Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2007
Comparative StudyDark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender.
Pulse oximetry may overestimate arterial oxyhemoglobin saturation (Sao2) at low Sao2 levels in individuals with darkly pigmented skin, but other factors, such as gender and oximeter probe type, remain less studied. ⋯ Multivariate analysis indicated that Sao2 level, sensor type, skin color, and gender were predictive of errors in Spo2 estimates at low Sao2 levels. The data suggest that clinically important bias should be considered when monitoring patients with saturations below 80%, especially those with darkly pigmented skin; but further study is needed to confirm these observations in the relevant populations.
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Anesthesia and analgesia · Dec 2007
ReviewPhotoplethysmography: beyond the calculation of arterial oxygen saturation and heart rate.
In this article, I examine the source of the photoplethysmograph (PPG), as well as methods of investigation, with an emphasize on amplitude, rhythm, and pulse analysis. The PPG waveform was first described in the 1930s. Although considered an interesting ancillary monitor, the "pulse waveform" never underwent intensive investigation. ⋯ Future trends are being heavily influenced by modern digital signal processing, which is allowing a re-examination of this ubiquitous waveform. Key to unlocking the potential of this waveform is an unfettered access to the raw signal, combined with standardization of its presentation, and methods of analysis. In the long run, we need to learn how to consistently quantify the characteristics of the PPG in such a way as to allow the results from research efforts be translated into clinically useful devices.
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Anesthesia and analgesia · Dec 2007
Comparative StudyThe analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments.
Immersive virtual reality (VR) is a novel form of distraction analgesia, yet its effects on pain-related brain activity when used adjunctively with opioid analgesics are unknown. We used subjective pain ratings and functional magnetic resonance imaging to measure pain and pain-related brain activity in subjects receiving opioid and/or VR distraction. ⋯ These subjective pain reports and objective functional magnetic resonance imaging results demonstrate converging evidence for the analgesic efficacy of opioid administration alone and VR distraction alone. Furthermore, patterns of pain-related brain activity support the significant subjective analgesic effects of VR distraction when used as an adjunct to opioid analgesia. These results provide preliminary data to support the clinical use of multimodal (e.g., combined pharmacologic and nonpharmacologic) analgesic techniques.
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Anesthesia and analgesia · Dec 2007
Comparative StudyCoordination of appointments for anesthesia care outside of operating rooms using an enterprise-wide scheduling system.
An anesthesia department implemented scheduling of anesthetics outside of operating rooms (non-OR) by clerks and nurses from other departments using its hospital's enterprise-wide scheduling system. ⋯ Enterprise-wide scheduling can coordinate anesthetics with other appointments on the same date and improve consistency and accuracy of patient instructions customized to the probability of an anesthetic starting early. The usefulness of implementation depends on the value in having more patient-centered care and/or in having patients arrive just in time for non-OR anesthesia, surgery, or regional block placement (e.g., at facilities with limited physical space).
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Anesthesia and analgesia · Dec 2007
Comparative StudyA prospective evaluation of the POVOC score for the prediction of postoperative vomiting in children.
A score to predict postoperative vomiting (PV) in children (POVOC score) has recently been published but has not yet undergone an external validation. ⋯ Using the POVOC score, PV in pediatric patients can be predicted with sufficient accuracy comparable to the results in adult patients, even if one of the risk factors is not applicable.