Anesthesia and Analgesia Management
Anesthetic types
General anesthesia produces unconsciousness with volatile agents or total intravenous anesthesia; regional anesthesia blocks sensation; monitored anesthesia care provides sedation and analgesia with airway support as needed. Know that volatile anesthetics and succinylcholine are malignant hyperthermia triggers.
Analgesia
Use multimodal analgesia: scheduled acetaminophen and NSAIDs when not contraindicated, regional blocks, ketamine, and opioids for breakthrough pain. Match the plan to surgical intensity. For PCA, confirm the patient is the only one pressing the button and monitor sedation, respiratory rate, and capnography. Naloxone reverses opioids but can precipitate severe pain, hypertension, and pulmonary edema; use titrated doses only for clinically significant respiratory depression.
Traps
Succinylcholine is avoided in hyperkalemia, major burns, prolonged immobility, and denervation because of potassium release. Neostigmine can cause bradycardia and increased secretions; give with an anticholinergic. Sugammadex reverses rocuronium but may reduce hormonal contraceptive efficacy. Do not assume a patient with opioid tolerance needs no opioids; they may need more. Distinguish sedation from analgesia.
Worked example
A patient on buprenorphine reports severe pain. Buprenorphine has high affinity but partial agonism; giving more buprenorphine may not help. Consult the prescriber about continuing or adjusting it and use multimodal non-opioid agents plus carefully titrated full agonists with monitoring.
Rule of thumb: treat pain with a ladder of modalities, and treat respiratory depression with support first, naloxone second.