Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2021
LetterEndotracheal tube inflation tubing defect: an unusual cause of intraoperative volume leak.
Loss of endotracheal cuff pressure can lead to airway compromise and loss of volume delivery in mechanical ventilation requiring immediate intervention. A 40 years old male posted for bilateral interpositional arthroplasty was intubated nasally with 7.5 mm flexometallic endotracheal tube. In the intraoperative period airway leak was detected due to loss of cuff pressure even after repeated attempt of cuff inflation. After changing endotracheal tube, leak was detected from the inflation tubing distal to the cuff, which was apparent only when cuff pressure was increased above 30 cm of H2O.
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J Clin Monit Comput · Oct 2021
The influence of depth of anesthesia and blood pressure on muscle recorded motor evoked potentials in spinal surgery. A prospective observational study protocol.
For high-risk spinal surgeries, intraoperative neurophysiological monitoring (IONM) is used to detect and prevent intraoperative neurological injury. The motor tracts are monitored by recording and analyzing muscle transcranial electrical stimulation motor evoked potentials (mTc-MEPs). A mTc-MEP amplitude decrease of 50-80% is the most common warning criterion for possible neurological injury. ⋯ This may contribute to fewer false positive warnings. By performing this study after induction and prior to incision, this protocol provides a unique opportunity to study the effects of depths of anesthesia and blood pressure on mTc-MEPs alone with as little confounders as possible. Trial registration number NL7772.
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J Clin Monit Comput · Oct 2021
Randomized Controlled TrialPhysiological effects of two driving pressure-based methods to set positive end-expiratory pressure during one lung ventilation.
During one-lung ventilation (OLV), titrating the positive end-expiratory pressure (PEEP) to target a low driving pressure (∆P) could reduce postoperative pulmonary complications. However, it is unclear how to conduct PEEP titration: by stepwise increase starting from zero PEEP (PEEPINCREMENTAL) or by stepwise decrease after a lung recruiting manoeuvre (PEEPDECREMENTAL). In this randomized trial, we compared the physiological effects of these two PEEP titration strategies on respiratory mechanics, ventilation/perfusion mismatch and gas exchange. ⋯ In the PEEPDECREMENTAL group the PaO2/ FIO2 ratio increased significantly after intervention (from 140 [99-176] to 186 [152-243], p < 0.001). Both the PEEPINCREMENTAL and the PEEPDECREMENTAL strategies were able to decrease intraoperative shunt, but only PEEPDECREMENTAL improved oxygenation and lowered intraoperative ΔP. Clinical trial number NCT03635281; August 2018; "retrospectively registered".
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In anesthesia automation, one of the main important issues is the availability of a reliable measurement of the depth of consciousness level (hypnosis) of the patient. According to this value, the hypnotic drug dosage can be adequately calculated. One of the most studied hypnosis indexes is the bispectral index (BIS). ⋯ The objectives of this study are, first, to validate the accuracy of the PSI describing the hypnosis level during the maintenance phase of general anesthesia, by comparing with the BIS and, second, to model the relationship between propofol infusion rate and PSI values, obtained from a SEDLine monitor. For this, real data from patients undergoing general anesthesia simultaneously monitored with both BIS and PSI signals was used. Results obtained are interesting for a correct interpretation of PSI signal in clinical practice.