Journal of clinical monitoring and computing
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J Clin Monit Comput · Jan 2000
Randomized Controlled Trial Clinical TrialThe relationship between rate of administration of an intubating dose of rocuronium and time to 50% and 90% block at the adductor pollicis muscle.
To determine the relationship between the rate of rocuronium injection and the onset time of neuromuscular block. ⋯ We conclude that rate of injection influences only the initial phase of development of the block and that slower injection times do not significantly affect time to 90% relaxation at the adductor pollicis muscle.
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J Clin Monit Comput · Jan 2000
Randomized Controlled Trial Clinical TrialSpecific elements of a new hemodynamics display improves the performance of anesthesiologists.
We tested the hypothesis that a monitoring display proposed by Blike et al. improves the performance of anesthesiologists. We measured the performance of anesthesiologists using the new display and compared it to their performance with a traditional display. We studied three different displays on how they affected recognition and differentiation of five etiologies of shock-anaphylaxis, bradycardia, hypovolemia, ischemia and pulmonary embolus. ⋯ The new display with "emergent features" can improve the diagnostic performance of clinicians.
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J Clin Monit Comput · Jan 2000
Computer assisted physiologic monitoring and stability assessment in vascular surgical patients undergoing general anesthesia--preliminary data.
Physiologic monitors present an influx of numerical data that can be overwhelming to the clinician. We combined several parameters in an effort to reduce the amount of information that must be continuously monitored including oxyhemoglobin saturation by pulse oximetry, end-tidal CO2 concentration, arterial blood pressure, and heart rate into an integrated measure--the health stability magnitude (HSM). The HSM is computed for a predetermined basal period, the reference HSM (RHSM), and recalculated continuously for comparison with the baseline value. In this study we present the HSM concept and examine changes in the HSM during abdominal aortic aneurysm surgery. ⋯ The correlation between HSM and dHSM depicts changes in multiple monitored parameters that can be viewed using a single graphical representation. Projection of individual cases on the contour diagram may help the clinician to distinguish relative intraoperative stability from important events. Data reduction in this manner may guide clinical decision-making in response to unanticipated or unrecognized events.
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J Clin Monit Comput · Jan 2000
Partial CO2 rebreathing indirect Fick technique for non-invasive measurement of cardiac output.
Evaluation in animals of a non-invasive and continuous cardiac output monitoring system based on partial carbon-dioxide (CO2) rebreathing indirect Fick technique. ⋯ The partial CO2 rebreathing technique for measurement of cardiac output is non-invasive, automated, and based on the well accepted Fick principle. The limits of agreement between NICO and TDco is within the recommended value for NICO to be a clinically acceptable method for cardiac output measurement. The results of this canine study show that NICO performed as well, and in some cases better, than other currently available non-invasive cardiac output techniques over a wide range of cardiac outputs.
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J Clin Monit Comput · Jan 2000
ReviewHRCT imaging of airway responsiveness: effects of anesthetics.
The noninvasive imaging method, high resolution computed tomography (HRCT), has been developed in animal models and applied to humans with obstructive lung disease for assessing regional and individual airway responsiveness. The ability to directly view airway responses during provocations such as tracheal intubation in an asthmatic could greatly enhance our understanding and treatment of airway hyperresponsiveness. HRCT uses increased kilovoltage peak (kVp) and milliamperage (mAs) settings, thin slices, high spacial frequency reconstruction algorithms, and small fields of view to resolve structures as small as 200 microm. ⋯ HRCT allows direct in vivo measurement of airway responsiveness to pharmacological and physiological stress that induces bronchoconstriction or bronchodilation. Using HRCT, we are able to measure airway dilation at baseline airway tone with inhalation anesthetics, differentiate the bronchodilating properties of inhalational agents in airways with tone, assess bronchodilating agents commonly used as premedications prior to anesthesia, and measure airway heterogeneity at baseline tone and their response to a variety of stimuli. This ability of HRCT to measure airway caliber and response heterogeneity in vivo noninvasively will dramatically improve our understanding of pulmonary physiology in general and the effects of anesthetics on the airways specifically.