Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 1998
Detection of postoperative myocardial ischemia by bedside ST-segment analysis in coronary artery bypass graft patients.
To determine if the ST-segment monitoring software of a bedside electrocardiograph (ECG) monitor would detect postoperative myocardial ischemia (POMI) as reliably as the clinical gold standard 12-lead ECG, and to compare the characteristics of ischemia thus detected with prior studies performed using Holter monitoring. ⋯ Bedside monitoring of the ST segment in leads II and V5 using Hewlett-Packard Merlin monitors after CABG surgery is as accurate for the measurement of ST deviation in those leads as the clinical gold standard of a 12-lead ECG read by an experienced cardiologist. However, the 12-lead ECG will detect POMI more reliably than an automated two-lead bedside ST-segment analyzer because it allows evaluation of more leads and of ST-segment and T-wave morphology. Bedside ST-segment monitoring in this study confirmed the high incidence of ischemia after CABG surgery shown previously using Holter monitoring.
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J. Cardiothorac. Vasc. Anesth. · Dec 1998
Ensuring early discharge following major surgery: orthopedic surgery.
Managed care, critical pathways, and length of stay issues have a major impact on current hospital policy and patient care. In orthopedic surgery, significant strides have been made in improving efficiency, decreasing costs, and reducing length of stay. ⋯ In many studies, pain management, type of anesthesia, and amount of blood loss are not significant factors in length of hospital stay. These factors must be approached as quality-of-life issues and appropriate decisions made.