sevoflurane + remifentanil + sufentanil

This is a combination of three anesthetic agents—sevoflurane, remifentanil, and sufentanil—used together to provide balanced general anesthesia during surgical procedures. - **Sevoflurane** is a volatile inhalational anesthetic that induces and maintains general anesthesia by enhancing inhibitory neurotransmission via GABA-A receptors in the central nervous system, leading to loss of consciousness and amnesia. It also causes vasodilation and myocardial depression, contributing to its hypotensive effects. - **Remifentanil** is an ultra-short-acting synthetic opioid analgesic that acts as a potent agonist at the μ-opioid receptor. Its rapid onset and offset allow for precise titration during surgery; it also has some activity at kappa and delta opioid receptors, which may contribute to cardioprotective effects. - **Sufentanil** is a highly potent synthetic opioid analgesic acting primarily as a μ-opioid receptor agonist. It provides profound analgesia with minimal hemodynamic disturbance when used appropriately. The combination aims to optimize intraoperative hemodynamic stability, suppress stress responses (such as those seen during sternotomy), provide effective analgesia, minimize postoperative respiratory depression compared with higher doses of single opioids alone, and enable rapid recovery after surgery[1][2][4]. This regimen is particularly useful in high-stress surgeries requiring both deep anesthesia and strong suppression of sympathetic responses.