Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2008
Comparative pharmacodynamic modeling using bispectral and narcotrend-index with and without a pharmacodynamic plateau during sevoflurane anesthesia.
We compared two pharmacodynamic models, one with and one without a plateau effect. Bispectral indices (BIS, Aspect Medical Systems, Natick, MA, version XP) and Narcotrend (NCT, MonitorTechnik, Bad Bramstedt, Germany, version 4.0) were used as an electroencephalographic measure of sevoflurane drug effect. In addition, we tried to analyze the origin of the plateau. ⋯ A pharmacokinetic/pharmacodynamic model consisting of two sigmoid curves with an intervening plateau describes the effect of sevoflurane on BIS and NCT indices better than a model with a single sigmoid curve.
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Anesthesia and analgesia · Apr 2008
The ability of a novel algorithm for automatic estimation of the respiratory variations in arterial pulse pressure to monitor fluid responsiveness in the operating room.
Respiratory variations in arterial pulse pressure (deltaPP(man)) are accurate predictors of fluid responsiveness in mechanically ventilated patients. However, they cannot be continuously monitored. In our study, we assessed the clinical utility of a novel algorithm for automatic estimation of deltaPP (deltaPP(auto)). ⋯ DeltaPP(auto) is strongly correlated to deltaPP(man) is an accurate predictor of fluid responsiveness, and allows continuous monitoring of deltaPP. This novel algorithm has potential clinical applications.
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Anesthesia and analgesia · Apr 2008
Less impairment of hemostasis and reduced blood loss in pigs after resuscitation from hemorrhagic shock using the small-volume concept with hypertonic saline/hydroxyethyl starch as compared to administration of 4% gelatin or 6% hydroxyethyl starch solution.
Small-volume resuscitation using hypertonic saline/hydroxyethyl starch 200/0.62 (HS-HES) has been shown to be an effective alternative to the administration of crystalloids or colloids in trauma patients. All i.v. fluids cause dose-related dilutional coagulopathy and show intrinsic effects on the hemostatic system, but only few data refer to functional consequences after small-volume resuscitation. ⋯ Resuscitation from hemorrhagic shock with HS-HES 200/0.62 results in less impairment of clot formation when compared with compensation of blood loss by administering 6% HES 130/0.4 or 4% gelatin.
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Anesthesia and analgesia · Apr 2008
Randomized Controlled TrialA novel vibrotactile display to improve the performance of anesthesiologists in a simulated critical incident.
Current methods of information transfer in the operating room between monitor and anesthesiologist rely on visual and auditory modalities. These modalities can easily become overloaded in a high cognitive workload situation, such as in a critical incident. The use of vibrotactile communication has been shown to improve information transfer in other high cognitive workload environments such as aviation. We designed a novel waist-mounted vibrotactile display to be worn by the anesthesiologist to test if a vibrotactile display could improve the clinical response time to begin treating a simulated case of anaphylaxis when compared with a group using traditional information displays. In addition, we evaluated differences in situational awareness (SA) between the two groups. ⋯ Our study provides evidence that vibrotactile communication can reduce response time to critical incidents.