Journal of clinical monitoring and computing
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Anesthesiology is a stressful medical profession. While anesthesia in particular has become safer for the patient in the last decades, anesthesiology as a profession represents a medical field in which the professionals are permanently tense. The various reasons for this situation include the fact that anesthesiology is a team profession that requires perfect cooperation with other specialists. ⋯ This reality created the need to look for remedies; some authors recommend a long list of measures to be taken in order to prevent or reduce the magnitude of professional stress. This list includes a continuous self-care attitude, consisting of having a balanced professional and personal life; adequate sleep; avoiding drugs, obesity, and "workaholic" behavior; as well as better use of leisure. Finally, more studies are needed to find out which preventive means may potentially reduce the risk of professional stress among anesthesiologists.
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J Clin Monit Comput · Aug 2012
ReviewMonitoring tissue oxygenation by near infrared spectroscopy (NIRS): background and current applications.
Conventional cardiovascular monitoring may not detect tissue hypoxia, and conventional cardiovascular support aiming at global hemodynamics may not restore tissue oxygenation. NIRS offers non-invasive online monitoring of tissue oxygenation in a wide range of clinical scenarios. NIRS monitoring is commonly used to measure cerebral oxygenation (rSO(2)), e.g. during cardiac surgery. ⋯ Therefore, measuring and obtaining adequate tissue oxygenation may prevent (postoperative) complications and may thus be cost-effective. NIRS monitoring may also be used to detect tissue hypoxia in (prehospital) emergency settings, where it has prognostic significance and enables monitoring of therapeutic interventions, particularly in patients with trauma. However, optimal therapeutic agents and strategies for augmenting tissue oxygenation have yet to be determined.
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Monitoring of continuous blood pressure and cardiac output is important to prevent hypoperfusion and to guide fluid administration, but only few patients receive such monitoring due to the invasive nature of most of the methods presently available. Noninvasive blood pressure can be determined continuously using finger cuff technology and cardiac output is easily obtained using a pulse contour method. In this way completely noninvasive continuous blood pressure and cardiac output are available for clinical use in all patients that would otherwise not be monitored. Developments and state of art in hemodynamic monitoring are reviewed here, with a focus on noninvasive continuous hemodynamic monitoring form the finger.
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J Clin Monit Comput · Aug 2012
ReviewFrom system to organ to cell: oxygenation and perfusion measurement in anesthesia and critical care.
Maintenance or restoration of adequate tissue oxygenation is a main goal of anesthesiologic and intensive care patient management. Pathophysiological disturbances which interfere with aerobic metabolism may occur at any stage in the oxygen cascade from atmospheric gas to the mitochondria, and there is no single monitoring modality that allows comprehensive determination of "the oxygenation". To facilitate early detection of tissue hypoxia (or hyperoxia) and to allow a goal directed therapy targeted at the underlying problem, the anesthesiologist and intensive care physician require a thorough understanding of the numerous determinants that influence cellular oxygenation. This article reviews the basic physiology of oxygen uptake and delivery to tissues as well as the options to monitor determinants of oxygenation at different stages from the alveolus to the cell.
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J Clin Monit Comput · Aug 2012
Clinical TrialVariations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery.
The analgesia nociception index (ANI) is an online heart rate variability analysis proposed for assessment of the antinociception/nociception balance. In this observational study, we compared ANI with heart rate (HR) and systolic blood pressure (SBP) during various noxious stimuli in anaesthetized patients. 15 adult patients undergoing laparoscopic appendectomy or cholecystectomy were studied. Patients received target controlled infusions of propofol (adjusted to maintain the Bispectral index in the range [40-60]) and remifentanil (with target increase in case of haemodynamic reactivity [increase in HR and/or SBP >20% of baseline]), and cisatracurium. ⋯ After completion of surgery, ANI returned to 90 (34). ANI seems more sensitive than HR and SBP to moderate nociceptive stimuli in propofol-anaesthetized patients. Whether ANI monitoring may allow preventing haemodynamic reactivity to noxious stimuli remains to be demonstrated.