Journal of clinical monitoring and computing
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Anaesthesia is a multivariable problem where a combination of drugs are used to induce desired hypnotic, analgesia and immobility states. The automation of anaesthesia may improve the safety and cost-effectiveness of anaesthesia. ⋯ In this paper, several significant challenges in automation of anaesthesia are discussed, namely model uncertainty, controlled variables, closed-loop application and dependability. The increasingly reliable measurement device, robust and adaptive controller, and better fault tolerance strategy are paving the way for automation of anaesthesia.
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J Clin Monit Comput · Apr 2015
ReviewIntrathecal drug delivery for chronic pain management-scope, limitations and future.
Intrathecal drug delivery system (IDDS) is a targeted therapy system for treating pain and muscle spasm. IDDS is recommended for the treatment of chronic pain which does not respond to optimal medical management. The aim of this review article is to give an up to date and concise account of the use of IDDS. ⋯ IDDS is an invasive technique, which can result in severe morbidity and mortality. The up to date knowledge gained from this article along with the recommendations for improving safety in patients receiving IDDS, makes it a valuable resource for healthcare practitioners. Continued research, including outcome studies of this therapy continues to be necessary.
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J Clin Monit Comput · Apr 2015
Comparative StudyComparison of two devices using near-infrared spectroscopy for the measurement of tissue oxygenation during a vascular occlusion test in healthy volunteers (INVOS(®) vs. InSpectra™).
The aim of this study was to compare tissue oxygen saturation as measured by INVOS® and InSpectra™ during a vascular occlusion test (VOT) in the same subject. Twenty healthy adults were investigated. The INVOS® and InSpectra™ probes were placed randomly on the right and left thenar eminence in the same participant and monitoring of tissue oxygen saturation (SrO2 from INVOS® and StO2 from InSpectra™) were begun. ⋯ SrO2 declined to 40% more rapidly than did the StO2 (147±38 vs. 199±41 s, p<0.01). The deoxygenation and reoxygenation rates were higher (p<0.01) and the reactive hyperemic area was more extensive for INVOS® than for InSpectra™ (p=0.015). In conclusion, the VOT on the thenar muscle using INVOS® was as clinically applicable as InSpectra™, but baseline values and dynamic changes of INVOS® differed from those of InSpectra™.
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J Clin Monit Comput · Apr 2015
Observational StudyThe evaluation of a non-invasive respiratory volume monitor in surgical patients undergoing elective surgery with general anesthesia.
Continuous respiratory assessment is especially important during post-operative care following extubation. Respiratory depression and subsequent adverse outcomes can arise due to opioid administration and/or residual anesthetics. A non-invasive respiratory volume monitor (RVM) has been developed that provides continuous, real-time, measurements of minute ventilation (MV), tidal volume (TV), and respiratory rate (RR) via a standardized set of thoracic electrodes. ⋯ The average RR difference was -0.22 breaths/minute (bias: -1.8%, precision: 3.7% accuracy: 4.1%). Correlations between the RVM traces and the ventilator were compared at various points with correlations>0.90 throughout. Pairing the close correlation to ventilator measurements in intubated patients demonstrated by this study with previously described accuracy compared to spirometry in non-intubated patients, the RVM can be considered to have the capability to provide continuity of ventilation monitoring post-extubation This supports the use of real-time continuous RVM measurements to drive post-operative and post-extubation protocols, initiate therapeutic interventions and improve patient safety.