Journal of clinical monitoring and computing
-
J Clin Monit Comput · Apr 2021
ReviewPerioperative echocardiography-guided hemodynamic therapy in high-risk patients: a practical expert approach of hemodynamically focused echocardiography.
The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. ⋯ Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy.
-
J Clin Monit Comput · Apr 2021
Ultrasound guided tracheal intubation with a styleted tracheal tube in anticipated difficult airway.
Ultrasonography is a simple, reliable, non-invasive technique which helps in real-time assessment of airway anatomy and contributes to safer airway management in various settings like operating rooms, intensive care units and emergency departments. It also helps us to plan the appropriate anesthetic technique especially in difficult airway cases. Here, we discuss the importance of styleted tracheal tube in improving the accuracy of ultrasound guided tracheal intubation in anticipated difficult airway.
-
J Clin Monit Comput · Apr 2021
Regional cerebral oximetry is consistent across self-reported racial groups and predicts 30-day mortality in cardiac surgery: a retrospective analysis.
Darker skin pigmentation appears to cause underestimation of regional oxygen saturation (rSO2) for certain cerebral oximetry devices. This presents a risk of triggering unindicated interventions and may limit its utility for predicting adverse outcomes. Our goal was to quantify the impact of self-reported race on oximetry measurements during cardiac surgery and elucidate whether race has a mediating role in the association of rSO2 with mortality. ⋯ Mean pre-bypass rSO2 under 63% was an independent predictor of higher 30-day mortality risk (OR: 2.86, CI 1.39 to 5.53, p = 0.003), and the interaction variable between rSO2 and race was not statistically significant (p = 0.299). Cerebral oximetry measurements are more consistent across racial groups than previously reported, supporting its utility for intraoperative monitoring and risk stratification. Pre-intervention rSO2 is associated with increased 30-day mortality at a higher threshold than previously reported and was not significantly impacted by self-reported race.
-
J Clin Monit Comput · Apr 2021
Randomized Controlled TrialThe effect of audiovisual distraction on patient-controlled sedation under spinal anesthesia: a prospective, randomized trial.
Audiovisual distraction (AVD) has been used to augment or replace procedural sedation. We investigated whether AVD in patients having total hip (THA) or total knee arthroplasty (TKA) under spinal anesthesia would reduce self-administered propofol consumption during surgery. 50 participants were randomized equally into a patient-controlled sedation (PCS) group or AVD group. All participants were given a spinal block and a propofol PCS device prior to surgery. ⋯ Historical clinician-controlled usage of propofol demonstrated a median of 39.3 mcg/kg/min (29.2-51.2). There were few differences in the secondary outcome measures. The use of AVD did not reduce patient-controlled propofol consumption in patients having a THA or TKA surgery under spinal anesthesia.
-
J Clin Monit Comput · Apr 2021
Randomized Controlled TrialPhotoplethysmography-derived approximate entropy and sample entropy as measures of analgesia depth during propofol-remifentanil anesthesia.
The ability to monitor the physiological effect of the analgesic agent is of interest in clinical practice. Nonstationary changes would appear in photoplethysmography (PPG) during the analgesics-driven transition to analgesia. The present work studied the properties of nonlinear methods including approximate entropy (ApEn) and sample entropy (SampEn) derived from PPG responding to a nociceptive stimulus under various opioid concentrations. ⋯ The result showed that low Ceremi (0 and 1 ng·ml-1) could be differentiated from high Ceremi (3 and 5 ng·ml-1) by ApEn and SampEn. Depending on the coefficient employed in algorithm: ApEn with k = 0.15 yielded the largest PK value (0.875) whereas SampEn gained its largest PK of 0.867 with k = 0.2. Thus, PPG-based ApEn and SampEn with appropriate k values have the potential to offer good quantification of analgesia depth under general anesthesia.