Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2024
Nociception level index-directed superficial parasternal intercostal plane block vs erector spinae plane block in open-heart surgery: a propensity matched non-inferiority clinical trial.
This single-center study explored the efficacy of superficial parasternal intercostal plane block (SPIPB) versus erector spinae plane block (ESPB) in opioid-sparing within Nociception Level (NOL) index-directed anesthesia for elective open-heart surgery. After targeted propensity matching, 19 adult patients given general anesthesia with preincisional SPIPB were compared to 33 with preincisional ESPB. We hypothesized that SPIPB is non-inferior to ESPB in reducing total intraoperative fentanyl consumption, with a non-inferiority margin (δ) set at 0.1 mg. ⋯ The SPIPB group had a significantly higher average NOL index, p = 0.003, and greater NOL index variability, p = 0.027. This study could not demonstrate that SPIPB was inferior to ESPB for intraoperative fentanyl consumption. Significant differences were observed in secondary outcomes, with SPIPB leading to higher postoperative morphine use, higher pain scores, and reduced nociception control.
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J Clin Monit Comput · Oct 2024
Comparison of time-series models for predicting physiological metrics under sedation.
This study presents a comprehensive comparison of multiple time-series models applied to physiological metric predictions. It aims to explore the effectiveness of both statistical prediction models and pharmacokinetic-pharmacodynamic prediction model and modern deep learning approaches. Specifically, the study focuses on predicting the bispectral index (BIS), a vital metric in anesthesia used to assess the depth of sedation during surgery, using datasets collected from real-life surgeries. ⋯ The study emphasizes the importance of selecting and building appropriate time-series models to achieve accurate predictions in biomedical applications. This research provides insights to guide future efforts in improving vital sign prediction methodologies for clinical and research purposes. Clinically, with improvements in the prediction of physiological parameters, clinicians can be informed of interventions if an anomaly is detected or predicted.
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J Clin Monit Comput · Oct 2024
Improving quantitative neuromuscular monitoring: an education initiative on stimulating electrode placement.
Quantitative neuromuscular monitoring reduces the incidence of residual neuromuscular block, but broad acceptance of monitoring has been elusive despite recommendations for quantitative monitoring for decades. Acceptance of quantitative monitoring may, in part, be related to the quality of the data from monitoring systems. This evaluation explored proper stimulating electrode positioning for electromyographic (EMG) monitoring, the impact of an educational intervention on electrode positioning and anesthesia provider (anesthesiologist, resident, anesthetist) confidence in the monitoring data from the device. ⋯ There was a significant relationship between correct stimulating electrode placement and anesthesia provider confidence in the EMG derived data on neuromuscular block status. An educational intervention to improve EMG electrode positioning proved meaningful. It increased anesthesia provider confidence in the EMG derived data during anesthesia case management.
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J Clin Monit Comput · Oct 2024
Time to maximum pupil constriction is variable in neurocritical care patients.
Quantitative pupillometry (QP) use has grown exponentially. Each QP scan captures images of the pupil before, during, and after light exposure to provide component measures of the pupillary light reflex (PLR). This study explores if the time to maximum constriction (tMC) is uniform among neuroscience intensive care unit (NSICU) patients. ⋯ The between-subject mean tMC was 0.97 (0.17) s and ranged from 0.46 s to 1.35 s. The tMC does not occur at a fixed point in time. Clinical applications that seek to characterize pupil health should account for varied tMC and explore relationships to discrete outcomes to determine the clinical usefulness of tMC.