European journal of anaesthesiology
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Review
Cardiac risk reduction in non-cardiac surgery: the role of anaesthesia and monitoring techniques.
Cardiac complications are the major cause of perioperative morbidity and mortality of patients undergoing non-cardiac surgery. This is related to the frequent presence of underlying coronary artery disease. ⋯ On the other hand, less attention was given to the role of anaesthesia and monitoring techniques in the cardiac risk management of high-risk patients undergoing non-cardiac surgery. The aim of this review was to summarize the current evidence from published studies on the effect of the type of anaesthesia and monitoring techniques on perioperative cardiac outcome in non-cardiac surgery.
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The 'wet vs. dry' philosophy in patients undergoing abdominal surgery is a subject of substantial debate. It has been suggested that restricting fluid input would significantly reduce complications and improve outcome following abdominal surgery. Keeping the patients dry may be a two-edged sword because the resulting hypovolaemia may result in compromised organ perfusion and poor tissue oxygenation. ⋯ Current evidence indicates that using crystalloids exclusively may cause overloading of the interstitial compartment with considerable negative sequelae, whereas using colloids may improve microperfusion and tissue oxygenation. This review shows that the meagre literature on a restricted volume replacement strategy in abdominal surgery patients cannot clearly support the 'dry' approach. Further well-performed studies are necessary to elucidate the ideal amount and type of fluid replacement and determine how to guide fluid therapy.
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Sedation is commonly required by critically ill patients and inadequate sedation may be hazardous. Traditionally, subjective scales have been used for monitoring sedation. Bispectral index has been proposed, although its utility in the intensive care unit is debated. Our aim was to evaluate the depth of sedation in intubated surgical critically ill patients by means of two sedation scales (Ramsay and Observer's Assessment of Alertness and Sedation) and bispectral index. ⋯ Sedation should be monitored routinely in intensive care units. The Ramsay and the Observer's Assessment of Alertness and Sedation scales showed equal efficacy. Bispectral index might prove useful for discriminating between deeper levels of sedation.