Journal of clinical monitoring and computing
-
J Clin Monit Comput · Jan 1999
Comparative StudyComparison of statistical methods to predict the time to complete a series of surgical cases.
We present a statistical model for predicting the time to complete a series of successive, elective surgical cases. The use of sample means of case times and turnover times when scheduling cases does not minimize the operating room labor costs associated with errors in predicting times to complete series of cases. ⋯ The independent variables are the numbers of cases in each series that are in various categories (i.e., combinations of scheduled procedures and surgeons). Although the computational method is preferred on theoretical grounds to that involving sample means, application of both methods shows that the more practical method is to use the sample means of previous case times and turnovers.
-
J Clin Monit Comput · Jan 1999
Case ReportsIntraoperative diagnosis of aortic pseudoaneurysm with transesophageal echocardiography.
A pseudoaneurysm of the ascending aorta is a rare complication of aortic valve endocarditis that requires prompt diagnosis. Several imaging strategies can be used; however, transesophageal echocardiography (TEE) has been utilized more frequently due to its superior resolution in detection of aortic valve complications. This case presents a patient with prosthetic valve dysfunction in which intraoperative TEE was used to diagnose a previously undetected aortic pseudoaneurysm, thus leading to a change in surgical management.
-
J Clin Monit Comput · Jan 1999
A simple strategy for faster induction and more cost-effective use of anesthetic vapor.
Inducing general anesthesia often involves mask ventilation using high fresh gas flow (FGF) to administer anesthetic vapor prior to endotracheal intubation. A common practice is to turn the vaporizer off when the mask is removed from the patient's face to avoid room contamination (VAPOff). An alternative approach is to leave the vaporizer on and turn the FGF to minimum to reduce the amount of vapor laden gas that can enter the room (FGFOff). The objective of this study is to compare the relative induction times and vapor costs associated with each induction strategy. ⋯ The strategy of turning the FGF to minimum and leaving the vaporizer on during intubation does not contaminate the room and speeds induction by fostering a greater alveolar concentration than the VAPOff method. Cost savings are derived using FGFOff since a higher alveolar concentration is achieved at the same vapor cost. Additional cost savings are demonstrated since a low flow technique is possible immediately after intubation when using FGFOff. The practice of turning off the vaporizer during endotracheal intubation while FGF remains high should be abandoned.
-
J Clin Monit Comput · Jan 1999
A graphical object display improves anesthesiologists' performance on a simulated diagnostic task.
This study tests the hypothesis that a graphical object display (a data display consisting of meaningful shapes) will affect the ability of anesthesiologists to perform a diagnostic task rapidly and correctly. The diagnostic tasks studied were recognition and differentiation of five etiologies of shock--anaphylaxis, bradycardia, myocardial ischemia, hypovolemia, pulmonary embolus. ⋯ The primary finding of this study was that anesthesiologists using the object display format committed significantly fewer diagnostic errors when interpreting physiologic data. In addition, both the recognition of no-shock and the diagnosis of shock etiology were completed more rapidly when the object display was used. The major limitation of this initial trial is the simplicity of the test. Future investigation of the impact of the display on clinical decision making will require more realistic clinical scenarios with partial or full simulation to better understand the potential clinical impact.
-
The creation of agent mixtures from the addition of the wrong agent to a vaporizer might pose a risk to the patient. Patient injury would be more likely if the anesthesia gas monitor displayed erroneous concentration values. Conventional inhalation agent monitors do not necessarily distinguish anesthetic agents. ⋯ Patient injury could be more likely in this last case. In this last case and in all cases, piezoelectric crystal monitoring correctly displayed the sum of the two agent concentrations in volumes percent. Automatic agent identification can identify erroneous agents.