Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2019
Comparative Study Observational StudyA comparison of propofol-to-BIS post-operative intensive care sedation by means of target controlled infusion, Bayesian-based and predictive control methods: an observational, open-label pilot study.
We evaluated the feasibility and robustness of three methods for propofol-to-bispectral index (BIS) post-operative intensive care sedation, a manually-adapted target controlled infusion protocol (HUMAN), a computer-controlled predictive control strategy (EPSAC) and a computer-controlled Bayesian rule-based optimized control strategy (BAYES). ⋯ Both computer-based control systems are feasible to be used during ICU sedation with overall tighter control than HUMAN and even with lower required CePROP. EPSAC control required higher CeREMI than BAYES or HUMAN to maintain stable control. Clinical trial number: NCT00735631.
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J Clin Monit Comput · Aug 2019
Non-invasive real-time autonomic function characterization during surgery via continuous Poincaré quantification of heart rate variability.
Heart rate variability (HRV) provides an excellent proxy for monitoring of autonomic function, but the clinical utility of such characterization has not been investigated. In a clinical setting, the baseline autonomic function can reflect ability to adapt to stressors such as anesthesia. No monitoring tool has yet been developed that is able to track changes in HRV in real time. ⋯ HRV parameters were modelled into a real-time graph. Using the monitoring technique developed, autonomic changes could be successfully visualized in real-time. This could provide the basis for a novel, fast and non-invasive method of autonomic assessment that can be delivered at the point of care.
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J Clin Monit Comput · Aug 2019
Pediatric blood pressures during anesthesia assessed using normalization and principal component analysis techniques.
Expected values for blood pressure are known for both unanesthetized and anesthetized children. The statistics of changes in blood pressure during anesthesia, which may have important diagnostic significance, have not been reported. The purpose of this study was to report the variation in changes in blood pressure in four pediatric age groups, undergoing both cardiac and non-cardiac surgery. ⋯ Variations in systolic blood pressure over a 5-min period were wider: in non-cardiac from 0.1 (12.2) mmHg (first month) to 0.4 (11.5) mmHg (5-6 year old) and from 0.2 (12.5) to 0.4 (14.2) mmHg in cardiac cases. Absolute blood pressures and changes in blood pressure during anesthesia in pediatric cardiac and non-cardiac surgical cases have been analyzed from a population database. Using these values, the quantitative methods of normalization and principal component analysis allow the identification of statistically significant changes.
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J Clin Monit Comput · Aug 2019
Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach.
Although the beach-chair position (BCP) is widely used during shoulder surgery, it has been reported to associate with a reduction in cerebral blood flow, oxygenation, and risk of brain ischaemia. We assessed cerebral haemodynamics using a multiparameter transcranial Doppler-derived approach in patients undergoing shoulder surgery. 23 anaesthetised patients (propofol (2 mg/kg)) without history of neurologic pathology undergoing elective shoulder surgery were included. Arterial blood pressure (ABP, monitored with a finger-cuff plethysmograph calibrated at the auditory meatus level) and cerebral blood flow velocity (FV, monitored in the middle cerebral artery) were recorded in supine and in BCP. ⋯ Changes between phases did not result in CrCP reaching diastolic ABP, therefore DCM did not reach critical values (≤ 0 mm Hg). BCP resulted in significant cerebral haemodynamic changes. If left untreated, reduction in cerebral blood flow may result in brain ischaemia and post-operative neurologic deficit.