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Opioid Free Anesthesia

Opioid Free Anesthesia. Tom Baribeault MSN CRNA. What is Opioid Free Anesthesia. New technique of anesthesia administration Opioid-free intra-operatively Maintain hemodynamics with medications that protect the nervous system Acute surgical pain management Treat the cause of the pain. Why.

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Opioid Free Anesthesia

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  1. Opioid Free Anesthesia Tom Baribeault MSN CRNA

  2. What is Opioid Free Anesthesia New technique of anesthesia administration Opioid-free intra-operatively Maintain hemodynamics with medications that protect the nervous system Acute surgical pain management Treat the cause of the pain

  3. Why Safer anesthetic Less respiratory depression Acute surgical pain control Prevent chronic pain Avoid side effects of opioids Patient satisfaction Shorter hospital stay $$$ Reduce opioid addiction/dependence

  4. Preconceptions Opioids are: Necessary: hemodynamic control and pain management Beneficial: improve the patient experience Safe: respiratory depression and other side effects can be safely managed Adequate: pain is well controlled

  5. Special Populations Respiratory Complex Pain Management Opioid users/abusers Recovery High risk chronic pain PONV Cancer Elderly

  6. Anatomy Peripheral Nerves A Beta A Delta C Spinal Nerves Rexed Lamina I Rexed Lamina V

  7. Anatomy

  8. Anatomy Rexed Lamina I Midbrain Periaqueductal Grey Rostral Ventromedial Medulla Descending Fibers Rexed Lamina V Thalamus Pain Matrix

  9. Anatomy

  10. Natural Inhibition Periaqueductal Grey Rostral Ventromedial Medulla A Beta Inhibition

  11. Natural Inhibition

  12. Hyperalgesia Primary (Peripheral) Sensitization Inflammation Induced Central Sensitization Secondary (Central) Sensitization Allodynia Opioid Induced Hyperalgesia

  13. Peripheral Sensitization

  14. Peripheral Sensitization

  15. Hyperalgesia Primary (Peripheral) Sensitization Inflammation Induced Central Sensitization Secondary (Central) Sensitization Allodynia Opioid Induced Hyperalgesia

  16. Central Sensitization

  17. Central Sensitization

  18. Allodynia

  19. Opioid Induced Hyperalgesia

  20. History Balanced Anesthesia Fentanyl Multimodal Therapy Pre-emptive Analgesia Preventative Analgesia

  21. Peripheral and Central Inflammation Steroids Nsaids/Coxibs Cannabinoids? Local Anesthetics

  22. Central Sensitization Glutamate Ketamine N2O Magnesium Gabapentinoids Substance P Clonidine Dexmedetomidine Tizanidine

  23. Central Sensitization Anti-depressants Duloxetine Trazodone Tramadol Cyclobenzaprine Amitriptyline

  24. Analgesics Local Anesthetics Regional/Neuraxial Lidocaine infusion Acetaminophen Beta Blocker Opioids

  25. Plan Intra-operative Local Anesthetics A2 agonist NMDA antagonist Beta Blockers

  26. Plan Post-operative Acetaminophen NSAID/Cox 2 Gabapentinoid Anti-depressant Opioid Infusions Lidocaine A2 Ketamine

  27. OFA Expectations Normotensive Increased respiratory rate Initial wake up slower Less pain/more responsive to opioids

  28. Resources Goopioidfree.com info@goopioidfree.com

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