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Background The use of halogenated anaesthetics in cardiac surgery is still controversial. Preconditioning and postconditioning are the well described mechanisms that explain the protective myocardial effect of specific drugs in order to prevent the occurrence and/or to reduce the size of a necrotic post-ischemic myocardial area [1]: they play a well recognized role in the “protective effect” of the halogenated anaesthetics. Preconditioning and postconditioning protect the myocardial cell from oxidative stress and take place through the activation of specific receptors and second messengers systems [2]. Desflurane has shown a higher preconditioning and postconditioning power that could be optimal at 6% of Minimum Alveolar Concentration (MAC) [3]. The solubility of the halogenated anaesthetics can be altered during cardiac surgery: Desflurane has shown a rapid wash-in and wash-out profile in cardiac “on pump” surgery [5,6]. more...

Background Alpha-2 adrenergic agonists reduce mortality and myocardial infarction following vascular and cardiac surgery [1]. Few data exist about the weaning phase in this setting.

Background Pain is one of the complications that most often interfere with patient discharge after interventions performed on a day surgery basis. During the first postoperative hours, up to 40% of patients may experience moderate or severe pain, leading to delayed discharge or unplanned overnight hospitalization [1,2]. The use of a multimodal postoperative treatment plan is recommended. The combined effects of NSAIDs and/or paracetamol, weak opiates (codeine, tramadol) and local anesthetics administered and/or injected by various routes during the perioperative phase should be take in account. To permit rapid discharge, the possible use of NSAIDs with a prevalent impact on COX-1 and potent opioids at recommended therapeutic doses should take into account potential adverse effects (gastric bleeding and/or bleeding of the surgical wound site, NSAIDs induced renal damage, respiratory depression, delayed canalization, nausea, vomiting, excessive sedation, difficulty in urinating, pruritus induced by potent opioids, postoperative hyperalgesia resulting from elimination of rapid half-life intraoperative opioids such as alfentanil and remifentanil) [1-3]. more...