Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2014
Case ReportsBeware of "curare cleft" like changes during unilateral capnothorax.
Capnography is a standard monitoring tool during general anaesthesia. Diaphragmatic movement with the weaning of muscle relaxant effect produces the characteristic "curare cleft" on capnography. ⋯ Cautious interpretation and identification of these is essential to avoid any undue overdosing of the patients with muscle relaxants. We report "curare cleft" like artefact during ventilation with a single lumen tube in a patient with unilateral capnothorax undergoing minimally invasive esophagectomy.
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J Clin Monit Comput · Jun 2014
Comparative StudyA comparison of the incidence of hypercapnea in non-obese and morbidly obese peri-operative patients using the SenTec transcutaneous pCO2 monitor.
Obese patients are at increased risk for hypoventilation, leading to hypercapnea and acidosis. The primary objective of this study was to compare the incidence of perioperative hypercapnea in non-obese and morbidly obese patients using the SenTec transcutaneous PCO2 (tcPCO2) monitor. 10 morbidly obese subjects (BMI > 40 kg/m(2)) undergoing laparoscopic bariatric surgery, and 10 non-obese subjects (BMI < 30 kg/m(2)) undergoing laparoscopic abdominal procedures were studied, using a standardized anesthesia regimen. TcPCO2 and SpO2 were monitored continuously intraoperatively, and during the first 24 h postoperatively. ⋯ End-tidal CO2 (EtCO2) values were similar between groups during the intraoperative period, but tcPCO2 was significantly higher in the obese group at specific time points, and trended towards being higher throughout the case. Our study did not show significant tcPCO2 differences between non-obese and obese post-surgical patients, however, it did allow for continuous, trendable, nonobtrusive monitoring throughout the perioperative period. As V/Q mismatch increases with the PaCO2/EtCO2 gradient, and this effect is most pronounced in morbidly obese patients, tcPCO2 monitoring may prove to be a useful additional monitor in these patients during the intraoperative period.
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J Clin Monit Comput · Jun 2014
Clinical TrialIntraoperative flash VEPs are reproducible in the presence of low amplitude EEG.
Flash visual evoked potentials (FVEPs) are often irreproducible during surgery. We assessed the relationship between intraoperative FVEP reproducibility and EEG amplitude. Left then right eyes were stimulated by goggle light emitting diodes, and FVEPs were recorded from Oz–Fz′ (International 10-20 system) in 12 patients. ⋯ Raising the low cut filter to 10 and 30 Hz (in two patients) progressively reduced EEG and FVEP amplitude, reduced amplifier blocking time and improved FVEP reproducibility. FVEPs were more reproducible in the presence of low amplitude EEG than high amplitude EEG. This is the first report describing the effect of EEG amplitude on FVEP reproducibility during surgery
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J Clin Monit Comput · Jun 2014
Randomized Controlled TrialThe use of train of four monitoring for clinical evaluation of the axillary brachial plexus block.
The axillary approach of brachial plexus anesthesia is the most commonly used technique for forearm and hand surgery. Dynamometer is known as objective test for the clinical assessment of motor block of the nerves in brachial plexus block. However, the use of this device may not always be practical in operating room. ⋯ TOF values were gradually decreased and significant difference was observed between the development of a complete and partial motor block at 30th minute. TOF values were also significantly less in patients of complete sensory block than the patients of partial sensory block at 30th minute. The use of TOF monitoring may be beneficial to assess the objective clinical effect of motor block in the patients with axillary brachial plexus nerve block.