Journal of clinical monitoring and computing
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J Clin Monit Comput · May 2021
Choosing the best supraglottic airway for ophthalmic general anaesthesia: a manikin study.
General anaesthesia is sometimes favoured over regional anaesthesia in ophthalmic surgery. The use of supraglottic airway (SGA) or laryngeal mask airway (LMA) as the primary airway device is increasing due to numerous advantages over tracheal intubation. Compared with 1st generation SGAs, 2nd generation SGAs have an added benefit of isolating the airway from the alimentary tract. ⋯ We also describe a novel technique of utilising a 1st generation SGA with placement of an orogastric tube, although with some reservations. This study has several limitations and transferability of our findings into clinical practice is questionable as the use of a manikin may not fully imitate the real condition of the patient. Our study is the first study comparing vertical projected height of different SGAs in manikin, but future studies should investigate the use of SGA in the clinical setting during ophthalmic surgery.
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J Clin Monit Comput · May 2021
Observational StudyUsefulness of ANI (analgesia nociception index) monitoring for outpatient saphenectomy surgery outcomes: an observational study.
The Analgesia Nociception Index (ANI), derived from heart rate variability is a proposed guide to obtain an adequate control of the analgesic component during anaesthesia. This single blind observational study was designed to evaluate the relationship between intraoperative ANI values and length of stay in Day Surgery Units (DSU) in patients undergoing varicose vein intervention. 131 patients (ASA I-II) scheduled for elective varicose vein surgery were studied. A propofol closed-loop TCI was used to maintain a specific level of BIS. ⋯ Discharge timing from DSU was statistically different among study sub-groups (p = 0.005). An adequate nociception level measured by ANI during varicose vein surgery might reduce the length of stay at DSU. Further studies are needed to assess the usefulness of ANI in other anaesthesia conditions.
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J Clin Monit Comput · May 2021
A new photoplethysmographic device for continuous assessment of urethral mucosa perfusion: evaluation in a porcine model.
This study proposes to evaluate an innovative device consisting of an indwelling urinary catheter equipped with a photoplethysmography (PPG) sensor in contact with the urethral mucosa that provides a continuous index called urethral perfusion index (uPI). The goal of this study was to determine if the uPI could bring out tissue perfusion modifications induced by hypotension and vasopressors in a porcine model. Twelve piglets were equipped for heart rate, MAP, cardiac index, stroke volume index, systemic vascular resistance index and uPI monitoring. ⋯ This relationship, assessed with the GLMM, yielded a significant positive fixed effect coefficient (+ 0.2, P < 0.00001) below the DT and a significant negative fixed effect (- 0.14, P < 0.00001) above DT. In an experimental setting, the PPG device and its index uPI permitted the detection of urethral mucosa perfusion alterations associated with hypotension or excessive doses of vasopressors. Further studies are needed to evaluate this device in a clinical context.
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J Clin Monit Comput · May 2021
Randomized Controlled TrialEffects of intraoperative positive end-expiratory pressure optimization on respiratory mechanics and the inflammatory response: a randomized controlled trial.
Applying lung protective mechanical ventilation (LPV) during general anaesthesia even in patients with non-injured lungs is recommended. However, the effects of an individual PEEP-optimisation on respiratory mechanics, oxygenation and their potential correlation with the inflammatory response and postoperative complications have not been evaluated have not been compared to standard LPV in patients undergoing major abdominal surgery. Thirty-nine patients undergoing open radical cystectomy were enrolled in this study. ⋯ Intraoperative PEEP-optimization resulted in significant improvement in gas exchange and pulmonary mechanics as compared to standard LPV. Whether these have any effect on short and long term outcomes require further investigations. Trial registration: Clinicaltrials.gov, identifier: NCT02931409.
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J Clin Monit Comput · May 2021
Implementation of strategies to prevent and treat postoperative delirium in the post-anesthesia caring unit : A German survey of current practice.
Postoperative delirium is associated with worse outcome. The aim of this study was to understand present strategies for delirium screening and therapy in German Post-Anesthesia-Caring-Units (PACU). We designed a German-wide web-based questionnaire which was sent to 922 chairmen of anesthesiologic departments and to 726 anesthetists working in ambulatory surgery. ⋯ For the treatment of delirium, alpha-2-agonists (83%, 80-85) were used most frequently for vegetative symptoms, benzodiazepines for anxiety in 71% (68-74), typical neuroleptics in 77% (71-82%) of patients with psychotic symptoms and in 20% (15-25) in patients with hypoactive delirium. 45% (39-51) of the respondents suggested no therapy for this entity. Monitoring of delirium is not established as a standard procedure in German PACUs. However, symptom-oriented therapy for postoperative delirium corresponds with current guidelines.