Masui. The Japanese journal of anesthesiology
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General anesthesia using remifentanil is accompanied with post-operative shivering at a high incidence. Post-operative shivering can be divided into thermoregulatory and non-thermoregulatory. Hypothermia causes thermoregulatory shivering. ⋯ Thus, opioid transition using fentanyl and/or morphine during anesthetic management is essential for the prevention of non-thermoregulatory shivering. It is also reported that magnesium, ketamine and pethidine have preventive effects on non-thermoregulatory shivering. The mechanism underlying post-operative shivering associated with general anesthesia using remifentanil is very complicated; therefore, we speculate that multimodal approach is required for its prevention.
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Critical care echocardiography (CCE) using the transthoracic approach is a noninvasive imaging tool at the bedside and is of great value in the intensive care setting because of its portability, widespread availability, and rapid diagnostic capability. Time-dependent scenarios occur during shock and during cardiopulmonary resuscitation. Potentially treatable causes of shock or cardiac arrest including hypovolemia, cardiac tamponade, left ventricular failure, or massive pulmonary embolism should be detected or excluded as soon as possible. ⋯ Competence in basic CCE includes qualitative assessment of left ventricular cavity size, left ventricular systolic function, right ventricular cavity size and function, identification of pericardial fluid, and measurement of inferior vena cava diameter. Basic CCE should be a required part of the training of every ICU physician. This review discusses the application of basic CCE performed by the emphasis on focused or goal-directed assessment.