Comment conduire l'analgésie peropératoire ?

During general anaesthesia opioids are more essential to prevent responses to noxious stimuli than to limit hypnotic dosage. Controlling effects by adjusting opioid administration is based on pharmacokinetic knowledge of each drug, so as adequate concentration at action site can be constantly warranted and anticipated. Opioid injection can be effected either by iterative boluses (for short procedures, with sufentanil, fentanyl, alfentanil) or by constant-rate infusion (possible with remifentanil, alfentanil or sufentanil, but unadvisable with fentanyl), or best by target-controlled infusion (TCI). This last mode of administration being much more accurate and flexible improves cardiovascular stability and adjustment to age or weight characteristics, as well as recovery time. Opioid-TCI software is still limited by regulations. Given the synergy of opioids and hypnotics, there are several strategies to provide an adequate anaesthesia. A balanced association of both agents gives maximal synergy and should be preferred to unbalanced strategies with hypnotic or opioid excess.