Journal of clinical monitoring and computing
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Anaesthesia is a multivariable problem where a combination of drugs are used to induce desired hypnotic, analgesia and immobility states. The automation of anaesthesia may improve the safety and cost-effectiveness of anaesthesia. ⋯ In this paper, several significant challenges in automation of anaesthesia are discussed, namely model uncertainty, controlled variables, closed-loop application and dependability. The increasingly reliable measurement device, robust and adaptive controller, and better fault tolerance strategy are paving the way for automation of anaesthesia.
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J Clin Monit Comput · Apr 2015
Comparative StudyComparison of two devices using near-infrared spectroscopy for the measurement of tissue oxygenation during a vascular occlusion test in healthy volunteers (INVOS(®) vs. InSpectra™).
The aim of this study was to compare tissue oxygen saturation as measured by INVOS® and InSpectra™ during a vascular occlusion test (VOT) in the same subject. Twenty healthy adults were investigated. The INVOS® and InSpectra™ probes were placed randomly on the right and left thenar eminence in the same participant and monitoring of tissue oxygen saturation (SrO2 from INVOS® and StO2 from InSpectra™) were begun. ⋯ SrO2 declined to 40% more rapidly than did the StO2 (147±38 vs. 199±41 s, p<0.01). The deoxygenation and reoxygenation rates were higher (p<0.01) and the reactive hyperemic area was more extensive for INVOS® than for InSpectra™ (p=0.015). In conclusion, the VOT on the thenar muscle using INVOS® was as clinically applicable as InSpectra™, but baseline values and dynamic changes of INVOS® differed from those of InSpectra™.
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J Clin Monit Comput · Apr 2015
Clinical TrialEstimation of shunt fraction by transesophageal echocardiography during one-lung ventilation.
As the blood flow volume in non-dependent lung composed the primary part of the intrapulmonary shunt during one-lung ventilation (OLV), the shunt fraction (SF) during OLV can be represented by the ratio of blood flow volume in non-dependent lung to the bilateral lung. The purpose of this study is to estimate the shunt in non-dependent lung by transesophageal echocardiography (TEE). Fifteen adult patients requiring OLV for thoracic surgery were enrolled in the study. ⋯ There was significant liner correlation between SF and PaO2 (r=0.717), and between BFP and PaO2 (r=0.593). It is feasible to estimate intrapulmonary shunt by TEE in anesthetized patients undergoing OLV. SF measured by TEE has significant correlation with PaO2, and it would expected to be used to predict hypoxemia during OLV.
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J Clin Monit Comput · Apr 2015
Observational StudyThe evaluation of a non-invasive respiratory volume monitor in surgical patients undergoing elective surgery with general anesthesia.
Continuous respiratory assessment is especially important during post-operative care following extubation. Respiratory depression and subsequent adverse outcomes can arise due to opioid administration and/or residual anesthetics. A non-invasive respiratory volume monitor (RVM) has been developed that provides continuous, real-time, measurements of minute ventilation (MV), tidal volume (TV), and respiratory rate (RR) via a standardized set of thoracic electrodes. ⋯ The average RR difference was -0.22 breaths/minute (bias: -1.8%, precision: 3.7% accuracy: 4.1%). Correlations between the RVM traces and the ventilator were compared at various points with correlations>0.90 throughout. Pairing the close correlation to ventilator measurements in intubated patients demonstrated by this study with previously described accuracy compared to spirometry in non-intubated patients, the RVM can be considered to have the capability to provide continuity of ventilation monitoring post-extubation This supports the use of real-time continuous RVM measurements to drive post-operative and post-extubation protocols, initiate therapeutic interventions and improve patient safety.