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Non-Opiate Surgical Anesthesia - A Paradigm Shift

There is some contention as to whether there is a need to use opioids in combination with other anesthesia drugs for the purpose of general anesthesia and/or sedation. What we know is that the use and combination of opioids with other anesthesia medicines depends on the doctor, hospital and the location or country. In Australia, I recently went in to hospital for two procedures which required anesthesia/sedation and no opioids were used as I specifically requested for them to not be used, however the anesthesiologist actually advised me that he did not normally use opioids with other anesthesia medicines, instead they used propofol for my procedures.

A presentation of materials put together by the Department of anesthesiology Sint Jan Bruges, in Belgium – in collaboration with M DeKock UCLeuven, details a vast account of a “paradigm shift” away from using opioids in combination with other drugs for anesthesia. What has been observed is that the use of opioids administered for anesthesia actually cause suppression of the body’s own immunity-processes, which is definitely a negative side-effect.

In a lot of cases, research and studies are showing that there is no essential need to include an opiate in the anesthesia process. This is not true of every case, however if there are a range of procedures and circumstances where there is no need to use opiates in conjunction with other anesthetics than they should not be included in the administration of anesthesia.

There are some risks and side-effects of using opioids in the general anesthesia of patients, and this is something the medical community would obviously want to reduce. There is a chance of developing opioid-induced hyperalgesia which is an increase in the sensitivity to pain.

Some of the critical factors for considering the non-use of opioids are discussed in the below points extracted from the above case materials mentioned:

  • Morphine decreases natural and acquired immunity, both directly and indirectly via the activation of central receptors.
  • The immunological effects of opioids are receiving considerable attention because of concerns that opioid-induced changes in the immune system may affect the outcome of surgery or of a variety of disease processes, including bacterial and viral infections and cancer.
  • The impact of the opioid-mediated immune effects could be particularly dangerous in selective vulnerable populations, such as the elderly or immune-compromised patients.
  • Choosing anesthetic drugs without an effect on immune responses may be an important consideration in anesthesia.

All of these points are important to consider when going in for a procedure that requires general anesthesia. As usual, it is best to consult with your doctors and physicians to determine your best course of action and treatment for your current health and situation.

Reference:

http://publicationslist.org/data/jan.mulier/ref-373/J%20P%20Mulier%20opioid%20free%20anesthesia.pdf

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