Multimodal Anesthesia as an Important Component of Eras

Abstract

Introduction. The ideology of Fast Track-Surgery (FTS) and Enhanced Recovery After Surgery (ERAS) represents modern trends in global surgical practice. Anesthesiology aims to provide ideal and universal solutions for protecting patients from surgical aggression. A multimodal approach, which includes multilevel, multifaceted antinociception, is well-founded, where maximum effectiveness is combined with minimal side effects.
 The aim. To analyze the issue of multimodal pain management as an important component of ERAS (Enhanced Recovery After Surgery) from modern sources of literature for optimizing perioperative care in the minimally invasive surgery department.
 Materials and methods. Bibliosemantic, comparative, and systemic analysis methods were employed. The proposed recommendations were developed based on an analysis of modern literature, the results of randomized trials and meta-analyses, as well as our own studies dedicated to the study of perioperative pain issues.
 The results. It has been proven that the use of opioids in anesthesia practice is decreasing. New and modern methods of continuous monitoring of vital organs in patients are being introduced as supplements to classical monitoring protocols. These methods are used to avoid excessive or inadequate dosing of anesthetics, adjust the concentration of substances used, reduce post-anesthesia complications, and improve patient comfort. The method of perioperative energy monitoring significantly complements the "International Standards for Safe Anesthetic Practice", WFSA (2010), and enhances perioperative patient safety by detecting metabolic disturbances and implementing appropriate pathogenetic correction. The importance of regional anesthesia under ultrasound control, nociception-antinociception balance management, and the impact of these methods on opioid consumption, patient satisfaction, and postoperative recovery have been proven.
 Conclusions. The most commonly used combination of drugs for multimodal analgesia often includes acetaminophen and NSAIDs (strong recommendation). It has been proven that deep and prolonged sedation in intensive care unit (ICU) patients is associated with worse outcomes, longer mechanical ventilation duration, extended ICU and hospital stays, and higher rates of complications, including infections and sometimes even death.