Journal of clinical monitoring and computing
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Electronic medical records now store a wealth of intraoperative hemodynamic data. However, analysis of such data is plagued by artifacts related to the monitoring environment. Here, we present an algorithm for automated identification of artifacts and replacement using interpolation of arterial line blood pressures. ⋯ The average difference between manual review and algorithm in identifying the start of arterial line monitoring was 0.17, and 2.1 min for the end of monitoring. Application of the algorithm decreased the percent of time below 55 mmHg from 4.3 to 2.0% (2.1% with manual review) and time above 100 mmHg from 8.8 to 7.3% (7.3% manual). This algorithm's performance was comparable to manual review by a human anesthesiologist and reduced the incidence of abnormal MAP values identified using a sample analysis tool.
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J Clin Monit Comput · Jun 2019
Comparative StudyTwo different methods to assess sympathetic tone during general anesthesia lead to different findings.
Noxious stimulation influences the autonomic nervous system activity. Sympathetic tone monitoring is currently used to assess the adequacy of the balance between nociception and anti-nociception during general anesthesia. The Surgical Plethysmographic Index (SPI) and the EBMi software (Custos©) are commercial devices that use different algorithms to measure it. ⋯ Longer SPI ≥ 60 episodes were associated with lower anti-nociception anesthetic regimen. Different methods of sympathetic tone assessment during general anesthesia provide conflicting information. Prospective studies should be undertaken to clarify the clinical indications of both techniques.
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J Clin Monit Comput · Jun 2019
Observational StudyTracheal sounds accurately detect apnea in patients recovering from anesthesia.
Apnea should be monitored continuously in the post anesthesia care unit (PACU) to avoid serious complications. It has been confirmed that tracheal sounds can be used to detect apnea during sedation in healthy subjects, but the performance of this acoustic method has not been evaluated in patients with frequent apnea events in the PACU. Tracheal sounds were acquired from the patients in the PACU using a microphone encased in a plastic bell. ⋯ The log-var apnea detection algorithm detected apnea with 92% sensitivity, 98% specificity, 46 PLR and 0.08 NLR. The performance of apnea detection in the PACU using the log-var tracheal sounds method proved to be reliable and accurate. Tracheal sounds could be used to minimize the potential risks from apnea in PACU patients.
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J Clin Monit Comput · Jun 2019
Effect of neuromuscular blockade on transcranial electric motor evoked potentials during surgical correction for idiopathic scoliosis under total intravenous anesthesia.
Transcranial electric motor evoked potentials (TCeMEPs) play an important role in reducing the risk of iatrogenic paraplegia. TCeMEPs could be obviously suppressed by neuromuscular blockade (NMB). The aims of this study were to examine the effects of NMB on TCeMEPs and to determine an appropriate level of partial neuromuscular blockade (pNMB) for TCeMEPs during surgical correction of idiopathic scoliosis under total intravenous anesthesia (TIVA). ⋯ Neither the amplitude and AUC nor the efficacy of TCeMEPs were affected at TOF4-5 of abductor halluces muscles TCeMEPs (AH-TCeMEPs) or at TOF3-5 of tibialis anterior muscles TCeMEPs (TA-TCeMEPs) compared with nNMB. However, the rate of unexpected movement was increased significantly at TOF5 and nNMB compared with TOF1 and TOF4. The application of pNMB with TOFR aimed at 26-50% for AH-TCeMEPs or 16-50% for TA-TCeMEPs seems to be an appropriate regimen for TCeMEPs during surgical correction for idiopathic scoliosis under TIVA.
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J Clin Monit Comput · Jun 2019
Letter Case ReportsPatent ductus arteriosus closure and somatic regional oxyhemoglobin saturation.
The authors report a case of a 14-day-old infant patient with patent ductus arteriosus (PDA) with pulmonary hypertension. Accidental clipping of the left pulmonary artery (LPA) during intended PDA closure was revealed, and subsequent urgent PDA closure and releasing a clip of the LPA were conducted. During surgeries we measured somatic regional oxyhemoglobin saturation (rSO2) values and change in those might be a key for early diagnosis of accidental clipping of the LPA. These findings suggest that we should understand the risk of accidental closure of the LPA during PDA surgery and somatic rSO2 values will provide information for early diagnosis of critical complication.