Anesthesiology clinics of North America
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The Bispectral Index (BIS) is a newly processed electroencephalogram parameter that was specifically developed to measure the hypnotic effects of anesthesia. Results from volunteer studies demonstrate that BIS correlates well with clinical assessments of sedation induced by sedative-hypnotic drugs. ⋯ The data suggest that improved anesthetic titration with BIS provides sufficient clinical and economic benefits to justify its routine use. This article summarizes the clinical development and validation of BIS and describes how BIS monitoring can be used to improve anesthetic outcomes.
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Initial assessment to determine pulselessness, monitoring the status of the patient, and the effectiveness of resuscitation efforts are integral parts of cardiopulmonary resuscitation. This article focuses on aspects of monitoring during cardiopulmonary resuscitation: electrocardiography and assessment of the adequacy of chest compressions.
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The goals of tracheal intubation are to place the tube in the trachea and to position the tube at an appropriate depth inside the trachea. Various clinical signs and technical aids are described to verify tracheal intubation and to diagnose esophageal intubation. Many of these methods fail under certain circumstances. ⋯ Based on available information, two algorithms are proposed: one for emergency intubation (Fig. 9) and the other for verification of tracheal tube position in elective intubation (Fig. 10). These algorithms are designed [figure: see text] to assist the clinician and should not be substituted for clinical judgment. Under no circumstances should clinical signs be ignored in the presence of conflicting information from monitors and technical aids.
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Anesthesiol Clin North America · Dec 2001
ReviewNeuromuscular blockade. Inadvertent extubation of the partially paralyzed patient.
Residual neuromuscular block is common after the use of neuromuscular blocking drugs during anesthesia. Although careful reversal [table: see text] techniques usually result in adequate return of neuromuscular recovery, sometimes it is not possible to achieve full recovery of neuromuscular block. ⋯ In those situations, in which some TOF fade is still obvious, the anesthesiologist should consider retaining the endotracheal tube in position; it is not a sign of failure to return a patient whose trachea is still intubated to the postanesthesia care unit. The inadvertent extubation of patients who are partially paralyzed results in increased postoperative morbidity.
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Anesthesiol Clin North America · Dec 2001
ReviewSpinal cord monitoring: somatosensory- and motor-evoked potentials.
Monitoring myogenic motor EPs after transcranial electrical stimulation is effective in detecting spinal cord ischemia. During thoracoabdominal aortic aneurysm surgery, this technique is sufficiently rapid to allow timely interventions aimed at correcting ischemic conditions and preserving spinal cord blood flow. ⋯ The response time is too slow to be of practical use. SSEPs also do not provide information regarding anterior horn motor function and supply, whereas the motor neurons in the anterior horn are most likely to sustain ischemic injury.