European journal of anaesthesiology. Supplement
-
Neuromuscular relaxants may be administered to ICU patients for days or weeks. The most frequent indications are facilitation of mechanical ventilation and management of neurosurgical patients after severe head injury. ⋯ The mechanisms are still poorly understood and under investigation. Although neuromuscular monitoring provides guidelines for the administration of muscle relaxants in critically ill patients, it does not prevent the development of a myopathy.
-
Multiple drugs are used to provide anaesthesia. On average, four to six drugs are used during anaesthesia and, therefore, drug interactions are common. These interactions are primarily either pharmacokinetic or pharmacodynamic. ⋯ Pharmacodynamic-drug interactions between anaesthetic drugs, however, are potentially serious. This may reflect that anaesthesia is not a single entity, but a process provided by a combination of drugs; i.e. loss of consciousness, analgesia and neuromuscular blockade. An understanding of each drug's pharmacokinetics, pharmacodynamics and drug interactions will allow clinicians to administer drugs to provide a more optimal anaesthetic.
-
Eur J Anaesthesiol Suppl · May 1997
Target-controlled anaesthesia: concepts and first clinical experiences.
Propofol has a favourable pharmacokinetic profile for total intravenous anaesthesia and several manual infusion schemes have been proposed to maintain a constant blood concentration during anaesthesia. However, such schemes cannot respond predictably to changing surgical and anaesthetic requirements. A pharmacokinetic model for propofol has been incorporated into a target-controlled infusion system. ⋯ There is no single blood concentration of an anaesthetic agent which will result in satisfactory anaesthesia for all patients and all surgical conditions. It is necessary to titrate the target concentration against each patient's clinical response. Target-controlled systems provide the best estimate of the blood concentration at any time and permit the required target concentration to be achieved as accurately and as rapidly as possible.
-
Adequate treatment of pain in ICU patients should be an integral part of ICU management, as inadequately treated pain leads to a series of complications that may counteract the success of ICU treatment. For continuous intravenous use we recommend sufentanil in a dose of 0.75-1.0 microgram kg-1 h-1 in mechanically ventilated patients and in a dose of 0.25-0.35 microgram kg-1 h-1 in intubated and spontaneously breathing patients. ⋯ Patients with trauma to the thorax, pelvic fracture, or after major surgical interventions will be better managed by regional application of analgesic drugs alone or in combination with a systemic analgesic drug infusion. To achieve the best results it is necessary to be well informed and trained in the method, to know the advantages and disadvantages, the correct and modified dosages of the drugs used, and the indications and contraindications.
-
Eur J Anaesthesiol Suppl · Mar 1997
ReviewPharmacological prophylaxis of bleeding in surgical patients treated with aspirin.
A Medline search and subsequent meta-analysis shows that pre-operative aspirin increases blood loss and transfusion requirements in patients undergoing coronary artery bypass grafting. Both aprotinin and desmopressin are effective in counteracting this. There are almost no data on the effects of bleeding of aspirin, aprotinin and desmopressin in other procedures.