European journal of anaesthesiology. Supplement
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Remifentanil is a new potent mu-agonist with a unique pharmacokinetic profile due to a rapid metabolism by non-specific tissue esterases. As a consequence, remifentanil pharmacokinetics are not modified by severe renal or hepatic dysfunction. During general anaesthesia, any dosage of remifentanil may be used without undue lengthening of emergence times. ⋯ The rapid termination of remifentanil action warrants modifications of the current practice concerning early postoperative pain control. Remifentanil may be used as a sedative during monitored analgesia, or as a postoperative analgesic in spontaneously breathing patients, provided bolus doses are avoided. Remifentanil may increase patients' safety by eliminating the risk of delayed respiratory depression, but its correct use requires major changes in our prescribing habits.
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In clinical practice, indirect and non-specific signs are used for monitoring anaesthetic adequacy. These include haemodynamic, respiratory, muscular and autonomic signs. These measures do not indicate adequacy of anaesthesia in a reliable manner. ⋯ An alternative approach is to monitor evoked potentials. Middle latency auditory evoked potentials may be helpful in assessing anaesthetic adequacy. Both techniques need further validation.
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From the patient's point of view, the Intensive Care Unit is both a frightening place and a safe haven. Psychologically, what we see most commonly are regression, delirium and paranola. Regression requires no treatment; delirium is treatable not only medically but psychologically as well; paranoia is best treated by prevention.