Acta anaesthesiologica Belgica
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The incidence of postoperative residual curarisation after a neuromuscular blocking drug infusion is important. The greater risk for postoperative residual curarisation than with a single bolus can only be tackled by neuromuscular transmission monitoring, and selectively antagonising the block. Such monitoring is seldom used in cardiac surgery. ⋯ Moreover, by only administering a single neuromuscular blocking drug bolus at induction, postoperative residual curarisation can be avoided, becoming more and more important in fast tracking. Finally, in patients undergoing cardiac surgery, cost-effective combinations of drugs and techniques need to be used that provide adequate anaesthesia and analgesia, as well as appropriate muscle relaxation, while offering ideal operative conditions with minimal risk of myocardial ischaemia and residual curarisation. Therefore the continuous administration of neuromuscular blocking drugs, during cardiac surgery, seems unnecessary.
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Perioperative fluid therapy remains the subject of active controversy. Indeed, clinical trials investigating the effects of fluid administration on outcome in surgical patients report controversial results. Critical review of these trials reveals that current standard fluid therapy is not at all evidence-based. ⋯ The debate "Wet or Dry" is not a real one. Fluids should be administered in the perioperative period through a goal-directed approach taking into account patients characteristics and surgical-related events, and not through a "recipe book" approach. The type of fluid to be administered should depend on the specific space that needs to be restored (intracellular, extracellular or intravascular) and on the pharmacokinetic properties of the different solutions.
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Acta Anaesthesiol Belg · Jan 2007
Randomized Controlled TrialHaemodynamics during remifentanil induction by high plasma or effect-site target controlled infusion.
During total intravenous anaesthesia, the target controlled infusion concentration of remifentanil can be achieved either in limiting maximum plasma concentration (Cp) to the effect site target concentration which corresponds to a plasma TCI technique (pTCI) or as fast as possible to achieve the effect-site target without limiting Cp (eTCI). The aim of this study was to compare the haemodynamic effects of remifentanil pTCI and eTCI during induction of anaesthesia in ASA III patients undergoing cardiac surgery. ⋯ In ASA III patients scheduled for elective cardiac surgery, remifentanil eTCI can be preferred to remifentanil pTCI for induction because of its shorter onset with the same haemodynamic stability.