Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2009
Bi-spectral index guided closed-loop anaesthesia delivery system (CLADS) in pheochromocytoma.
Anaesthetic management of pheochromocytoma is far from satisfactory even though various techniques are available. Feasibility as well as safety of Bi-spectral Index (BIS)-guided closed-loop control of anaesthesia has been shown in various clinical settings. We evaluated the performance of BIS-guided closed-loop-anaesthesia-delivery system (CLADS) in patients undergoing resection of pheochromocytoma. ⋯ CLADS performed well in patients undergoing pheochromocytoma surgeries which represent one of the few clinically extreme situations.
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J Clin Monit Comput · Aug 2009
Model fitting of volumetric capnograms improves calculations of airway dead space and slope of phase III.
This study assessed the performance of a Functional Approximation based on a Levenberg-Marquardt Algorithm (FA-LMA) to calculate airway dead space (VD(aw)) and the slope of phase III (S(III)) from capnograms. ⋯ The Functional Approximation based on a Levenberg-Marquardt Algorithm showed less bias and dispersion compared to the traditional Fowler's method when calculating VD(aw) and S(III).
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J Clin Monit Comput · Aug 2009
Visual cueing with context relevant information for reducing change blindness.
Physiological monitoring is a requisite for optimal care to ensure that the condition of a patient is maintained within safe levels. Monitoring can be jeopardized by the inability of a clinician to recognize important changes in the visual display of data throughout the duration of the monitoring task. We hypothesized that the addition of a visual cue imparting contextual information to a physiological display would improve the detection ability and response time of a clinician to a change in a patient variable. ⋯ The data collected and analyzed in this study supports the addition of a visual cue to future physiological monitors. The graphic representation and the context relevant information that it transmits appears to aid clinicians. While the results indicate that enhanced visualization of context relevant information can lead to a significant improvement in event recognition and identification, further evaluation in clinical settings is required.
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J Clin Monit Comput · Aug 2009
Dose and timing effect of etomidate on motor evoked potentials elicited by transcranial electric or magnetic stimulation in the monkey and baboon.
Etomidate has been shown to both enhance and depress the cortical amplitude of somatosensory evoked potentials (SSEP) depending on the dose used. Similar amplitude increases with etomidate and motor evoked potentials resulting from cortical magnetic (tcMMEP) and electric (tcEMEP) stimulation have not been consistent. We used a primate model to elucidate the time and dose characteristics of the effect. ⋯ This study demonstrates that a low dose (0.1 mg/kg) of etomidate increases the com- pound muscle action potential (CMAP) amplitude for tcEMEP and tcMMEP in the monkey whereas higher doses decrease the amplitude. Epidural recordings demonstrate a marked increase in the number of I waves consistent with a cortical effect similar to the postulated effect that results in amplification of the cortical SSEP. This suggests the amplitude loss in the hypothenar muscles may be due to depression of the spinal cord by etomidate. The CMAP response amplification at low doses was greater in tcMMEP than tcEMEP and the depression at higher doses was more with the tcMMEP technique consistent with the greater dependence of the tcMMEP technique on synaptic activation.