Episode 109: Non-Opioid Adjuncts with Drs. Grant and Bicket part 2

In this 109th episode we pick up where we left off in episode 108 and discuss the intraoperative use of non-opioid adjuncts.

References:

Wick EC, Grant MC and Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques A Review. JAMA Surg. 2017;152(7):691-697.

Bahr MP, Williams BA. Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care. Regional Anesthesia and Pain Medicine. 2018:43(8):815-818.

Grant MC, Ouanes JP, Joshi BL. Perioperative Esmolol and Opioids: Is More Really Less? Regional Anesthesia and Pain Medicine. 2018:43(8):813-814.

IV Lidocaine: https://academic.oup.com/bjaed/article/16/9/292/1743710

Ketamine: https://www.ncbi.nlm.nih.gov/pubmed/29870457

Dextramethorphan: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755866

5 Replies to “Episode 109: Non-Opioid Adjuncts with Drs. Grant and Bicket part 2”

  1. Hello, long-time listener here. Can you talk about the benefits of low-volume-high-rate ventilation in the OR, what types of cases it’s most beneficial for, and does the anesthesia community think that this lung-protective ventilation should only apply to ICU patients? Thanks, Ro

    1. Hi Ro,

      I assume you are referring to lung protective ventilation strategies for patients WITHOUT ARDS. Is so, the evidence we have is that it is probably beneficial. Our goal is to start all patients at 6cc/kg of predicted body weight. This should apply to all patients, regardless of whether they are going to the ICU or not.

      See the following studies for more information:
      Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, Marret E, Beaussier M, Gutton C, Lefrant JY, Allaouchiche B, Verzilli D, Leone M, De Jong A, Bazin JE, Pereira B, Jaber S; IMPROVE Study Group. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013 Aug 1;369(5):428-37.

      Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Espósito DC, Pasqualucci Mde O, Damasceno MC, Schultz MJ. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012 Oct 24;308(16):1651-9.

  2. Hi there,

    thank you for asking the question of the reality of pain (a conscious sensation) vs. neurovegetative symptoms resulting from nociception pathways activation.

    Opioid free anesthesia is my daily practice and we aim at controlling the hemodynamics with dexmed, IV lido and ketamine +/- magnesium without perioperative opiates which were introduced in anesthesia ONLY as hemodynamic stabilizers as most textbooks rightfully state…. we tend to forget that it has never been a problem of pain during anesthesia
    ..

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