Combined anaesthesia procedures

The additive properties of general and regional anesthetic techniques are b rought together in combined anesthesia to minimise side effects of the indi vidual techniques. Despite a wide experience with both used as single anest hetic techniques, no definite recommendations regarding indications, genera l contraindications and procedure exist for their combination. Beneficial e ffects on haemodynamics, respiratory function, intestinal motility and post operative stress response have been demonstrated for a combination of gener al anesthesia and thoracic epidural anesthesia (TEA). In addition TEA is fa vourable in the management of postoperative pain, which has advantageous ef fects on convalescence especially in a high risk patient group. Nevertheles s, until now no reduction of perioperative morbidity and mortality has been demonstrated. Since the combination of two anesthesia techniques theoretic ally increases the rate of complication,the expected benefit for the patien t must predominate. To estimate the risks and benefits of combined anesthes ia, the anesthesiologist must be familiar with each single method, as well as with the synergistic effects of both techniques in order to evaluate the individual indication.