Strategies to optimise propofol-opioid anaesthesia.
Propofol-opioid combinations are widely used in today's anaesthetic practice. Over the past 20-30 years the pharmacology of these agents has been described in increasingly greater detail. Together with novel intravenous administration devices and improved anaesthetic depth monitoring, this has created a basis for the optimisation of the administration of propofol-opioid anaesthesia. This article describes the current strategies regarding the application of this type of anaesthesia, focusing on three strategic tools: (i) application of pharmacokinetic-pharmacodynamic knowledge of propofol and the opioids, with particular attention to pharmacodynamic interactions between them; (ii) the use of state-of-the-art administration techniques; and (iii) the application of bispectral index monitoring. Together, these techniques have improved the level of control, the flexibility and the safety of anaesthetic practice.
Lichtenbelt
Bart-Jan
BJ
Department of Anaesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
Mertens
Martijn
M
Vuyk
Jaap
J
D000758:Anesthesia / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D004347:Drug Interactions; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D006801:Humans; D009294:Narcotics / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D015742:Propofol / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*
D018686:Anesthetics, Intravenous; D009294:Narcotics; D015742:Propofol