: The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34 066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

We conclude that advances in the management of intrahospital transport of critically ill patients have led to an overall decrease of complications. However, an undeniable risk remains, especially in relation to disease severity and the urgency of such transports.

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Plasma disappearance rate of indocyanine green (PDRICG) has been proposed for assessment of liver function in liver transplants donors and recipients, in patients with chronic liver failure, and as a prognostic factor in critically ill patients. The assessment of PDRICG using a newly developed noninvasive digital pulse densitometry method was simultaneously compared to invasive aortic fiber-optic method in patients undergoing orthotopic liver transplantation (OLT). Fourteen consecutive liver transplant candidates (11 male, 3 female) were prospectively enrolled into the study. A 4F aortic catheter with an integrated fiber-optic device and a thermistor was inserted via a femoral artery sheath for invasive aortic (INV) PDRICG assessment in all patients. The fiber-optic device was connected to a computer system (COLD-Z021, PULSION Medical Systems, Munich, Germany). A finger-piece sensor was used for non-invasive (NINV) pulsedensitometric PDRICG assessment. For the PDRICG assessment .5 mg/kg of ICG in cooled saline (10-15 mL) was injected through a central venous catheter. The assessments of PDRICG were performed after induction of anesthesia, after clamping of the hepatic artery, after clamping of the inferior vena cava, after reperfusion of the graft, and on the first postoperative day. During the PDRICG measurements, the investigators were blinded for the results of the noninvasive monitoring. Seventy-one pairs of measurements were performed successfully. PDRICG ranged from 0%/min to 43.8 %/min (11.6%/ min ؎ 9.6 %/min, mean ؎ SD) for invasive and from I ndocyanine green (ICG) is a water-soluble anioniccompound that is injected intravenously and binds mainly albumin and ␤-lipoproteins in the plasma. ICG is then selectively taken up by hepatocytes, independent of adenosine triphosphate (ATP), and is later excreted unchanged into the bile via an ATP-dependent transport system. It is not metabolized and does not undergo enterohepatic recirculation. 1 Due to these features, ICG has been proposed for assessment of liver function in liver tranplants donors and recipients, in patients with chronic liver failure, and as a prognostic factor in critically ill patients. 2 -5 Plasma disappearance rate of ICG (PDRICG), plasma clearance rate, and retention rate are some of the parameters calculated from the decay of the dilution curve after intravenous ICG injection. PDRICG is the most commonly used ICG-derived parameter for clinical and experimental assessment of liver function with normal range of 18 -25 %/min.There are different techniques assessing the PDRICG in vivo. The gold standard relies on serial blood sampling after ICG injection at certain time intervals and consecutive spectrophotometric concentration analysis. 3,4 However, this method proves to be both expensive and time consuming. Another method implements the use of a fiber-optic aortic catheter inserted via the femoral artery sheath. 6,7 This method was found to correlate well with the serial blood-samAbbreviations: ICG, indocyanine green; ATP, adenosine tripho...

This prospective, interventional observer-blinded study demonstrates that SVV obtained by APCO, using the FloTrac/Vigileo system, is not a reliable predictor of fluid responsiveness in the setting of major abdominal surgery.

No abstract

Epinephrine seemed to be necessary for return of spontaneous circulation, but was subsequently associated with declining hemodynamic variables in this rabbit model of bupivacaine-induced cardiac arrest. Further study is required to define the role of epinephrine in lipid-based resuscitation from local anesthetic-induced cardiac arrest.

SummaryIntravenous lipid emulsion has proven benefit in lipophilic drug-induced cardiotoxicity. Its effect in reversal of central nervous system depression secondary to overdose with lipophilic psychotropic agents remains uncertain. Twenty adult New Zealand White rabbits were anaesthetised with 20 mg.kg )1 thiopental and randomised to receive either 4 ml.kg )1 saline 0.9% or 4 ml.kg )1 lipid emulsion 20% immediately afterwards. Depth of anaesthesia was monitored using bispectral index (BIS) at 1-min intervals. Duration of anaesthesia was measured as time to regain the righting reflex (ability of the animal to right spontaneously from dorsal recumbency to sternal recumbency). The BIS was greater in the control group (p = 0.011). The greatest BIS differential was observed immediately following treatment (mean (SD) BIS 75.0 (9.5) for saline vs 58.6 (10.4) for lipid, 95% CI 5.75-27