AANA journal
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Comparative Study
Evaluation of a nasal/oral discriminate sampling system for capnographic respiratory monitoring.
Although continuous end-tidal carbon dioxide (PETCO2 mmHg) measurements permit the earliest detection of alveolar hypoventilation, apnea and/or obstruction, technical difficulties have thus far precluded its reliable implementation in the spontaneously breathing patient with a natural (e.g., nonartificially secured) airway. Among the technical difficulties is the fact that conventional sampling devices do not take into account the possibility that breathing may take place primarily through either the nose or the mouth. As a result, the efficacy of a new nasal/oral discriminate sampling system (NODSS) was examined for capnographic observation of respiratory adequacy. ⋯ A comparison between PaCO2 values and noninvasive nasal and/or oral PETCO2 obtained by NODSS showed a positive correlation (r value) of 0.602 to 0.849 when statistically analyzed by Pearson's product-moment correlation coefficient. There was no significant difference between the mean (PaCO2-PETCO2) gradient derived through nasal sampling, as compared to the mean gradient derived by oral sampling with this device (P > 0.05). Noninvasive capnographic monitoring by NODSS is a convenient, reliable, effective, and accurate alternative to direct arterial blood gas determination that may be used for the early detection of respiratory inadequacy in the spontaneously breathing patient who has a natural airway.
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Case Reports
Adenosine treatment of supraventricular tachycardia following epidural test dose: a case study.
This is a case report of supraventricular tachycardia following initiation of epidural analgesia with use of an epinephrine test dose in a parturient during active labor. Vagal stimulatory efforts failed to interrupt the arrhythmia, but treatment with adenosine was successful. Fetal monitoring with a scalp electrode provided evidence of fetal well-being throughout the episode. Adenosine was chosen because of its safety for both the mother and the fetus and its lack of the hypotensive effect often seen with verapamil.