Minerva anestesiologica
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Minerva anestesiologica · Nov 2006
Effect site concentrations of remifentanil maintaining cardiovascular homeostasis in response to surgical stimuli during bispectral index guided propofol anestesia in seriously obese patients.
The aim of this prospective study was to determine the effect site concentrations of remifentanil maintaining cardiovascular homeostasis in response to surgical stimuli during bispectral index (BIS) guided propofol anesthesia in seriously obese patients. ⋯ This study suggests that tolerance to remifentanil infusion is profound and develops very rapidly in morbidly obese patients submitted to open bariatric surgery during BIS guided propofol anesthesia. The administration of opiates during anesthesia based on target-controlled infusion should include corrections for the development of tolerance.
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Echocardiography has evolved to become one of the most versatile modalities for diagnosing and guiding treatment of critically ill patients. Both transthoracic (TTE) and transesophageal echocardiography (TEE) provide real-time bedside information about a variety of structural and functional abnormalities of the heart as well as contractility, filling status and cardiac output, rendering it the method of choice for the assessment of cardiac function in the intensive care unit (ICU). Both approaches have its benefits and limitations. ⋯ Since echocardiography provides different information than other devices for hemodynamic monitoring such as the pulmonary artery catheter the methods are therefore not competitive but rather complementary. The present body of evidence supporting the use of TEE in critically ill patients lacks prospective, randomized controlled studies focusing on end-points like cost-effectiveness, morbidity or mortality. However, present evidence as well as experience, points to the significant benefits which may be gained by the availability of echocardiography and especially TEE in ICUs, as well the necessity for a training of intensive care physicians.