“We’ve come up with strategies that allow us to dose the same drugs that are generally used but in different proportions that allow us to achieve an anesthetic state that is much more desirable,” said Brown, a Professor in the Picower Institute for Learning and Memory at MIT and a practicing anesthesiologist at Massachusetts General Hospital.
In the paper Brown and co-authors lay out exactly how and where each major anesthetic drug affects the nociceptive circuits of the nervous system. Nociception is the body’s sensing of tissue damage. It is not pain, which is a conscious perception of that.
Then the authors show how in four different surgical cases they were able to use neuroscience to guide their choice of a “multimodal” combination of drugs to target nociceptive circuits at several different points. That way they didn’t have to use much of any individual drug. Because reduced arousal is a byproduct of the strategy, they also didn’t have to administer much medicine to ensure unconsciousness, a state they scrupulously monitor in the operating room by watching brainwaves captured by electroencephalography (EEG).
“If you do it this way, you have better control of nociception and you can get the same amount of unconsciousness with less drug,” said Brown, who is also associate director of MIT’s Institute for Medical Engineering and Science and a professor in MIT’s Department of Brain and Cognitive Sciences and Harvard Medical School. “Patients wake up quicker, and if you carry the multimodal strategy into the postoperative period you have taken into account controlling pain such that you can use few opioids or no opioids.”
Reducing opioids has become a major goal of anesthesiologists in recent years as an epidemic of overdoses has ravaged the United States.