Journal of clinical monitoring and computing
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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.
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J Clin Monit Comput · Dec 2021
Observational StudyIntraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children.
In pediatric anesthesia, deviations from normothermia can lead to many complications, with infants and young children at the highest risk. A measurement method for core temperature must be clinically accurate, precise and should be minimally invasive. Zero-heat-flux (ZHF) temperature measurements have been evaluated in several studies in adults. ⋯ There was no significant or relevant change of temperature over time (0.006 °C per hour measurement interval, p = 0.199) and no relevant differences in the subgroups. Due to the mean bias of +0.26 °C in TZHF, the risk of hypothermia may be underestimated, while the risk of hyperthermia may be overestimated. Nevertheless, because of its high precision, we consider ZHF valuable for intraoperative temperature monitoring in children and infants.
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J Clin Monit Comput · Oct 2021
Letter Meta AnalysisComparison between laryngeal handshake and palpation techniques in the identification of cricothyroid membrane: a meta-analysis.
Because the use of conventional digital palpation technique for the identification of cricothyroid membrane (CTM) has been widely believed to be unreliable, the 'laryngeal handshake' technique (LH) has been introduced for CTM identification in the event of cricothyroidotomy. To provide evidence for clinical practice, this pilot meta-analysis aimed at investigating whether identification of CTM with the LH is superior to that with the palpation technique. Studies that evaluated the accuracy of CTM identification by using LH or palpation techniques (i.e., LH group vs. ⋯ Four studies published from 2018 to 2020 were considered relevant and were read in full. We found no significant difference in success rate of CTM identification [Risk Ratio (RR) 1.09, 95% CI 0.89-1.34, p = 0.41] between the two groups. These preliminary results of the current study demonstrated no significant differences in success rate between the laryngeal handshake and conventional palpation techniques in cricothyroid membrane identification.
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J Clin Monit Comput · Oct 2021
Randomized Controlled TrialPostoperative respiratory state assessment using the Integrated Pulmonary Index (IPI) and resultant nurse interventions in the post-anesthesia care unit: a randomized controlled trial.
Although postoperative adverse respiratory events, defined by a decrease in respiratory rate (RR) and/or a drop in oxygen saturation (SpO2), occur frequently, many of such events are missed. The purpose of the current study was to assess whether continuous monitoring of the integrated pulmonary index (IPI), a composite index of SpO2, RR, end-tidal PCO2 and heart rate, alters our ability to identify and prevent adverse respiratory events in postoperative patients. Eighty postoperative patients were subjected to continuous respiratory monitoring during the first postoperative night using RR and pulse oximetry and the IPI monitor. Patients were randomized to receive intervention based on standard care (observational) or based on the IPI monitor (interventional). ⋯ Compared to the observational group, the use of the IPI monitor led to an increase in the number of interventions performed by nurses to improve the respiratory status of the patient (average 13 versus 39 interventions, p < 0.001). This difference was associated with a significant reduction of the median number of events per patient (2.5 versus 6, p < 0.05) and a shorter median duration of events (62 s versus 75 s, p < 0.001). The use of the IPI monitor in postoperative patients did not result in a reduction of the number of patients experiencing adverse respiratory events, compared to standard clinical care. However, it did lead to an increased number of nurse interventions and a decreased number and duration of respiratory events in patients that experienced postoperative adverse respiratory events.