Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2019
Non-sinusoidal waves in the EEG and their simulated effect on anaesthetic quantitative EEG monitors.
The effect of anaesthetic drugs on the cortex are commonly estimated from the electroencephalogram (EEG) by quantitative EEG monitors such as the Bispectral Index (BIS). These monitors use ratios of high to low frequency power which assumes that each neurological process contributes a unique frequency pattern. However, recent research of the effect of deep brain stimulation on EEG beta oscillations suggests that wave shape, a non-sinusoidal feature that is only measurable in the time-domain, can change the frequency 'signature' of a neurological rhythmical process by the inclusion or removal of harmonic frequencies. ⋯ Age was found to be the only significant predictor of alpha wave triangularity. The artificially modified square-alpha waves increased the power in the frequency spectrum at 26 Hz by 1-5 dB, and increased the BetaRatio by 0.7. The alpha-wave of anaesthetised patients contains non-sinusoidal components which likely impact depth of anaesthesia calculations.
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J Clin Monit Comput · Dec 2019
An exploratory clinical evaluation of a head-worn display based multiple-patient monitoring application: impact on supervising anesthesiologists' situation awareness.
Supervising anesthesiologists overseeing several operating rooms must be aware of the status of multiple patients, so they can consult with the anesthetist in single operating rooms or respond quickly to critical events. However, maintaining good situation awareness can be challenging when away from patient bedsides or a central monitoring station. In this proof-of-concept study, we evaluated the potential of a head-worn display that showed multiple patients' vital signs and alarms to improve supervising anesthesiologists' situation awareness. ⋯ Head-worn displays can improve supervising anesthesiologists' situation awareness in multiple-patient monitoring situations. The anesthesiologists who participated in the study expressed enthusiasm about monitoring patients with a head-worn display and wished to use and evaluate it further.
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J Clin Monit Comput · Dec 2019
Significant factors influencing inadvertent hypothermia in pediatric anesthesia.
Thermal imbalances are very common during surgery. Hypothermia exposes the patient to post-operative shivering, cardiac dysfunction, coagulopathy, bleeding, wound infection, delayed anesthesia recovery, prolonged hospital stay and increased hospitalization cost. There are many factors contributing to intraoperative hypothermia. ⋯ Intraoperative hypothermia can be life threatening if it is not handled carefully. Various methods are used before, during and after surgery to maintain a patient's body temperature within the normothermia range. The use of an active warming device like the Bair Hugger® air-forced warming system seems to be a good method for reducing the risk of intraoperative hypothermia and effectively maintaining body temperature for all major and minor surgeries.
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J Clin Monit Comput · Dec 2019
Acceptance of a propofol and remifentanil infusion dosing algorithm to optimize postoperative emergence and analgesia.
We implemented a pharmacokinetic/pharmacodynamic (PK/PD) based optimization algorithm recommending intraoperative Remifentanil and Propofol infusion rates to minimize time to emergence and maximize the duration of analgesia in a clinical setting. This feasibility study tested the clinical acceptance of the optimization algorithm's recommendations during scoliosis surgical repair for 14 patients. ⋯ While following the optimization's recommendations the anesthesiologist decreased Propofol infusions from an average of 164-135 mcg/kg/min [p = 0.002] and increased Remifentanil infusions from an average of 0.22-0.30 mcg/kg/min [p = 0.004]. The anesthesiologists appeared to accept and follow the recommendations from a PK/PD based optimization algorithm.
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J Clin Monit Comput · Dec 2019
Correction to: Economic and operational impact of an improved pathway using rapid molecular diagnostic testing for patients with influenza-like illness in a German emergency department.
The article Economic and operational impact of an improved pathway using rapid molecular diagnostic testing for patients with influenza-like illness in a German emergency department, written by Matthias Brachmann, Katja Kikull, Clemens Kill and Susanne Betz, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 04 January 2019 without open access.