Opioid analgesics have been widely used during the perioperative period for
premedication, as part of nitrous-narcotic-relaxant (so-called "balanced") techniques, and
for the management of acute postoperative pain. Increasingly, physicians are beginning
to examine the use of non-opioid compounds as alternatives to the opioid analgesics
before, during and even after surgery1).
In the past, premedication with opioids was recommended to produce sedation and
minimize coughing and acute hemodynamic responses during induction and tracheal
intubation. More recently, proponents of "pre-emptive" analgesia have also encouraged
the administration of opioid analgesic drugs prior to the surgical incision2). However,
when opiod analgesics are administered for premedication they can produce repiratory
depression and pruritis, as well as increase the symptoms of postoperative nausea and
vomiting (PONV). the use of sympatholytic drugs (e.g., β-blockers, Ca-channel
blockers, α2-agonists) can blunt the acute autonomic responses to noxious stimuli
during surgery (e.g., laryngoscopy, intubation, skin incision)3∼7), without producing
opioid-related side effects.
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