Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Nov 2014
ReviewEffects of intravenous solutions on acid-base equilibrium: from crystalloids to colloids and blood components.
Intravenous fluid administration is a medical intervention performed worldwide on a daily basis. Nevertheless, only a few physicians are aware of the characteristics of intravenous fluids and their possible effects on plasma acid-base equilibrium. According to Stewart's theory, pH is independently regulated by three variables: partial pressure of carbon dioxide, strong ion difference (SID), and total amount of weak acids (ATOT). ⋯ The scenario is however complicated by the possible presence of weak anions (albumin, phosphates and gelatins) and their effect on plasma pH. The present manuscript summarises the characteristics of crystalloids, colloids, buffer solutions and blood components and reviews their effect on acid-base equilibrium. Understanding the composition of intravenous fluids, along with the application of simple physicochemical rules best described by Stewart's approach, are pivotal steps to fully elucidate and predict alterations of plasma acid-base equilibrium induced by fluid therapy.
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Anaesthesiol Intensive Ther · Nov 2014
ReviewWhy crystalloids will do the job in the operating room.
The current trend in anaesthesia is to choose crystalloid over colloid fluids for volume replacement in the operating room. Outcome-oriented studies and kinetic analyses have recently provided more insight into how crystalloid infusions should be managed. These fluids have a much better short-term effect on the plasma volume than previously believed. ⋯ Clinicians who do not want to prolong the length of the hospital stay by 1-2 days due to such problems may use colloid fluid selectively, but calculations show that the therapeutic window for colloids is quite narrow. Inflammation is likely to decrease the fluid efficiency of colloid fluids, while its effect on crystalloids is unclear. However, some recent evidence suggests that inflammation accelerates the turnover of crystalloid fluid as well.
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Anaesthesiol Intensive Ther · Sep 2014
Randomized Controlled Trial Comparative StudyAssessment of the depth of anaesthesia during inhalational and intravenous induction of general anaesthesia.
Tracheal intubation is one of the strongest stimuli during general anaesthesia and may result in an insufficient depth of anaesthesia. The aim of the study was to compare the clinical evaluation of the depth of anaesthesia with an evaluation using entropy during inhalational and intravenous induction of general anaesthesia. ⋯ We found a discrepancy in the evaluation of the depth of anaesthesia based on clinical criteria compared with evaluations based on entropy values during both intravenous and inhalational induction of general anaesthesia.
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Anaesthesiol Intensive Ther · Sep 2014
Randomized Controlled TrialThe effect of bispectral index monitoring on anaesthetic requirements in target-controlled infusion for lumbar microdiscectomy.
Target-controlled infusion (TCI) is used to maintain the desired concentration of a hypnotic drug in the plasma and brain. However, pharmacodynamic variability can cause problems with maintaining the adequate level of anaesthesia. The bispectral index (BIS) is one of only a few parameters that allow an assessment of the depth of anaesthesia. In the present study, we attempted to determine the optimal dosages of drugs used for total intravenous anaesthesia with TCI based on BIS-guided monitoring of depth of anaesthesia. ⋯ BIS monitoring reduces the doses of opioids and hypnotics used during total intravenous anaesthesia by TCI.