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Are there beneficial effects to hybrid anesthesia*?

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Abstract

As the COVID-19 pandemic increased the use of propofol in the intensive care unit for the management of respiratory sequelae and supply had become a major issue. Indeed, most hospitals in Japan were forced to use propofol only for induction of anesthesia with inhalational maintenance. Large amounts of propofol remain in the syringe which exacerbates the problems by increased waste. I propose that use of low dose propofol in combination with a low concentration inhaled anesthetic as an alternative and call this hybrid anesthesia. Several advantages of hybrid anesthesia are evident in the literature. Volatile anesthesia has several disadvantages such as cancer progression, emergence agitation, marked reduction in motor evoked potentials (MEP), laryngospasm with desflurane and postoperative nausea and vomiting (PONV). Volatile anesthesia exerts some beneficial actions such as myocardial protection and fast emergence with desflurane. In contrast, total intravenous anesthesia (TIVA) provides better survival in patients undergoing radical cancer surgery, reduction in emergence agitation, laryngospasm, PONV and better MEP trace Intraoperative awareness occurs more often during TIVA. When intravenous and volatile anesthesia are combined (hybrid anesthesia), the disadvantages of both methods may be offset by clear advantages. Thus, hybrid anesthesia may, therefore, be a viable anesthetic choice.

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Acknowledgements

I thank Professor David G Lambert (University Department of Cardiovascular Sciences, Anaesthesia, Critical Care and Pain Management, University of Leicester, Leicester, UK) for his valuable comments.

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  1. Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan

    Kazuyoshi Hirota

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Correspondence to Kazuyoshi Hirota.

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Main content of this article was presented at Baxter Ltd (desflurane distributor in Japan) sponsored lecture in the 28th annual meeting of Japanese Society for Intravenous Anesthesia held in Fukui, November 27, 2021.

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Hirota, K. Are there beneficial effects to hybrid anesthesia*?. J Anesth (2024). https://doi.org/10.1007/s00540-024-03310-y

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