**5. Anesthetic management**

Based on the latest evidence found in the literature, it is considered good anesthetic practice for resection of bone tumors to perform a TIVA based on remifentanil and


*NK-natural killer. HPA- Hypothalamus pituitary adrenal. NSAIDs- Non-steroidal anti-inflammatory drugs. COX-2- Cyclooxygenase 2.*

### **Table 2.**

*Perioperative strategies to reduce the risk of tumor recurrence.*

propofol, in addition to adjuvant regional techniques according to the procedure to be performed (**Table 2**) [5]. We propose the example of a healthy young patient who undergoes resection surgery for osteosarcoma of the knee. After adequate standard ASA (American Society of Anesthesiologists) monitoring (**Figure 6**) [72], and monitoring of anesthetic depth through NINDEX monitor, (**Figure 7**) [73], the anesthetic technique that would provide the greatest benefits based on the previously mentioned; is combined general-epidural anesthesia. A propofol and remifentanil

### **Figure 6.**

*Standard ASA monitoring (American Society of Anestesiologists).*

**Figure 7.** *Anesthetic depth monitoring NINDEX (Narcosis INDEX).*

## *Anesthesia Management to Improve Outcomes DOI: http://dx.doi.org/10.5772/intechopen.106672*

TIVA, target-controlled infusion in effect-site (TCIce), plus a continuous infusion of 1% lidocaine, 1 mg/kg/hour through the epidural catheter. It is also vitally important to help with NSAIDs such as Ketoprofen.

Through this anesthetic technique, multiple objectives are achieved: Propofol:

