Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2021
A systematic review of invasive, high-fidelity pressure studies documenting the amplification of blood pressure from the aorta to the brachial and radial arteries.
It is commonly accepted that systolic blood pressure (SBP) is significantly higher in the brachial/radial artery than in the aorta while mean (MBP) and diastolic (DBP) pressures remain unchanged. This may have implications for outcome studies and for non-invasive devices calibration. We performed a systematic review of invasive high-fidelity pressure studies documenting BP in the aorta and brachial/radial artery. ⋯ Further studies on SPAmp phenotypes (positive, null, negative) are advocated. Non-invasive device calibration assumptions were confirmed, namely unchanged MBP and DBP from the aorta to the brachial artery. Data did not allow for firm conclusions on the amount of BP changes from the aorta to the radial artery, and from the aorta to the brachial/radial arteries in other populations.
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J Clin Monit Comput · Dec 2021
Letter Case ReportsLoss of spectral alpha power during spine surgery: what could be wrong?
The electroencephalographic signatures of anesthetic drugs relate to a specific set of action mechanisms within the neural circuits. During intraoperative care, the recognition and correct interpretation of the EEG spectrogram can be used as a tool to guide anesthetic administration. For example, loss of alpha power during propofol anesthesia may be a sign of lighter level of hypnosis and/or of an increase in nociceptive inputs. We describe a case report of inadvertent interruption of propofol delivery that was first detected by changes in the electroencephalogram spectrogram.
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Awake fibreoptic intubation has always been considered the gold standard for expected difficult airway management. However, the use of fibreoptic intubation was limited because it is time-consuming, requires skillful operators and easily affected by blood or secretions in the oral or nasopharynx. We reported a modified technique of awake fibreoptic nasal intubation with the aid of End-tidal carbon dioxide (ETCO2) monitoring, aiming to improve the efficiency and safety of awake fibreoptic intubation.
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J Clin Monit Comput · Dec 2021
Comparative study of silicone membrane simulator and animal eye models for sub-Tenon's block.
To compare and assess silicone membrane-based sub-Tenon's block (STB) simulator and animal eye model (goat's eye) for practicing STB in terms of anatomical similarity and feel of texture of eye layers. The study included 34 participants (26 learners and 8 consultants) from tertiary ophthalmic centres. The participants were divided into groups A and B. ⋯ Overall, 89% participants preferred the simulator; the reasons included ease of usage, helpful warning system, absence of biological waste, and facility for repeatable training. The study validated anatomical accuracy, preference, and ability of usage of the STB simulator. For broader usage, further study involving higher number of participants is recommended.
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J Clin Monit Comput · Dec 2021
Electromyographic assessment of blink reflex throughout the transition from responsiveness to unresponsiveness during induction with propofol and remifentanil.
General anesthesia is a reversible drug-induced state of altered arousal characterized by loss of responsiveness due to brainstem inactivation. Precise identification of the moment in which responsiveness is lost during the induction of general anesthesia is extremely important to provide information regarding an individual's anesthetic requirements and help intraoperative drug titration. To characterize the transition from responsiveness to unresponsiveness more objectively, we studied neurophysiologic-derived parameters of electromyographic records of electrically evoked blink reflex as a means of identifying the precise moment of loss of responsiveness. ⋯ Our results suggest that electrically evoked blink reflex could be used during the induction of anesthesia as a surrogate of the Richmond Agitation-Sedation Scale to provide an objective endpoint as far as a - 4. At this point, at the moment of loss of R1, the propofol infusion may be stopped, as overshooting increases slightly the effect-site concentration afterward and eventually reaching loss of responsiveness. If the desired target is not achieved, the infusion can then be resumed.