Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2017
Editorial CommentPeripheral Nerve Catheters: Ready for a Central Role?
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A number of different technologies have been developed to measure tissue oxygenation, with the goal of identifying tissue hypoxia and guiding therapy to prevent patient harm. In specific cases, tissue oximetry may provide clear indications of decreases in tissue oxygenation such as that occurring during acute brain ischemia. However, the causation between tissue hemoglobin-oxygen desaturation in one organ (eg, brain or muscle) and global outcomes such as mortality, intensive care unit length of stay, and remote organ dysfunction remains more speculative. ⋯ Furthermore, well-designed prospective studies that test the hypothesis that monitoring oxygenation status in one organ predicts outcomes related to other organs need to be done. Finally, we call for more work that defines regional variations in tissue oxygenation and improves technology for measuring and even imaging oxygenation status in critical organs. Such studies will contribute to establishing that monitoring and imaging of tissue oxygenation will become routine in the care of high-risk patients because the monitors will provide outputs that direct therapy to improve clinical outcomes.
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Anesthesia and analgesia · Jan 2017
Multicenter StudyChallenges of Anesthesia in Low- and Middle-Income Countries: A Cross-Sectional Survey of Access to Safe Obstetric Anesthesia in East Africa.
The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be averted with access to safe surgery, including cesarean delivery, we set out to assess the capacity to provide safe anesthetic care for mothers in the main referral hospitals in East Africa. ⋯ We identified significant shortages of both the personnel and equipment needed to provide safe anesthetic care for obstetric surgical cases across East Africa. There is a need to increase the number of physician anesthetists, to improve the training of nonphysician anesthesia providers, and to develop management protocols for obstetric patients requiring anesthesia. This will strengthen health systems and improve surgical outcomes in developing countries. More funding is required for training physician anesthetists if developing countries are to reach the targeted specialist workforce density of the Lancet Commission on Global Surgery of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030.
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Anesthesia and analgesia · Jan 2017
ReviewAdvanced Uses of Pulse Oximetry for Monitoring Mechanically Ventilated Patients.
Pulse oximetry is an undisputable standard of care in clinical monitoring. It combines a spectrometer to detect hypoxemia with a plethysmograph for the diagnosis, monitoring, and follow-up of cardiovascular diseases. These pulse oximetry capabilities are extremely useful for assessing the respiratory and circulatory status and for monitoring of mechanically ventilated patients. ⋯ In this article, we present and describe these extended monitoring capabilities and propose a more holistic monitoring concept that takes advantage of these advanced uses of pulse oximetry in the monitoring of ventilated patients. Today's monitors need to be improved if such novel functionalities were to be offered for clinical use. Future developments and clinical evaluations are needed to establish the true potential of these advanced monitoring uses of pulse oximetry.
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Anesthesia and analgesia · Jan 2017
Comparative StudyApplying Computer Models to Realize Closed-Loop Neonatal Oxygen Therapy.
Within the context of automating neonatal oxygen therapy, this article describes the transformation of an idea verified by a computer model into a device actuated by a computer model. Computer modeling of an entire neonatal oxygen therapy system can facilitate the development of closed-loop control algorithms by providing a verification platform and speeding up algorithm development. ⋯ Although the performance of the 3 control algorithms was equivalent, it is suggested that the adaptive model, with its ease of use, may have the best utility.