Journal of clinical monitoring and computing
-
J Clin Monit Comput · Jan 2000
Randomized Controlled Trial Clinical TrialDoes monitoring of post-tetanic count prevent alarms of airway pressure or visible muscle activity during intratracheal jet ventilation? A prospective study with five different neuromuscular blocking agents.
Profound neuromuscular block (NMB) quantified by post-tetanic count (PTC) may prevent all muscle activity during anesthesia. We studied whether monitoring of PTC prevents airway pressure alarms or visible movements of the vocal cords and the abdomen during endolaryngeal procedures (ELPs). ⋯ PTC-monitoring following 50 Hz stimulation does not ensure total inactivity of muscles during alfentanil-propofol anesthesia, regardless which relaxant has been chosen. During ELPs, simultaneous observation of the vocal cords and the abdomen is more sensitive in detecting early recovery of NMB compared to our method of airway pressure monitoring.
-
J Clin Monit Comput · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialComparison of non-invasive blood pressure measurements on the arm and calf during cesarean delivery.
Shivering may occur in 75% of women undergoing spinal anesthesia for cesarean delivery and may render an automated noninvasive blood pressure (ANIBP) device incapable of determining blood pressurc (BP). When patients shiver under spinal anesthesia, the lower extremities do not exhibit the same involuntary muscle movements as do the upper extremities. This study was undertaken to determine if a correlation exists between ANIBP measurements in the arm and calf of women undergoing cesarean delivery under spinal anesthesia. ⋯ We conclude that there is a poor correlation between the BP measured by an ANIBP on the calf and one on the arm. In the parturient undergoing cesarean section, lower extremity BP as measured by an ANIBP does not correlate with the arm ANIBP and should not be used to assure fetal well being.
-
Noninvasive ventilation refers to any form of ventilatory support applied without the use of an endotracheal tube. It offers the potential to provide primary treatment for acute respiratory failure while avoiding complications associated with mechanical ventilation with endotracheal intubation. Noninvasive ventilation has been most commonly studied in hypercapnic respiratory failure. ⋯ Patient selection is clearly the most important issue in considering noninvasive ventilation for acute respiratory failure. Unfortunately, patients who benefit from noninvasive ventilation represent only a minority of the total group with any one disease, and thus it is difficult to make broad conclusions concerning applicability of this treatment modality. Future studies are needed to focus on determining the specific patient populations who will benefit the most, evaluating the optimal ventilatory mode and mask for providing noninvasive ventilation, and clarifying its impact on clinical outcomes.
-
J Clin Monit Comput · Jan 2000
ReviewAtelectasis formation during anesthesia: causes and measures to prevent it.
Pulmonary gas exchange is regularly impaired during general anaesthesia with mechanical ventilation. This results in decreased oxygenation of blood. A major cause is collapse of lung tissue (atelectasis), which can be demonstrated by computed tomography but not by conventional chest x-ray. ⋯ In summary, atelectasis is present in most humans during anaesthesia and is a major cause of impaired oxygenation. Avoiding high fractions of oxygen in inspired gas during induction and maintenance of anaesthesia may prevent formation of atelectasis. Finally, intermittent "vital capacity"-manoeuvres together with PEEP reduces the amount of atelectasis and pulmonary shunt.
-
J Clin Monit Comput · Jan 2000
Randomized Controlled Trial Clinical TrialNeonatal monitoring after maternal fentanyl analgesia in labor.
To characterize different methods of monitoring neonatal effects associated with maternal opioid analgesia. Special focus was on the static-charge-sensitive bed (SCSB), which could potentially serve as a non-invasive neonatal monitor. ⋯ Several differences were seen between the fentanyl and the control group babies. The SCSB method proved sensitive enough to find neonatal effects of maternal analgesia. Together with ECG and SpO2 monitoring, SCSB gives plentiful information on neonatal well-being in a non-invasive way. Results of this study emphasize the importance of neonatal monitoring after maternal opiate use in labor.