Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2013
ReviewMuscle relaxant use during intraoperative neurophysiologic monitoring.
Neuromuscular blocking agents have generally been avoided during intraoperative neurophysiological monitoring (IOM) where muscle responses to nerve stimulation or transcranial stimulation are monitored. However, a variety of studies and clinical experience indicate partial neuromuscular blockade is compatible with monitoring in some patients. This review presents these experiences after reviewing the currently used agents and the methods used to assess the blockade. ⋯ Monitoring of muscle responses from cranial nerve stimulation may require a higher degree of stimulation and less neuromuscular blockade. The role of tetanic or sensory conditioning of the nervous system is not fully characterized. The impact of neuromuscular pathology or the effect of partial blockade on monitoring muscle responses from spontaneous neural activity or mechanical nerve stimulation has not been described.
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J Clin Monit Comput · Feb 2013
Comparative StudyCardiac parameters in children recovered from acute illness as measured by electrical cardiometry and comparisons to the literature.
Electrical cardiometry (EC) is a non-invasive cardiac output method that can assess cardiac index (CI) and stroke index (SI) but there are no reference values for children per se. The primary aim of this study was to develop reference values for clinical application. The secondary aim was to compare the EC measurements to published values. ⋯ There is a curvilinear relationship of CI or SI and age by EC in normal children. Cardiac parameters reported in the literature using alternative methods are different from those obtained with EC but are within acceptable ranges, with EC biased to underestimate CI. Adjustment of target value is required for EC goal-directed therapies.
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J Clin Monit Comput · Feb 2013
Validation of continuous and noninvasive hemoglobin monitoring by pulse CO-oximetry in Japanese surgical patients.
We evaluated the accuracy of noninvasive and continuous total hemoglobin (SpHb) monitoring with the Radical-7(®) Pulse CO-Oximeter in Japanese surgical patients before and after an in vivo adjustment of the first SpHb value to match the first reference value from a satellite laboratory CO-Oximeter. Twenty patients undergoing surgical procedures with general anesthesia were monitored with Pulse CO-Oximetry for SpHb. Laboratory CO-Oximeter values (tHb) were compared to SpHb at the time of the blood draws. ⋯ In patients with adequate perfusion (PI ≥1.4) the correlation coefficient was 0.89. In vivo adjustment of SpHb significantly improved the accuracy in our cohort of Japanese surgical patients. The strongest correlation between SpHb and tHb values was observed in patients with adequate peripheral perfusion suggesting that low perfusion may affect the accuracy of SpHb monitoring.
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J Clin Monit Comput · Feb 2013
Comparative StudyComparison of two different generations of "NIRS" devices and transducers in healthy volunteers and ICU patients.
The purpose of this study is to compare Near Infrared Spectroscopy (NIRS) thenar eminence parameters obtained with 2 different devices from the same manufacturer (InSpectra Models 325 and 650, Hutchinson Tech, Min USA), and 2 different probes (15 vs. 25 mm spacing), in healthy volunteers (HV) and ICU patients. Prospective, observational study in ICU setting. Simultaneous, cross over NIRS inter-device comparison and comparison between different probes (25 vs. 15 mm spacing) were done at baseline and during vascular occlusion tests (VOTs). ⋯ StO(2) data obtained with NIRS model 650 and 15 mm probe differ from values obtained with the previous device (325 and probe spacing 25 or 15 mm). This difference is not related to the population tested, but to the device and probe spacing. As a consequence, despite similar trends for variations between HV and patients during VOT, threshold and predictive values for outcome should be revisited with the new device before the acceptance for routine clinical use.