Journal of clinical monitoring
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The pulse oximeter, a noninvasive and continuous monitor of arterial oxygenation that is reliable in adults, children, and infants, was evaluated for use in neonates in the delivery suite. One hundred newborn infants, weighing 850 to 5,230 g each, delivered vaginally or by cesarean section with general or epidural anesthesia were studied. After delivery, each infant was placed in a radiant warmer, and a pulse oximetry probe was placed on the right hand. ⋯ Oxygen saturation did not differ significantly between neonates delivered vaginally or by cesarean section, regardless of the presence or type of anesthetic used. Arterial oxygen saturation measured by pulse oximetry showed a statistically significant relationship when compared with the traditional Apgar scoring system. Pulse oximetry was found to be very useful in objectively judging the adequacy of resuscitative efforts, as well as in identifying children who had marked arterial desaturation during the early neonatal period.
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Comparative Study
Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies.
Postoperative hemorrhage in patients undergoing open-heart surgery is a major cause of morbidity and mortality. Monitoring of coagulation in these patients has routinely involved the activated clotting time. Thromboelastography is currently used as a monitor of coagulation during liver transplantation. ⋯ Thirty-eight patients (29 undergoing coronary artery bypass grafting and 9 undergoing valve replacement) were studied with activated clotting time, thromboelastography, and coagulation profiles during three periods: before bypass, during bypass, and after protamine administration. Thromboelastography was a significantly better predictor (87% accuracy) of postoperative hemorrhage and need for reoperation than was the activated clotting time (30%) or coagulation profile (51%). Thromboelastography is easy to use and provides diagnostic data within 30 minutes of blood sampling.
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Comparative Study
Noninvasive continuous blood pressure measurement from the finger: optimal measurement conditions and factors affecting reliability.
We recorded finger arterial blood pressure (FINAP) in 50 male patients during various types of surgical operations. Three different types of cuffs were used on four fingers of each patient. Measurements were made by the arterial volume-clamp method of Penaz. ⋯ The slopes for the various finger-cuff combinations ranged from 0.537 to 0.996, and the intercepts ranged from 0.083 to 32.387 from mean pressure. In 3 patients (6%) the FINAP measurement was not possible because of insufficient peripheral circulation. In 9 other patients (18%) the FINAP measurements were not accurate during some periods of time.(ABSTRACT TRUNCATED AT 250 WORDS)
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We have developed an anesthesia information system (AIS) that supports the anesthesiologist in monitoring and recording during a surgical operation. In development of the system, emphasis was placed on providing an anesthesiologist-computer interface that can be adapted to typical situations during anesthesia and to individual user behavior. One main feature of this interface is the integration of the input and output of information. ⋯ A one-page record of the anesthesia is automatically plotted on a multicolor digital plotter during the operation. An example of the use of the AIS is presented from a field test of the system during which it was evaluated in the operating room without interfering with the ongoing operation. Medical staff who used the AIS imitated the anesthesiologist's recording and information search behavior but did not have responsibility for the conduct of the anesthetic.
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One hundred and five children with congenital heart disease were monitored by pulse oximetry during cardiac catheterization. Excellent correlation (r = 0.95) was found between oxygen saturation values obtained with pulse oximetry and those obtained from arterial blood in 133 data pairs. ⋯ The clinical usefulness of pulse oximetry in the early recognition of decreased pulmonary blood flow or partial airway obstruction was demonstrated. Early diagnosis of changes in oxygenation was especially helpful in children with cyanotic congenital heart disease, in whom small changes in arterial oxygen tension may cause large changes in oxygen saturation.