
Challenges administer patient-individualized anesthesia and
achieve hemodynamic balance or prevent hypertension,
hypotension, tachycardia, and bradycardia
The American Society of Anesthesiologists (ASA)physical
status classification system

the American College of Cardiology and American Heart

Association 2007 Guidelines on Perioperative
Cardiovascular Evaluation and Care for Noncardiac
Surgery

stratification of patients based on their overall risk of

morbidity and mortality from their surgery and the
anesthetic regimen
 Practice recommendations for
generalanesthesia
ASA updated for the management of acute pain in the
perioperative

Therapeutic options such as epidural or intrathecal opioids, systemic

opioid as a patient-controlled analgesic, and regional techniques

The updates also recommend patient-individualized multimodal

techniques in combination with perioperative techniques for pain
management.
Commonly used agents for induction and
maintenance of general anesthesia
A plan for general anesthesia
Combination of agents that rapidly induce
Without side effects
Rapid emergence and recovery from surgery

A Combination
volatile inhalational agents muscle relaxants
intravenous (IV) hypnotics opioids
and sedatives
 Total intravenous anesthesia
Total intravenous anesthesia (TIVA) with propofol alone or in
combination with the opioids

Opioids act as -opioid receptor agonists

Side Effect
bradycardia PONV,
hypotension delayed emergence
respiratory depression Tolerance and dependence due
pruritus to continued use
laryngeal rigidity
Advantages of short-acting opioids in the
maintenance of general anesthesia
 Though short-acting opioids may be safely used in various
applications, potential side effects such as bradycardia, hypotension,
respiratory depression, PONV, and shivering are possible

In the absence of a postoperative analgesic care plan, use of short-

acting opioids may be disadvantageous, especially if pain is expected
after the procedure.
 summary
To achieve better surgical outcomes, improved perioperative care
coupled with effective postoperative pain management strategies are
critical

The new fentanyl-based short-acting opioids administered in

combination with propofol-based TIVA or volatile inhalational agents
have demonstrated significant efficacies
THANK YOU