Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2013
Review Historical ArticleIs pulse oximetry an essential tool or just another distraction? The role of the pulse oximeter in modern anesthesia care.
Since the discovery of anesthetic agents, patient monitoring has been considered one of the core responsibilities of the anesthesiologist. As depicted in Robert Hinckley's famous painting, The First Operation with Ether, one observes William Thomas Green Morton carefully watching over his patient. Since its founding in 1905, 'Vigilance' has been the motto of the American Society of Anesthesiologists (ASA). ⋯ This article reviews the available evidence for pulse oximetry. Further, it discusses contemporary issues, events, and perceptions that may help to explain how and why pulse oximetry may have been adopted as a standard of care despite the lack of supportive. Lastly, it discusses less obvious benefits of pulse oximetry that may have further implications on the future of anesthesia care and perhaps even automated anesthesia.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialOutcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial.
Intraoperative goal directed fluid therapy (GDT) guided by an arterial pressure-based cardiac output system has been reported to improve gastrointestinal (GI) recovery in high-risk patients. This study evaluates the impact of this approach on GI recovery in low to moderate risk patients undergoing major abdominal surgery. IRB approved randomized controlled trial in low to moderate risk adults scheduled for major surgery. ⋯ The GDT group had faster return of GI function (p = 0.004) and higher quality of recovery scores. In low to moderate risk patients undergoing major abdominal surgery, intraoperative GDT guided by SVV optimization was associated with faster restoration of GI recovery and higher quality of recovery scores. These results suggest that outcome benefits related to the use of an intraoperative goal directed fluid protocol guided by SVV are not limited to high-risk patients.
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J Clin Monit Comput · Jun 2013
Comparative Study Observational StudyCardiac output monitoring in septic shock: evaluation of the third-generation Flotrac-Vigileo.
Continuous cardiac index (CI) monitoring is frequently used in critically ill patients. Few studies have compared the pulse contour-based device FloTrac/Vigileo to pulmonary artery thermodilution (PAC) in terms of accuracy for CI monitoring in septic shock. The aim of our study was to compare the third-generation FloTrac/Vigileo to PAC in septic shock. ⋯ The overall correlation coefficient between PAC-CI and FloTrac/Vigileo CI was 0.47 (p < 0.01), with r(2) = 0.22. The area under the curve of the ROC curve for detecting concordant and significant changes in CI was 0.72 (0.53; 0.87). In our study, third-generation Flowtrac-Vigileo appears to be too inaccurate to be recommended for CI monitoring in septic shock.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialThe effects of DEX premedication on volatile induction of mask anesthesia (VIMA) and sevoflurane requirements.
We investigated the effect of intravenous premedication with single dose of dexmedetomidine (DEX) on volatile anesthetic induction time and sevoflurane requirements of anesthesia maintenance in adults by monitoring the bispectral index (BIS). Sixty adult patients with status of ASA I-II undergoing general anesthesia with endotracheal intubation were randomly divided into two groups: The first group; a control group (group C, n = 30) and the second group; DEX group (group D, n = 30). Each patient in group D was premedicated with intravenous DEX 0.5 μg/kg or placebo 10 min before the induction of anesthesia. ⋯ Analgesic requirement was noted in postoperative 24 h-period. The time to induction of anesthesia (p < 0.0001) and Etsevoflurane at 1 min (p < 0.05) were significantly lower in group D than in group C. Intravenous premedication with 0.5 μg/kg of DEX decreased the induction time by almost 75 % and provided a significant decrease in Etsevoflurane.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialStO₂ guided early resuscitation in subjects with severe sepsis or septic shock: a pilot randomised trial.
The scientific community has agreed upon developing accurate monitoring of tissue perfusion and oxygenation to improve the management of subjects with sepsis. This pilot study aimed to investigate the feasibility of targeting tissue oxygen saturation (StO₂) in addition to the currently recommended resuscitation goals, central venous pressure, mean arterial pressure and central venous oxygen saturation, in patients with severe sepsis or septic shock. A pilot, single-centre, randomised, non-blinded trial recruited 30 subjects with severe sepsis upon intensive care unit admission at an academic medical centre in France. ⋯ At study day 7, there were 5/15 (33.3 %) subjects who died or had a DSOFA > 0 in the experimental arm and 4/15 (26.6 %) who died or had a DSOFA > 0 in the control arm (p = 1.00). This pilot study was the first randomised controlled trial using an algorithm derived from the SSC recommendations, which included StO₂ as a treatment goal. However, the protocol showed no clear trend for or against targeting StO₂.