[Choice of anaesthetic approach and anaesthetic drugs].
BACKGROUND
All types of anaesthesia should ensure absence of pain, inhibit autonomic responses and provide optimal conditions for surgery. Choice of anaesthetic approach (local, regional or general anaesthesia or a combination of methods) depends on type of surgery and the patients' health and preferences.


METHODS
The review is based on literature identified through non-systematic searches in PubMed and own research and experience.


RESULTS
When selecting anaesthetic approach and anaesthetic drugs one has to consider not only the perioperative period, but also postoperative aspects such as pain relief, awakeness, functional ability and absence of nausea. After major surgery, regional anaesthesia (especially epidural anaesthesia) and postoperative analgesia have been shown to reduce pulmonary complications and chronic pain. General anaesthesia can be administered either by volatile agents for inhalation, intravenous hypnotics, potent opioids or a combination (often used). Volatile agents, shown to be cardioprotective during cardiac surgery, are recommended for major non-cardiac surgery in patients with heart disease (even though clinical documentation is limited).


CONCLUSIONS
An appropriate anaesthetic approach, taking into account patient characteristics and type of surgery, is important for safety and potential complications. In some situations, the anaesthetic approach and anaesthetic drugs may have an impact on outcome.
Kirkebøen
Knut Arvid
KA
Anestesiavdelingen, Oslo universitetssykehus, Ullevål 0407 Oslo, Norway. k.a.kirkeboen@medisin.uio.no
Lindholm
Espen
E
Raeder
Johan
J
D000700:Analgesics / Q000008:administration & dosage; D000758:Anesthesia / Q000379:methods* / Q000592:standards; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000772:Anesthesia, Local; D000777:Anesthetics / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D009619:Nociceptors / Q000187:drug effects / Q000502:physiology; D010149:Postoperative Pain / Q000517:prevention & control; D011229:Preanesthetic Medication; D013514:Surgical Procedures, Operative / Q000379:methods
D000700:Analgesics; D000777:Anesthetics; D006993:Hypnotics and Sedatives