Newly Published
Editorial Views  |   September 2019
The Art of General Anesthesia: Juggling in a Multidimensional Space
Author Notes
  • From the Department of Anaesthesia and Pain Medicine, Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
  • Accepted for publication January 27, 2019.
    Accepted for publication January 27, 2019.×
  • Correspondence: Address correspondence to Dr. Sleigh: Jamie.sleigh@waikatodhb.health.nz
Article Information
Editorial Views
Editorial Views   |   September 2019
The Art of General Anesthesia: Juggling in a Multidimensional Space
Anesthesiology Newly Published on September 27, 2019. doi:10.1097/ALN.0000000000002709
Anesthesiology Newly Published on September 27, 2019. doi:10.1097/ALN.0000000000002709
The art of general anesthesia involves making intuitive predictions of how a particular patient will respond to anesthetic drugs and to the noxious stimuli of surgery. Patient responses might consist of somatic movements, various autonomic nervous system effects (including tachycardia, bradycardia, hypertension, sweating, mydriasis), return of consciousness and memory, and endocrine and immune activation. To suppress these responses we use many different classes of anesthetic drugs or adjuncts. Clearly the delivery of anesthesia requires an appreciation of a multiplicity of dimensions. In this issue of Anesthesiology, an article by Kuizenga et al.1  attempts to bring some scientific quantification to the question of hypnotic–opioid interactions. They investigated how the addition of an opioid drug (remifentanil) alters responses to two commonly used hypnotic drugs (propofol and sevoflurane). This sort of study has been done previously,2–4  but the novelty of the present study was the use of a within-subject design to formally compare the effects of remifentanil on propofol head-to-head with sevoflurane. Thus they studied three input variables (two hypnotic drugs and one analgesic drug) and two output variables (the resting state of the cortical activity as measured by the Patient State Index [a processed electroencephalographic measure], and the probability of behavioral response to graded external stimulation). Because they were looking at perhaps five dimensions, it is hard to represent the totality of their results graphically in a single diagram. Instead we follow the conventional methods of reductive science, and ask separate, tractable (but two-dimensional) questions.