Inhaled Anesthesia Tips
Avoid Distressing Awareness
• Check your equipment (e.g. Vaporizer is full and well seated).
• Use EEG monitor to guide pharmacodynamic endpoint (sufficient hypnotic effect).
• Target alpha/theta spindles and delta waves on EEG trace or red train tracks in delta and alpha frequency bands on the
spectrogram (depending on which monitor is being used).
• Do not rely exclusively on processed EEG index.
• Use exhaled age-adjusted MAC to guide sufficient hypnotic dosing (effect-site concentration).
• Set an audible alert (alarm) for low end tidal volatile anesthetic concentration to ensure that inhaled anesthetic is
being delivered, as intended.
• Consider targeting brief deep anesthesia (e.g. periods of EEG suppression) for intense stimuli (e.g. intubation, incision)
• Provide adequate analgesia.
• Avoid excessive NM-blockade (e.g. maintain 2 twitches on TOF).
• Reverse NM-blockade prior to discontinuing volatile anesthetic at the end of the case.
• Ensure sufficient analgesia is on board at emergence.
Avoid Excessive Hypnosis
• Use EEG monitor to guide pharmacodynamic endpoint (note excessive hypnotic effect, e.g. EEG suppression).
• Target alpha/theta spindles and delta waves on EEG trace or red train tracks in delta and alpha frequency bands on the
spectrogram (depending on which monitor is being used).
• Do not rely exclusively on processed EEG index.
• Use age-adjusted MAC to avoid excessive hypnotic dosing (effect-site concentration).
• Consider decreasing volatile anesthetic concentration rate in the face of EEG suppression.
Avoid Prolonged Emergence
• Use EEG monitor to guide down-titration of volatile anesthetic towards the end of the case.
• Do not rely exclusively on processed EEG index.
• Use age-adjusted MAC to guide safe down-titration of volatile anesthetic towards the end of the case.
• Provide adequate analgesia to allow minimization of volatile anesthetic.
• Discontinue volatile anesthetic early while continuing analgesic administration towards the end of the case after reversal
of NM-blockade.
Avoid Unwanted Intraoperative Movement
• Target age-adjusted MAC for volatile anesthetics
• Provide adequate analgesia alongside volatile anesthetics
• Monitor depth of neuromuscular blockade when using paralytic agents
• Consider targeting brief deep anesthesia (e.g. periods of EEG suppression) for intense stimuli (e.g. intubation, incision)
