Journal of clinical monitoring
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Patients receiving intraspinal opiates should be monitored in the intensive care unit for at least 24 hours to prevent potentially lethal outcomes. These include respiratory depression caused by sequestration of the morphine in the cerebrospinal fluid and migration of epidural catheters in the subarachnoid or intravascular space. At this time, most hospitals are not equipped or staffed adequately to guarantee the safety of these patients outside the intensive care unit.
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The need to incorporate alarms in monitoring systems is related to the growing complexity of monitoring and the large number of variables. For sophisticated alarms, information about the inputs to the patient is of importance; for example, clinical interventions such as drug administration and ventilation readjustment need to be known to the monitoring system. Alarms are triggered by signals or signal features that exceed thresholds. ⋯ Approaches to determine such levels automatically are discussed in this article. Most promising seems the multiple signal approach using an expert system. It seems reasonable to expect that information concerning alarm limits, needed for the operation of knowledge-based alarm systems, may come from integrated departmental data bases.
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Comparative Study
Evaluation of a continuous noninvasive blood pressure monitor in obstetric patients undergoing spinal anesthesia.
A noninvasive blood pressure monitor (Finapres) that continuously displays the arterial waveform using the Penaz methodology has recently been introduced into clinical practice. We compared this device with an automated oscillometric blood pressure monitor (Dinamap 1846SX) in 20 patients during spinal anesthesia for nonemergency cesarean section according to a procedure suggested by the Association for the Advancement of Medical Instrumentation. After administration of the spinal anesthetic, the Finapres monitor produced systolic, mean, and diastolic pressure measurements greater than those of the Dinamap monitor (6.6 +/- 12.5, 3.3 +/- 10.4, and 7.2 +/- 9.8 mm Hg, respectively). ⋯ The Finapres monitor occasionally stopped working and had to be restarted. In 1 patient (not included in this analysis), the Dinamap monitor was unable to determine the blood pressure due to patient shivering; this did not appear to interfere with the Finapres. We conclude that the Finapres monitor does not consistently provide blood pressure information equivalent to that of the Dinamap in obstetric patients undergoing spinal anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Most patients receiving spinal narcotics can be monitored adequately by well-trained nurses on postoperative or postdelivery wards. Patients at high risk (e.g., those with preexisting lung disease or many elderly patients) do need monitoring in the intensive care unit. Also requiring special monitoring are patients for whom epidural narcotics alone will not cover their pain, such as young patients with multiple trauma. Patients without these restrictions, however, can be monitored successfully outside the intensive care unit, although the dose of epidural narcotic should be kept as low as possible.