Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2016
Impact of obesity on recovery and pulmonary functions of obese women undergoing major abdominal gynecological surgeries.
To determine impact of obesity on recovery parameters and pulmonary functions of women undergoing major abdominal gynecological surgeries. Eighty women undergoing major gynecological surgeries were included in this study. Anesthesia was induced by remifentanil bolus, followed by propofol and cisatracurium to facilitate oro-tracheal intubation and was maintained by balanced anesthesia of remifentanil intravenous infusion and sevoflurane in oxygen and air. ⋯ Hospital stay was significantly shorter for obese compared to morbid obese women. Obesity delays recovery from general anesthesia, adversely affects pulmonary functions and increases post-operative complications. Remifentanil infusion and sevoflurane could be appropriate combination for obese and morbidly obese women undergoing major surgeries.
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J Clin Monit Comput · Jun 2016
Respiratory variations in the photoplethysmographic waveform amplitude depend on type of pulse oximetry device.
Respiratory variations in the photoplethysmographic waveform amplitude predict fluid responsiveness under certain conditions. Processing of the photoplethysmographic signal may vary between different devices, and may affect respiratory amplitude variations calculated by the standard formula. The aim of the present analysis was to explore agreement between respiratory amplitude variations calculated using photoplethysmographic waveforms available from two different pulse oximeters. ⋯ Concordance rate with a fluid load was 91 %. Agreement between respiratory variations in the photoplethysmographic waveform amplitude calculated from the available signals output by two different pulse oximeters was poor, both evaluated by LMSO and Bland-Altman plot. Respiratory amplitude variations from the available signals output by these two pulse oximeters are not interchangeable.
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J Clin Monit Comput · Jun 2016
Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol.
Poor perioperative glycemic management can lead to negative surgical outcome. Improved compliance to glucose control protocol could lead to better glucose management. An Anesthesia Information Management System based decision support system-Smart Anesthesia Manager™ (SAM) was used to generate real-time reminders to the anesthesia providers to closely adhere to our institutional glucose management protocol. ⋯ Compliance to hourly glucose measurement and correct insulin doses increased significantly during the intervention period when compared with the baseline (from 52.6 to 71.2 % and from 13.5 to 24.4 %, respectively). In spite of improved compliance to institutional protocol, the mean glucose levels and other glycemic management parameters did not show significant improvement with SAM reminders. Real-time electronic reminders improved intraoperative compliance to institutional glucose management protocol though glycemic parameters did not improve even when there was greater compliance to the protocol.
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J Clin Monit Comput · Jun 2016
A numerical model of blood oxygenation during veno-venous ECMO: analysis of the interplay between blood oxygenation and its delivery parameters.
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an important tool in the management of most severe forms of acute respiratory failure. The determinants and management of oxygen delivery in patients treated with VV-ECMO is a complex topic. The physiological principles of oxygenation on VV-ECMO are reviewed in many textbooks. ⋯ The numerical analysis of variation and interplay between each oxygenation determinants during VV-ECMO is presented in graphical form. These results corroborate all the findings of previous studies. The proposed numerical model facilitates understanding of oxygenation physiology during VV-ECMO; it can be used for a medical simulation system and for teaching the principles of oxygenation during VV-ECMO.
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The FLOW-i anesthesia machine (Maquet, Solna, Sweden) can be equipped with automated gas control (AGC), an automated low flow tool with target control of the inspired oxygen concentration (FIO2) and end-expired concentration (FA) of a potent inhaled anesthetic. We examined the performance and quantitative aspects of the AGC. After IRB approval and individual informed consent, anesthesia in 24 ASA I-II patients undergoing abdominal or gynecological surgery was maintained with sevoflurane in O2/air with a target FIO2 of 40 % and a target sevoflurane FA (FAsevo) of 2.0 %. ⋯ Consequently, both FGF and the choice of speed become factors that influence agent usage. After 15 min, a 300 mL min(-1) maintenance FGF reduces agent usage to near closed-circuit conditions. This new addition to our automated low flow armamentarium helps to reduce anesthetic waste, cost, and pollution, while minimizing the ergonomic burden of low flow anesthesia.