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- W1597861191 abstract "An anaesthetic technique that provides haemodynamic stability is essential for most cardiac procedures. For many years high-dose fentanyl anaesthesia has been the gold standard in many centres. The drawback to this technique is delayed onset of spontaneous respiration after surgery. The technique of total intravenous anaesthesia with propofol and remifentanil provides the opportunity for earlier extubation after cardiac surgery. Remifentanil has a constant context-sensitive half-life of 3–5 min [1]. Thus, when a remifentanil infusion is stopped, the drug is rapidly cleared from the circulation at a rate independent of the duration of the infusion. Therefore, it is important that the administration of remifentanil is not inadvertently discontinued peri-operatively. We wish to highlight a potential cause of interruption of intravenous infusions during a subgroup of cardiac surgery operations. In cases where bicaval cannulation is employed, such as mitral valve surgery, it is important to ensure that the tip of the central venous pressure catheter is proximal to the superior vena caval snare. As shown in Fig. 1, if the catheter is placed distal to the snare, anaesthetic drugs may be delivered to a space not drained by the venous cannulae. If remifentanil is administered in this way, lack of analgesia could rapidly ensue. This complication may be avoided by ensuring that remifentanil is administered through an intravenous catheter distant from the caval cannulae. Schematic diagram showing a CVP catheter inserted beyond the SVC snare in a procedure requiring both SVC and IVC cannulation." @default.
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- W1597861191 date "1999-03-01" @default.
- W1597861191 modified "2023-09-26" @default.
- W1597861191 title "Awareness during cardiac anaesthesia" @default.
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- W1597861191 doi "https://doi.org/10.1046/j.1365-2044.1999.0811u.x" @default.
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