Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2018
Efficiency of oxygen delivery through different oxygen entrainment devices during sedation under low oxygen flow rate: a bench study.
Sedative anesthetic procedures outside the operating room may depend on cylinders as oxygen source. Cylinders have limited storage capacity and a low oxygen flow rate improves the durability. We conducted the bench study to evaluate the fraction of inspired oxygen (FiO2) in different oxygen entrainment devices under low oxygen flow rate. ⋯ In the hypoventilation group, oxygen reservoir units helped oxygen retention in local area and maintained a higher oxygen concentration. There were multiple factors lead to different oxygen fraction that we measured, such as different devices, respiratory patterns, and oxygen reservoir units. The result of our bench study provided some information for anesthesiologist to choose appropriate oxygen entrainment devices in various sedative anesthetic procedures.
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J Clin Monit Comput · Jun 2018
Changes in transcranial motor evoked potentials during hemorrhage are associated with increased serum propofol concentrations.
Transcranial motor evoked potentials (TcMEPs) monitor the integrity of the spinal cord during spine surgery. Propofol-based anesthesia is favored in order to enhance TcMEP quality. During intraoperative hemorrhage, TcMEP amplitudes may be reduced. ⋯ Multivariate analysis using hierarchical linear models indicated that the decline of TcMEP amplitude was primarily associated with rising propofol concentrations, but was also independently affected by reduced CO. We believe that the decrease in blood volume and CO during hemorrhage increased the serum concentration of propofol by reducing the volume of distribution and/or rate of hepatic metabolism of the drug. Despite wide acceptance of propofol as the preferred anesthetic when using TcMEPs, intravenous anesthetics are vulnerable to altered pharmacokinetics during conditions of hemorrhage and could contribute to false-positive TcMEP changes.
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J Clin Monit Comput · Jun 2018
Randomized Controlled TrialThe effect of intravenous lidocaine infusion on bispectral index during major abdominal surgery.
Intraoperative lidocaine infusion has become widely accepted as an adjunct to general anesthesia where its use has been associated with opioid-sparing and enhanced recovery. The aims of this study were to determine whether or not intravenous (IV) lidocaine infusion (a) has an anesthetic sparing effect during major colorectal procedures and (b) if it also affects level of hypnosis as measured by bispectral index (BIS). Twenty-five patients undergoing laparotomy for resection of colorectal tumours were randomized to receive either IV lidocaine (1.5 mg kg-1 bolus then 1 mg kg-1 per hour) or an equivalent volume of normal saline commenced after intravenous induction of general anesthesia. ⋯ Higher BIS values in the lidocaine versus placebo group may indicate that levels of hypnosis were not equivalent. Alternatively, BIS may not be a sensitive indicator of synergistic interactions between local anesthetic and volatile agent. Our results advocate a cautious approach to titration of general anesthesia when combined with lidocaine infusion.
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J Clin Monit Comput · Jun 2018
ReviewA review of recent advances in data analytics for post-operative patient deterioration detection.
Most deaths occurring due to a surgical intervention happen postoperatively rather than during surgery. The current standard of care in many hospitals cannot fully cope with detecting and addressing post-surgical deterioration in time. For millions of patients, this deterioration is left unnoticed, leading to increased mortality and morbidity. ⋯ This work also aims to highlight the opportunities that lie in personalizing the models developed for patient deterioration for these particular post-surgical patients and make the output more actionable. The integration of pre- and intra-operative data, e.g. comorbidities, vitals, lab data, and information about the procedure performed, in post-operative early warning algorithms would lead to more contextualized, personalized, and adaptive patient modelling. This, combined with careful integration in the clinical workflow, would result in improved clinical decision support and better post-surgical care outcomes.
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J Clin Monit Comput · Jun 2018
Comparative StudyComparison of endotracheal tube cuff pressure values before and after training seminar.
It is recommended that endotracheal cuff (ETTc) pressure be between 20 and 30 cm H2O. In this present study, we intend to observe average cuff pressure values in our clinic and the change in these values after the training seminar. The cuff pressure values of 200 patients intubated following general anesthesia induction in the operating theatre were measured following intubation. ⋯ Average pressure measure for Group I was 54 cm H2O, while average pressure in Group II declined to 33 cm H2O. It was observed that as the working period and experience of physician assistants increased, cuff pressure values decreased, however no statistically significant different was found (p < 0.375). We believe that clinical experience does not have significant effects on cuff pressure and that training seminars held at intervals would prevent high cuff pressure values and potential complications.