The degree of MR at rest is unrelated to exercise-induced changes in EROs, which are related to those in local LV remodeling and in mitral deformation but not those in global LV function.

Quantitation of functional MR during exercise is feasible in patients with heart failure. There is a good correlation between regurgitant volume measured during exercise by the PISA method and that obtained by quantitative Doppler echocardiography, suggesting that the technique is reliable. An increase in mitral regurgitant volume during dynamic exercise correlates well with elevation of systolic pulmonary artery pressure.

Background. Sufentanil and remifentanil are characterized by two different pharmacokinetic pro®les. The aim of this study was to compare the effects of sufentanil and remifentanil administered using target-controlled infusion (TCI) on recovery and postoperative analgesia after major abdominal surgery.Methods. Thirty adult patients scheduled for open colorectal surgery were included in a prospective, randomized study. Sufentanil TCI (sufentanil group) or remifentanil TCI (remifentanil group) was administered during surgery. In the remifentanil group, 30 min before the anticipated end of surgery, morphine 0.15 mg kg ±1 was administered i.v. In the sufentanil group, an effect-site concentration of 0.25 ng ml ±1 was targeted at extubation. In both groups, postoperative pain was controlled by titration of i.v. morphine and then patient-controlled analgesia with morphine.Results. The extubation time was similar in the two groups (mean (SD) 13 ( 6) and 14 (6) min in the sufentanil and remifentanil groups respectively). Visual analogue scale scores were signi®cantly greater during the ®rst 2 h after tracheal extubation in the remifentanil group than in the sufentanil group. The time to ®rst analgesic request in the postanaesthesia care unit was signi®cantly longer in the sufentanil group than in the remifentanil group (55 (64) (range 2±240) vs 11 (7) (1±29) min; P<0.001). The cumulative morphine dose for titration was signi®cantly greater in the remifentanil group (P<0.01). The cumulative morphine dose used during titration and patient-controlled analgesia was signi®cantly greater in the remifentanil group 4, 12 and 24 h after extubation (P<0.05). Conclusion.TCI sufentanil (0.25 ng ml ±1 effect-site concentration at extubation) is more effective than the intraoperative combination of remifentanil TCI infusion with morphine bolus (0.15 mg kg ±1 ) for postoperative pain relief after major abdominal surgery and does not compromise extubation and recovery.

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NIV is useful in PICUs if children are appropriately selected and carefully monitored. Technological advances and future clinical research will improve its use and success rate in PICU.