Journal of clinical monitoring and computing
-
J Clin Monit Comput · Dec 1998
A method for assessment of standards of care of anesthesia services in departments with different levels of resources.
In developing countries the standards of anesthesia care vary greatly between hospitals. In order to identify the urgent needs of disadvantaged hospitals, we compared three index hospitals in the greater Cairo area, one of which has excellent (category I), on intermediate (category II), and one with severely restricted resources (category III). Standards of care published by the American Society of Anesthesiologists (ASA) were used to develop a spreadsheet for documenting features of pre-, intra- and post-anesthetic care in patients undergoing tonsillectomies, a procedure commonly performed in all three hospitals. ⋯ Urgent help does not mean the need for sophisticated monitors or equipment only, but the establishment of practice standards first. Applying the priciples of modern management, we need to evaluate the structure, processes and outcome of anesthetic practice in developing countries in order to reengineer the way we provide help to anesthetic departments in developing nations. In this modest study we are presenting a means to evaluate the features and processes of the anesthesia services in developing countries.
-
J Clin Monit Comput · Dec 1998
The fast flush test--is the clinical comparison equivalent to its in vitro simulation?
An in vitro simulation of the fast flush (FL) test has previously been used to prove that the FL test-measures the dynamic response of entire the blood pressure monitoring system. This simulation has also been used to confirm that the FL test is equivalent to the "gold standard" test for determining dynamic response, namely the square wave (SW) test. The conditions of the in vitro simulation can be reproduced in vivo during cardiopulmonary bypass (CPB) and circulatory arrest. Therefore the present objective was to verify that the previous conclusions about the validity of the FL test, obtained from an in vitro model, are equally valid when applied to in vivo clinical conditions. A secondary objective was to determine whether the patient's arterial tree has any affect on the dynamic characteristics of fluid-filled manometers. ⋯ The clinical conditions during CPB and particularly during circulatory arrest duplicate the in vitro FL test simulation model. These results confirm the validity of the FL test in vivo as well as proving that the dynamic characteristics of a fluid-filled manometer are independent of the patient's vasculature.
-
J Clin Monit Comput · Aug 1998
Influence of the reference gas of paramagnetic oxygen analyzers on nitrogen concentrations during closed-circuit anesthesia.
Nitrogen (N2) may accumulate to unacceptable levels during closed-circuit anesthesia (CCA) when the sampled gases are redirected to the anesthesia circuit, because many gas analyzers entrain air as a reference gas to calibrate for oxygen analysis. Using oxygen instead of air as the reference gas for paramagnetic oxygen analysis could attenuate N2 accumulation. Forty-three adult ASA physical status I-III patients undergoing a variety of peripheral and abdominal procedures were assigned to one of two groups, depending on the reference gas used by a paramagnetic oxygen analyzer, either air (group I, n = 23) or oxygen (group II, n = 20). ⋯ N2Et0min, N2Et5min, and N2Et55min were 0.87+/-0.93, 2.6+/-1.5, and 10.1+/-2.9%, respectively. The correlation (r2) between N2Et55min and N2Et0min was 0.04, and between N2Et55min and N2Et5min it was 0.40. We conclude that paramagnetic oxygen analyzers that use oxygen as the reference gas significantly attenuate N2 accumulation during CCA, which may reduce the need for frequent flushing of the anesthesia system, may provide more constant oxygen and nitrous oxide concentrations, and may simplify pharmacokinetic studies of potent inhaled anesthetics.
-
J Clin Monit Comput · Aug 1998
Availability of records in an outpatient preanesthetic evaluation clinic.
Despite efforts to develop electronic access to medical records, there are few data on availability of past evaluations. Typical analyses assess only availability of paper charts. We studied the availability of prior internal and external medical documentation in the preanesthetic clinic of our tertiary teaching institution, which has had access to hospital-wide electronic records for five years. ⋯ Anesthesiologists retrieved, and added to the perioperative evaluation, information from previous encounters for 16% of patients. Despite our hospital-wide electronic records, internal information was missing for 22% of patients. Uneven deployment, and reliance on transcription may contribute to failures. A national electronic medical records system would benefit the 8% (one out of twelve) of outpatients missing external records identified in this study. For many patients, optimal medical understanding was not achieved during the planned preanesthetic evaluation.