Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2018
Comment LetterPhenylephrine and paradoxically increased muscle tissue oxygenation: is the mechanism related to local venoconstriction or augmented venous return?
Abstract
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J Clin Monit Comput · Dec 2018
Comparative StudyExperimental comparison of performances of Mega Acer Kit, Ranger and ThermoSens according to flow rates and distances.
We experimentally investigated the fluid warming performances of three warmers with different technology, according to flow rates and distances. We used the following intravenous fluid warmers: Mega Acer Kit (Group M, n = 8), Ranger (group R, n = 8), and ThermoSens (group T, n = 8). Fluids that had been stored in the operating room over the previous 24 h were delivered at sequent flow rates of from 440 mL/h up to 2500 mL/h through preheated warming devices. ⋯ It was significantly higher at the Pout1 than the Pout2 at all flow rates for each device (P < 0.001). Mega Acer Kit can warm fluid more effectively compared with ThermoSens and Ranger at the low flow rate whereas the ThermoSens and the Ranger are suitable at higher flow rates. Furthermore, the device performance is more effective with shorter extension lines.
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J Clin Monit Comput · Dec 2018
Randomized Controlled TrialComparison of clinical performance of size 1.5 Supreme™ LMA and Proseal™ LMA among Asian children: a randomized controlled trial.
To date, most of the studies on safety and efficacy of supraglottic airway devices were done in Caucasian patients, and the results may not be extrapolated to Asian patients due to the different airway anatomy. We conducted this study to compare Supreme™ LMA (SLMA) and Proseal™ LMA (PLMA) size 1.5 in anaesthetized children among an Asian population. This prospective randomized clinical trial was conducted in a tertiary teaching hospital from September 2013 until May 2016. ⋯ Secondary outcomes including time to insertion [20.8 (± 8.3) vs. 22.1 (± 8.3) s, p = 0.57], first attempt success rate for device insertion, fibreoptic view of larynx, and airway complications were also comparable between the two devices. We found that all the patients who had a failed device insertion (either PLMA or SLMA) were of a smaller size (5-6.2 kg). The oropharyngeal leak pressure of the SLMA 1.5 was comparable with the PLMA 1.5, and both devices were able to maintain an airway effectively without significant clinical complications in anaesthetized children from an Asian population.
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J Clin Monit Comput · Dec 2018
Clinical TrialPhenylephrine increases cardiac output by raising cardiac preload in patients with anesthesia induced hypotension.
Induction of general anesthesia frequently induces arterial hypotension, which is often treated with a vasopressor, such as phenylephrine. As a pure α-agonist, phenylephrine is conventionally considered to solely induce arterial vasoconstriction and thus increase cardiac afterload but not cardiac preload. In specific circumstances, however, phenylephrine may also contribute to an increase in venous return and thus cardiac output (CO). ⋯ After phenylephrine, the mean(SD) MAP, SV, CO, CVP and EtCO2 increased by 34(13) mmHg, 11(9) mL, 1.02(0.74) L min-1, 3(2.6) mmHg and 4.0(1.6) mmHg at T5 respectively, while both dynamic preload variables decreased: PPV dropped from 20% at baseline to 9% at T5 and to 13% at T10 and SVV from 19 to 11 and 14%, respectively. Initially, the increase in MAP was perfectly aligned with the increase in SVR, until 150 s after the initial increase in MAP, when both curves started to dissociate. The dissociation of the evolution of MAP and SVR, together with the changes in PPV, CVP, EtCO2 and CO indicate that in patients with anesthesia-induced hypotension, phenylephrine increases the CO by virtue of an increase in cardiac preload.
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J Clin Monit Comput · Dec 2018
Comparative StudyVolumetric and reflective device dead space of anaesthetic reflectors under different conditions.
Inhalation sedation is increasingly performed in intensive care units. For this purpose, two anaesthetic reflectors, AnaConDa™ and Mirus™ are commercially available. However, their internal volume (100 ml) and possible carbon dioxide reflection raised concerns. ⋯ Et-CO2 showed similar effects. In addition to volumetric dead space, reflective dead space was determined as 198 ± 6/58 ± 6/35 ± 0/25 ± 0 ml under ATP/BTPS/ISO-0.4/ISO-1.2 conditions for AnaConDa, and 92 ± 6/25 ± 0/25 ± 0/25 ± 0 ml under the same conditions for MIRUS, respectively. Under BTPS conditions and with the use of moderate inhaled agent concentrations, reflective dead space is small and similar between the two devices.