Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2010
Accuracy of methemoglobin detection by pulse CO-oximetry during hypoxia.
Methemoglobin in the blood cannot be detected by conventional pulse oximetry, although it can bias the oximeter's estimate (Spo2) of the true arterial functional oxygen saturation (Sao2). A recently introduced "Pulse CO-Oximeter" (Masimo Rainbow SET(R) Radical-7 Pulse CO-Oximeter, Masimo Corp., Irvine, CA) is intended to additionally monitor noninvasively the fractional carboxyhemoglobin and methemoglobin content in blood. The purpose of our study was to determine whether hypoxia affects the new device's estimated methemoglobin reading accuracy, and whether the presence of methemoglobin impairs the ability of the Radical-7 and a conventional pulse oximeter (Nonin 9700, Nonin Medical Inc., Plymouth, MN) to detect decreases in Sao2. ⋯ The Radical-7's methemoglobin readings become progressively more inaccurate as Sao2 decreases <95%, at times overestimating true values by 10% to 40%. Elevated methemoglobin causes the Spo2 readings to underestimate Sao2 similar to conventional 2-wavelength pulse oximeters at high saturation. Spo2 readings from both types of instruments continue to trend downward during the development of hypoxemia (Sao2 <90%) with methemoglobin levels up to 15%.
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Anesthesia and analgesia · Jul 2010
ReviewNoninvasive autoregulation monitoring with and without intracranial pressure in the naive piglet brain.
Cerebrovascular autoregulation monitoring is often desirable for critically ill patients in whom intracranial pressure (ICP) is not measured directly. Without ICP, arterial blood pressure (ABP) is a substitute for cerebral perfusion pressure (CPP) to gauge the constraint of cerebral blood flow across pressure changes. We compared the use of ABP versus CPP to measure autoregulation in a piglet model of arterial hypotension. ⋯ The use of ABP instead of CPP for autoregulation monitoring in the naïve brain with COx results in a higher threshold value to discriminate ABP above from ABP below the LLA. However, accuracy was similar with the 2 methods. These findings support and refine the use of near-infrared spectroscopy to monitor autoregulation in patients without ICP monitors.
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Anesthesia and analgesia · Jul 2010
Skin collagen synthesis is depressed in patients with severe sepsis.
Skin is an essential barrier in maintaining a stable internal environment. Adequate regenerative capacity is crucial to overcome the homeostatic challenges caused by a septic insult. In sepsis, coagulation and inflammation are activated to restore homeostasis, but it is not known whether sepsis also alters tissue regeneration processes such as skin collagen synthesis. ⋯ Skin collagen synthesis is depressed during severe sepsis and is followed by a compensatory response 3 and 6 months after the onset of sepsis.
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Anesthesia and analgesia · Jul 2010
Correlations between activated clotting time values and heparin concentration measurements in young infants undergoing cardiopulmonary bypass.
Monitoring heparin concentration along with the activated clotting time (ACT) may provide a more accurate guide for the administration of heparin to infants during cardiopulmonary bypass (CPB). However, standard laboratory assays of heparin concentration (antifactor Xa heparin concentration) require plasma instead of whole blood, and results are not immediately available to clinicians. Alternatively, measurements of whole blood heparin concentration may be performed at the bedside using an automated protamine titration device, the Hepcon instrument (Hepcon Hemostasis Management System Plus; Medtronics, Minneapolis, MN). The purpose of this investigation was to compare ACT measurements from 3 commercially available instruments and bedside measurements of whole blood heparin concentration using the Hepcon instrument with laboratory measurements of antifactor Xa plasma heparin concentration in infants younger than 6 months of age undergoing CPB. ⋯ In infants younger than 6 months old undergoing CPB, caution is warranted when using ACT values as the sole indication of adequate heparin anticoagulation. In general, ACT prolongation correlates poorly with plasma heparin concentration. Only i-STAT ACT values showed a moderate correlation when measured immediately before the termination of CPB. Alternatively, bedside measurements of whole blood heparin concentration measured by the Hepcon instrument agreed well with antifactor Xa laboratory measurements. Our data support the clinical utility of bedside measurements of heparin concentration to provide timely, convenient, and accurate measurements of heparin concentration in these infants.