Acta anaesthesiologica Belgica
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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.
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Acta Anaesthesiol Belg · Jan 2007
Evaluation of two different epidural catheters in clinical practice. narrowing down the incidence of paresthesia!
Although epidural anesthesia is considered safe, several complications may occur during puncture and insertion of a catheter. Incidences of paresthesia vary between 0.2 and 56%. A prospective, open, cohort-controlled pilot study was conducted in 188 patients, ASA I-III, age 19-87 years, scheduled for elective surgery and epidural anesthesia. ⋯ No accidental dural punctures occurred. An overall incidence of 13.3% of technical problems led to early catheter removal. The new catheter was at least equivalent to the standard regarding epidural success rate and safety : rate of paresthesia, intravascular and dural cannulation.
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Acta Anaesthesiol Belg · Jan 2007
Anaesthesia with remifentanil infusion in diabetic versus non-diabetic patients undergoing vitrectomy. A Holter-controlled study.
Diabetic patients are known to have additional risks in surgery. We evaluated haemodynamic profiles, incidence of arrhythmias and post-operative recovery when remifentanil infusion was used for vitrectomies. We compared 22 diabetics with 22 age-matched controls undergoing vitrectomy. ⋯ Time to obey commands or need for pain medicine postoperatively did not differ between the groups. Diabetic patients were haemodynamically more instable with more frequent hypotensive periods during anaesthesia despite of less amount of remifentanil compared to controls. On the other hand, during remifentanil infusion no ischaemic or clinically significant arrhythmic episodes occurred in either group.
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Acta Anaesthesiol Belg · Jan 2007
Case ReportsUse of BIS monitor during anaesthesia of a narcoleptic patient for avoiding possible delayed emergence.
Anaesthesia for a narcoleptic patient is not a common practice of anaesthesioligists' daily working life. Therefore special problems related to narcolepsy should be considered pre-, peroperatively and during emergence. The aim of presenting this case report is to emphasize the importance of BIS monitor use in a narcoleptic patient undergoing surgery under general anaesthesia to avoid possible prolonged emergence.