Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2015
The effects of cardiac output and pulmonary arterial hypertension on volumetric capnography derived-variables during normoxia and hypoxia.
The aim of this study was to test the effect of cardiac output (CO) and pulmonary artery hypertension (PHT) on volumetric capnography (VCap) derived-variables. Nine pigs were mechanically ventilated using fixed ventilatory settings. Two steps of PHT were induced by IV infusion of a thromboxane analogue: PHT25 [mean pulmonary arterial pressure (MPAP) of 25 mmHg] and PHT40 (MPAP of 40 mmHg). ⋯ The elimination of CO2 per breath decreased by 7% in PHT40 and by 12% in COdown but increased only slightly with COup. Dead space variables did not change significantly along the protocol. At constant ventilation and body metabolism, pulmonary artery hypertension and decreases in CO had the biggest effects on the SnIII of the volumetric capnogram and on the elimination of CO2.
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J Clin Monit Comput · Feb 2015
Controlled Clinical TrialThe effect of endotracheal tube cuff pressure change during gynecological laparoscopic surgery on postoperative sore throat: a control study.
Postoperative respiratory complications related to endotracheal intubation usually present as cough, sore throat, hoarseness. The aim of the study was to examine the effects of endotracheal tube cuff pressure changes during gynecological laparoscopic surgery on postoperative sore throat rates. Thirty patients who underwent gynecological laparoscopic surgery and 30 patients who underwent laparotomy under general anesthesia with endotracheal intubation were included. ⋯ In both groups, the endotracheal tube cuff pressure and peak airway pressure were significantly correlated (R=0.9431, P<0.01; R=0.8468, P<0.01). Compared to patients who had undergone laparotomy, patients who had undergone laparoscopic surgery showed significantly higher sore throat scores at both 2 and 24 h after surgery (P<0.01). Pneumoperitoneum and Trendelenburg position may increase airway pressure and cuff pressure, resulting in increased incidence of postoperative sore throat.
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J Clin Monit Comput · Feb 2015
Intraoperative neurophysiological monitoring during spine surgery with total intravenous anesthesia or balanced anesthesia with 3 % desflurane.
Total intravenous anesthesia (TIVA) with propofol and opioids is frequently utilized for spinal surgery when somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (tcMEPs) are monitored. Many anesthesiologists would prefer to utilize low dose halogenated anesthetics (e.g. 1/2 MAC). We examined our recent experience using 3% desflurane or TIVA during spine surgery to determine the impact on propofol usage and on the evoked potential responses. ⋯ The data from these cases indicates that 1/2 MAC (3%) desflurane can be used in conjunction with SSEP and tcMEP monitoring for some adult patients undergoing spine surgery. Further studies are needed to confirm the relative benefits versus negative effects of the use of desflurane and other halogenated agents for anesthesia during procedures on neurophysiological monitoring involving tcMEPs. Further studies are also needed to characterize which patients may or may not be candidates for supplementation such as those with neural dysfunction or who are opioid tolerant from chronic use.
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J Clin Monit Comput · Feb 2015
Randomized Controlled Trial Comparative StudyComparison of an ultrasound-guided technique versus a landmark-guided technique for internal jugular vein cannulation.
Central venous cannulation is a commonly preformed procedure in many branches of medicine, particularly in anaesthesia and intensive care medicine. The purpose of this study was to compare the landmark-guided technique to the ultrasound-guided technique for internal jugular vein cannulation in cardiovascular surgery patients. One hundred cardiovascular surgery patients, of whom 65 were male and 35 were female with ages ranging from 22 to 65, who had internal jugular cannulation between December 2010-March 2011 in our clinic were investigated prospectively. ⋯ Four patients had an arterial punction [group U (n=0) and group A (n=4)] and two patients had a hematoma [group U (n=1) and group A (n=1)]. Arterial punction complication was increased significantly in landmark group (p=0.041). The findings of this study indicate that internal jugular vein catheterization guided by real-time ultrasound results in a lower access time and a lower rate of attempts.
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J Clin Monit Comput · Feb 2015
Real-time two-dimensional and three-dimensional echocardiographic imaging of the thoracic spinal cord: a possible new window into the central neuraxis.
Transesophageal echocardiography of the spine has been difficult to perform, and high-quality images have been difficult to obtain with earlier available technology. New capabilities in hardware and software reconstruction may allow more reliable clinical data to be obtained. We describe an initial successful attempt to image the adult spinal canal, its contents, and in situ instrumentation. ⋯ Pulsed-wave Doppler determined a biphasic pattern of blood flow in the anterior spinal artery through pulse mapping of the anatomic area. New, advanced imaging hardware and software generate clinically useful imaging of the thoracic spine in 2-D and 3-D using TEE. We believe this technology holds promise for future diagnostic and therapeutic interventions in the operating room that were previously unavailable.