Journal of clinical monitoring and computing
-
J Clin Monit Comput · Oct 2020
Clinical TrialImpact of retrograde transillumination while securing the airway in obese patients undergoing bariatric surgery.
Video laryngoscopy (VL) is a well-established technique used in anaesthetising obese patients who present with higher risks of airway-related difficulties and desaturations due to shorter safe apnoea periods. However, VL has certain limitations and may fail. We present the Infrared Red Intubation System (IRRIS), a new technique facilitating glottis identification in severely obese patients undergoing anaesthesia for bariatric surgery. ⋯ The lowest SpO2 during intubation was 98 [IQR 83-100] %. Addition of IRRIS to VL insertion facilitated the intubation of difficult airways in severely obese patients. IRRIS improves the visualization of the intubation pathway by selectively highlighting the airway entrance and shortens the time to successfully conclude the intubation procedure.
-
J Clin Monit Comput · Oct 2020
Randomized Controlled TrialNear-infrared spectroscopy for assessing microcirculation during laparoscopic gynaecological surgery under combined spinal-general anaesthesia or general anaesthesia alone: a randomised controlled trial.
While pneumoperitoneum causes negative macrohaemodynamic effects, much less is known about microcirculatory effects of different anaesthetic techniques and laparoscopy. Therefore, we aimed to explore microcirculatory effects of combined spinal-general anaesthesia and laparoscopy, as measured by near-infrared spectroscopy over forearm and calf muscles utilising a 3-min ischemic challenge. Patients (n = 102) undergoing elective laparoscopic gynaecological surgery were randomised to receive general anaesthesia alone or in combination with high-dose or low-dose spinal analgesia (levobupivacaine 7.5 mg or 3.75 mg, respectively, plus sufentanil 2.5 μg). ⋯ During gynaecological laparoscopy patients show impaired calf but maintain forearm microcirculatory function, regardless of the anaesthetic technique. Reduction in post-ischaemic recovery with high-dose spinal analgesia is explained by its sympatholytic effects: number of perfused capillaries is increased, leading to a haemodynamically more favourable state. Blood pressure is positively correlated with the post-ischaemic recovery rate in vascular beds not affected by spinal analgesia.
-
J Clin Monit Comput · Oct 2020
Clinical TrialImpact of intravenous phenylephrine bolus administration on the nociceptive level index (NOL).
Recently, the nociceptive level index (NOL) was shown to more specifically and sensitively detect noxious stimuli during anesthesia, in comparison to previous methods that relied on such parameters as heart rate (HR) and mean blood pressure (MAP). An ongoing study (NCT#03410485) evaluates the intraoperative combination of both NOL and bispectral (BIS) indices to improve quality of recovery after colorectal surgery. Our ethical committee (REB approval #CER15083) initially agreed on an interim analysis of the data from the first 30 patients. ⋯ Our report also demonstrates that these same phenylephrine boluses induce a statistically significant increase of the NOL index which does not seem to have much of a clinical relevance for the novel NOL index used to monitor intraoperative nociception as well as for the more classical BIS index for depth of anesthesia. Nevertheless, doses of intravenous PE bolus used in the present study (1 µg kg-1) might be regarded as smaller than more conventional ones (100-200 µg per bolus). Further studies need to be done with the latter doses.
-
J Clin Monit Comput · Oct 2020
Warming efficacy of Ranger™ and FT2800 fluid warmer under different room temperatures and flow rates.
The comparison of the heating capabilities with different warming system between 3M™ Ranger™ warmer (3M) and FT2800 fluid warmer (FT) under different room temperatures and infusion rates, has been rarely reported previously. The study was then aimed to compare the warming efficacies of dry heat technology (3M) and coaxial warming system (FT) under different room temperatures and infusion rates, the advantages and disadvantages of both infusion systems would be compared to provide reference for clinical infusion practice. In the study, both target warming temperatures of 3M and FT warmer were set at 41 °C, fluid was administrated under 20, 22 and 24 °C room temperatures and drip rates of 60, 80, 100, 120, 140, 160, 200, 350 drops min-1. ⋯ Linear regression showed that the Toutlet of 3M increased with the speed up of drip rate, while the Toutlet of FT was decreased. The relationship between Toutlet & room temperature & drip rate for both 3M and FT warmers was calculated by a formula. 3M Ranger™ and FT2800 show different heating capabilities under different room temperatures and drip rates. 3M is more efficient at high flow rate while FT is more efficient at low flow rate. There is a formula relationship between Toutlet & room temperature & drip rate for both 3M and FT warmers.
-
J Clin Monit Comput · Oct 2020
Continuous respiratory rate monitoring during an acute hypoxic challenge using a depth sensing camera.
Respiratory rate is a well-known to be a clinically important parameter with numerous clinical uses including the assessment of disease state and the prediction of deterioration. It is frequently monitored using simple spot checks where reporting is intermittent and often prone to error. We report here on an algorithm to determine respiratory rate continuously and robustly using a non-contact method based on depth sensing camera technology. ⋯ These results were achieved with a 100% reporting uptime. In conclusion, excellent agreement was found between RRdepth and RRcap. Further work should include a larger cohort combined with a protocol to further test algorithmic performance in the face of motion and interference typical of that experienced in the clinical setting.