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Factors affecting recovery profile

What can we do to help ensure a smooth recovery from anaesthesia? In this article, we outline multiple factors that need to be considered.

TIVA’s recovery profile

Associated with a pleasant and smooth nature of emergence from general anaesthesia
Multifactorial anaesthetic plan needs to be both patient and procedure specific
- Procedure specific
  - Neurosurgery: prevention of coughing might be one of the most important considerations
  - Tonsillectomy: return of airway reflexes and timing of extubation
  - Day surgery: TIVA is associated with shorter time to home readiness
  - Longer surgery: consider a shorter-acting sedative
- Patient-specific
  - Age and cognitive function
  - High risk of PND
  - Baseline anxiety and fears
Elements of a smooth recovery
- Reasonable fast recovery
- Patient comfort:
  - Adequate postoperative analgesia
  - Absence of PONV
  - Avoidance of agitation
- Cardiovascular stability
- Return of airway reflexes
To provide us with the highest chance of providing a smooth recovery from anaesthesia knowledge of the following is required
- Pharmacokinetic characteristics and decrement times
- Pharmacodynamic interactions between different drugs
- Prevention of PONV
- Adjuncts for postoperative analgesia
- Optimal timing of emergence from anaesthesia
  - May be difficult to predict we should use all available information
  - Depth-of- anaesthesia (DoA) monitoring
    - Prevent excessive depth of anaesthesia
    - Improve the speed and quality of recovery from anaesthesia
    - Guidance states BIS range between 40-60 for general anaesthesia towards the end of the surgery this range can be narrowed to BIS between 50-60
Know your pump: Decrement function
Know your patient: The target effect site level that corresponds to loss of response to verbal stimlus when titrated slowly at induction corresponds well to return conciousness
Know your surgery: Noxious stimuli during the last part of surgery may result in the patient waking too soon if the dose of anaesthetic is turned off or reduced too soon
Know your surgeon: Consider reducing the target concentrations when wound closure begins.
- Who will be closing the patient and how long will it take?
- Stopping all drug infusions when the last sutures are being inserted