Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2019
Clinical TrialDevelopment and validation of an android-based application for anaesthesia neuromuscular monitoring.
Quantitative neuromuscular block (NMB) assessment is an internationally recognised necessity in anesthesia care whenever neuromuscular blocking agents are administered. Despite this, the incidence of residual neuromuscular block and its associated major respiratory morbidity and mortality remain unacceptably high considering its preventable nature. Recent surveys show that quantitative NMB assessment is not consistently employed by anesthesiologists. ⋯ This average inter-method difference was not significantly different than the a priori hypothesized difference cut-off of 0.001 (p = 0.78). Lin's concordance correlation coefficient and Pearson's correlation were both of 0.98. The custom developed Android application proved accurate for diagnosis of residual neuromuscular block.
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J Clin Monit Comput · Oct 2019
Observational StudyCerebral oxygen saturation monitoring in preeclamptic pregnant women undergoing cesarean section with spinal anesthesia: a prospective, observational study.
It has been suggested that cerebral oximetry can detect acute and chronic changes in cerebral oxygen saturation due to pregnancy related complications. Furthermore, regional cerebral oxygenation saturation (rcSO2) decreases were obtained during spinal anesthesia for cesarean section. The aim of this prospective observational study is to compare the effects of spinal anesthesia on rcSO2 in preeclamptic and normotensive pregnant women. ⋯ There is decrease in rcSO2 values after spinal anesthesia correlating with hypotension in preeclamptic women. However, the decrease is less than that of normotensive pregnant women, especially the first 5 min after spinal injection when the blood pressure is lowest. The clinical impact of these results and the relationship between cerebral desaturation and neurological complications remain to be determined.
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J Clin Monit Comput · Oct 2019
Clinical TrialUsing extra systoles and the micro-fluid challenge to predict fluid responsiveness during cardiac surgery.
Fluid responsiveness prediction is difficult during cardiac surgery. The micro-fluid challenge (micro-FC; rapid central infusion of 50 ml) and the extrasystolic method utilising post-extrasystolic preload increases may predict fluid responsiveness. Two study windows during coronary artery bypass graft surgery were defined, 1: After anaesthesia induction until surgical incision, 2: Left internal mammarian artery surgical preparation period. ⋯ The investigated methods revealed insufficient validity during cardiac surgery. RR interval corrected changes during a micro-FC should be investigated further. Trial registration Clinicaltrials.gov: NCT03002129.
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J Clin Monit Comput · Oct 2019
Anesthesia depth monitoring using alternative placement of entropy sensors: a prospective study.
Spectral entropy is based on analysis of variations in electroencephalography and frontal electromyography, and is a safe and reliable method for anesthesia depth monitoring. However, standard frontal positioning of entropy electrodes in patients undergoing cardiac surgery is sometimes challenging. The present study aimed to compare standard entropy sensor placement with an alternative (infraorbital) site. ⋯ Sensitivity/specificity analysis revealed 98.1% sensitivity, 93.3% specificity and 97.1% test efficiency for RE, and 99.2%, 95.1% and 98.5% for SE, respectively. Infraorbital entropy sensor placement in patients undergoing cardiovascular surgery is reliable and effective. The strong positive correlation between the two methods of registration enables alternative entropy measurement when frontal placement is not possible.
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J Clin Monit Comput · Oct 2019
Observational StudyThe accuracy and trending ability of cardiac index measured by the fourth-generation FloTrac/Vigileo system™ and the Fick method in cardiac surgery patients.
To compare the accuracy and trending ability of the cardiac index (CI) measured by FloTrac/Vigileo™ (CIFT) or derived by the Fick equation (CIFick) using E-CAiOVX (enables continuous monitoring of oxygen consumption) with that measured by thermodilution (CITD) in patients with off-pump coronary artery bypass surgery. Twenty-two patients undergoing elective off-pump coronary artery bypass surgery were included. CIFT and CIFick were determined simultaneously at six time-points during off-pump coronary artery bypass surgery. ⋯ The concordance rate of four-quadrant plot analysis was 93.3% for CIFT and 66.7% for CIFick in datasets where CITD ≥ 2.4 L/min/m2 before and after phenylephrine administration were included. CIFT and CIFick had wide limits of agreement with CITD, and were below acceptable limits for tracking phenylephrine-induced CI changes. However, subgroup analysis showed improved accuracy and trending ability of CIFT when only points where CITD ≥ 2.4 L/min/m2 were included, while there was no improvement in CIFick accuracy or trending ability.