Journal of clinical monitoring and computing
-
J Clin Monit Comput · Aug 2019
Observational StudyMuscular tissue oxygen saturation during robotic hysterectomy and postoperative nausea and vomiting: exploring the potential therapeutic thresholds.
The relationship between muscular tissue oxygen saturation (SmtO2) during surgery and postoperative nausea and vomiting (PONV) remains to be determined. Patients undergoing robotic hysterectomy participated in this prospective cohort study. SmtO2 of the brachioradialis muscle in the forearm was continuously monitored during surgery. ⋯ PONV occurred in 35 of 106 patients (33%). Based on the multivariable analysis, the SmtO2 threshold of 20% above baseline correlated with less PONV (OR 0.39; 95% CI 0.16-0.93; p = 0.034), and the following values correlated with more PONV: 5% below baseline (OR 2.37; 95% CI 1.26-4.45; p = 0.007), 20% below baseline (OR 16.08; 95% CI 3.05-84.73; p = 0.001), < 70% (OR 2.86; 95% CI 1.17-6.99; p = 0.021) and < 60% (OR 6.55; 95% CI 1.11-38.53; p = 0.038). Our study suggests that a potential therapeutic goal for PONV prophylaxis may be to maintain SmtO2 at > 70% and above baseline.
-
J Clin Monit Comput · Aug 2019
Intraoperative neuromonitoring of anterior root muscle response during hip surgery under spinal anesthesia.
The aim of this study was to evaluate the anterior root muscle (ARM) response monitorability during total hip arthroplasty (THA) under spinal anesthesia. A total of 20 adults (64.6 ± 13.87 years old) were monitored using ARM response and free-run electromyography during THA. To elicit the ARM response from muscles, percutaneous stimulation of the lumbosacral roots was performed by self-adhesive electrodes placed over the skin of the projection of the first and third lumbar interspinous space (anode) and over the abdominal skin of the umbilicus (cathode). ⋯ The mean latencies and amplitude values of the ARM response from muscles were as follows: 8.8 ± 1.4 ms; 98.8 ± 114.5 µV for RF; 9.8 ± 2.1 ms; 119.1 ± 122.23 µV for VL; 9.5 ± 1.6 ms; 39.6 ± 30.3 µV for BF; 15.1 ± 1.9 ms; 146.6 ± 150.9 µV for TA; 15.6 ± 2.4 ms; 81.0 ± 99.9 µV for Gastrocnemius. The present study demonstrates that the ARM response could easily and safely be obtained during THA under spinal anesthesia. This non-invasive technique may have a potential to detect early neurological deficit in patients who need complex hip surgery under spinal anesthesia.
-
J Clin Monit Comput · Aug 2019
Post-extrasystolic characteristics in the arterial blood pressure waveform are associated with right ventricular dysfunction in intensive care patients.
Right ventricular dysfunction (RVD) is associated with end-organ dysfunction and mortality, but has been an overlooked condition in the ICU. We hypothesized that analysis of the arterial waveform in the presence of ventricular extrasystoles could differentiate patients with RVD from patients with a normally functioning right ventricle, because the 2nd and 3rd post-ectopic beat could reflect right ventricular state (pulmonary transit time) during the preceding ectopy. We retrospectively identified patients with echocardiographic evidence of moderate-to-severe RVD and patients with a normal functioning right ventricle (control) from the MIMIC database. ⋯ We identified 34 patients in the control group and 24 patients in the RVD group with ventricular extrasystoles. The mean SBP reduction at the 2nd and 3rd beat was lower in the RVD group compared with the control group [- 1.7 (SD: 1.9) % vs. - 3.6 (SD: 1.9) %, p < 0.001], and this characteristic differentiated RVD subjects from control subjects with an AUC of 0.76 (CI [0.64; 0.89]), with a specificity of 91% and sensitivity of 50%. In this proof-of-concept study, we found that post-extrasystolic ABP characteristics were associated with RVD.
-
J Clin Monit Comput · Aug 2019
Can variable practice habits and injection port dead-volume put patients at risk?
Injection ports used to administer medications and draw blood samples have inherent dead-volume. This volume can potentially lead to inadvertent drug administration, contribute to erroneous laboratory values by dilution of blood samples, and increase the risk of vascular air embolism. We sought to characterize provider practice in management of intravenous (IV) and arterial lines and measure dead-volumes of various injection ports. ⋯ Mean (SD) dead-volume in microliters ranged from 0.1 (0.0) to 5.6 (1.0) in 1-way injection ports and from 54.1 (2.8) to 126.5 (8.3) in 4-way injection ports. The practices of our providers when giving medications and drawing blood samples are variable. The dead-volume associated with injection ports used at our institution may be clinically significant, increasing errors in medication delivery and laboratory analysis.