Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2008
Postoperative discomfort (other than pain) - a neglected feature of postanesthesia patient care.
Patients may experience various kinds of discomfort other than pain during the immediate period following surgery and anesthesia. These complaints may not be dealt with, especially when they are shadowed by the more pressing need to alleviate pain. The issue of discomfort in the setting of an adult post anesthesia care unit (PACU) has not been adequately addressed. We assessed the extent of unreported distressing or unpleasant events among patients who had undergone general surgery or orthopedic procedures under standard general anesthesia and their recall 24 h afterwards. ⋯ Almost one-fourth of the patients undergoing general surgery and orthopedic procedures under general anesthesia suffered from postoperative discomfort other than pain. Of these, >90% recalled 24 h after surgery having had postoperative discomfort. PACU staff needs to inquire for and attempt reducing such events.
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J Clin Monit Comput · Aug 2008
Randomized Controlled TrialA randomized-controlled study of intrathecal versus epidural thoracic analgesia in patients undergoing abdominal cancer surgery.
We sought to determine the effectiveness of continuous intrathecal thoracic analgesia (ITA) in comparison with continuous epidural thoracic analgesia (ETA) for the management of postoperative pain after abdominal cancer surgery in a randomised controlled study. ⋯ ITA and ETA produced the same levels of analgesia, without relevant complications.
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J Clin Monit Comput · Aug 2008
Computerized recording of neuromuscular monitoring and the risk of residual paralysis at the time of extubation.
We tested whether a newly installed neuromuscular monitoring device (NMT) with a computerized anesthesia recording system, incorporated in all anesthesia stations, could enhance the commitment to objective neuromuscular monitoring in a teaching hospital anesthesia department. ⋯ Despite the presence of quantitative objective neuromuscular monitoring in all operating rooms, and the automatic data recording system, the rate of monitoring neuromuscular blockade was not high enough to rule out the potential risk of residual paralysis at the time of extubation.
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J Clin Monit Comput · Aug 2008
Non-invasive automated measurement of cardiac output during stable cardiac surgery using a fully integrated differential CO(2) Fick method.
To re-evaluate the accuracy and precision of a non-invasive method for measurement of cardiac output based on the differential CO(2) Fick approach using an automated change in respiratory rate delivered by a ventilator under control by a prototype measurement system. ⋯ Acceptable agreement with thermo- dilution during surgery was found, particularly where the ventilatory change involved an increase in respiratory rate from a lower baseline. This approach has potential to be readily integrated into modern anesthesia delivery platforms, allowing routine non-invasive cardiac output measurement.
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J Clin Monit Comput · Aug 2008
Comparative StudyContinuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry.
Continuous and non-invasive measurement of cardiac output (CO) may contribute helpful information to the care and treatment of the critically ill pediatric patient. Different methods are available but their clinical verification is still a major problem. ⋯ In pediatric patients non-invasive measurement of CO and SV with TED and EV is useful for continuous monitoring after heart surgery. Both new methods seem to underestimate cardiac output in terms of absolute values. However, TED shows tolerable bias and precision and may be helpful for continuous CO monitoring in a deeply sedated and ventilated pediatric patient, e.g. in the operating room or intensive care unit.