Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2018
Comparative Study Observational StudyVelocity-pressure loops for continuous assessment of ventricular afterload: influence of pressure measurement site.
VPloop, the graphical representation of pressure versus velocity, and its characteristic angles, GALA and β, can be used to monitor cardiac afterload during anesthesia. Ideally VPloop should be measured from pressure and velocity obtained at the same arterial location but standard of care usually provide either radial or femoral pressure waveforms. The purpose of this study was to look at the influence of arterial sites and the use of a transfer function (TF) on VPloop and its related angles. ⋯ GALA and β are underestimated when measured with a radial catheter. Using pressure waveforms from femoral locations alters VPloops, GALA and β in a smaller extend. The use of a TF on radial pressure allows to correctly plot VPloops and their characteristic angles for routine clinical use.
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J Clin Monit Comput · Oct 2018
Comparative StudyComparison of the accuracy of noninvasive hemoglobin monitoring for preoperative evaluation between adult and pediatric patients: a retrospective study.
We measured noninvasive hemoglobin (SpHb) levels during the pre-anesthesia visit in patients planning elective surgery. Differences between SpHb and laboratory-measured hemoglobin (Hblab) were compared between adult and pediatric patients. In the pre-anesthesia visiting office, we routinely monitor noninvasive Hb levels with oxygen saturation and heart rate using Masimo Radical-7® Pulse CO-Oximetry (Masimo Corp., Irvine, CA, USA). ⋯ The correlation coefficient between the bias and Hblab was - 0.81 in adults and - 0.54 in pediatric patients (P < 0.001). SpHb and Hblab measured during pre-anesthesia visits showed a smaller difference in pediatric than in adult patients. Lower Hblab corresponded to higher accuracy.
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J Clin Monit Comput · Oct 2018
Observational StudyA pilot study to record visual evoked potentials during prone spine surgery using the SightSaver™ photic visual stimulator.
This is a pilot study to assess the clinical safety and efficacy of recording real-time flash visual evoked potentials (VEPs) using the SightSaver TM Visual Stimulator mask during prone spine surgery. A prospective, observational pilot study. Twenty patients presenting for spine surgery (microdiscectomy, 1-2 level lumbar fusion, or > 2 levels thoraco-lumbar fusion) were enrolled. ⋯ The definitive applications remain to be determined, but likely include use in select patients and/or surgeries. Here, we have validated the device as safe and effective, and show that VEPs can be recorded in real time under general anesthesia in the prone position. Future studies should be directed towards understanding the ideal anesthetic regimen to facilitate stable VEP recording during prone spine surgery.
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J Clin Monit Comput · Oct 2018
Observational StudyEvaluation of a wireless, portable, wearable multi-parameter vital signs monitor in hospitalized neurological and neurosurgical patients.
Unrecognized changes in patients' vital signs can result in preventable deaths in hospitalized patients. Few publications or studies instituting routine patient monitoring have described implementation and the setting of alarm parameters for vital signs. We wanted to determine if continuous multi-parameter patient monitoring can be accomplished with an alarm rate that is acceptable to hospital floor nurses and to compare the rate of patient deterioration events to those observed with routine vital sign monitoring. ⋯ Similar measures of comparison units did not change over the same period. Although unplanned patient deaths in the study unit were also reduced during the intervention period, this was not statistically significant. Continual, multi-parameter vital signs monitoring can be customized to reduce a high alarm rates, and may reduce rapid response team calls.
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J Clin Monit Comput · Oct 2018
Clinical TrialPupillary reflex dilation in response to incremental nociceptive stimuli in patients receiving intravenous ketamine.
Pupillometry is a non-invasive monitoring technique, which allows dynamic pupillary diameter measurement by an infrared camera. Pupillary diameter increases in response to nociceptive stimuli. In patients anesthetized with propofol or volatile agents, the magnitude of this pupillary dilation is related to the intensity of the stimulus. ⋯ In children, pupillary reflex dilation to nociceptive stimuli persists under deep sedation obtained with 1 mg kg-1 of intravenous ketamine combined with a 0.3 mg kg-1 oral morphine premedication, and its magnitude depends on the intensity of the stimulation. Our results confirm that pupillometry could be a relevant way to monitor nociception in anaesthetised subjects, including those receiving ketamine. Trial registration clinicaltrials.gov, NCT 02648412.