Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2017
Comparative StudyEchocardiographic Assessment of Mitral Stenosis Orifice Area: A Comparison of a Novel Three-Dimensional Method Versus Conventional Techniques.
A comprehensive evaluation of mitral stenosis (MS) severity commonly utilizes two-dimensional (2D) echocardiography techniques. However, the complex three-dimensional (3D) structure of the mitral valve (MV) poses challenges to accurate measurements of its orifice area by 2D imaging modalities. We aimed to assess MS severity by comparing measurements of the MV orifice area using conventional echocardiography methods to 3D orifice area (3DOA), a novel echocardiographic technique which minimizes geometric assumptions. ⋯ Novel measures of the stenotic MV 3DOA in patients with rheumatic heart disease are significantly smaller than calculated values obtained by conventional methods and may be consistent with a higher incidence of severe MS compared to 2D techniques. Further investigation is warranted to determine the clinical relevance of 3D echocardiographic techniques used to measure MV area.
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Anesthesia and analgesia · Sep 2017
Interest of Urinary [TIMP-2] × [IGFBP-7] for Predicting the Occurrence of Acute Kidney Injury After Cardiac Surgery: A Gray Zone Approach.
This study assessed the ability of 3-hour postoperative urinary tissue inhibitor of metalloproteinases-2 × insulin-like growth factor binding protein-7 ([TIMP-2] × [IGFBP-7]) to predict postoperative acute kidney injury (AKI) in patients undergoing cardiopulmonary bypass during cardiac surgery. ⋯ In patients undergoing cardiopulmonary bypass during cardiac surgery, urinary [TIMP-2] × [IGFBP-7] could not accurately predict the occurrence of postoperative AKI.
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Anesthesia and analgesia · Sep 2017
Blood Product Utilization Among Trauma and Nontrauma Massive Transfusion Protocols at an Urban Academic Medical Center.
Hospital-wide massive transfusion protocols (MTPs) primarily designed for trauma patients may lead to excess blood products being prepared for nontrauma patients. This study characterized blood product utilization among distinct trauma and nontrauma MTPs at a large, urban academic medical center. ⋯ The majority of initial nontrauma MTP activations did not require a switch to a trauma MTP. Patients remaining under a nontrauma MTP activation were associated with a lower number of transfused and unused plasma and apheresis platelet units. Future studies evaluating the use of hospital-wide nontrauma MTPs are warranted since an MTP designed for nontrauma patient populations may yield a key strategy to optimize blood product utilization in comparison to a universal MTP for both trauma and nontrauma patients.
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Anesthesia and analgesia · Sep 2017
Video-Based Physiologic Monitoring During an Acute Hypoxic Challenge: Heart Rate, Respiratory Rate, and Oxygen Saturation.
The physiologic information contained in the video photoplethysmogram is well documented. However, extracting this information during challenging conditions requires new analysis techniques to capture and process the video image streams to extract clinically useful physiologic parameters. We hypothesized that heart rate, respiratory rate, and oxygen saturation trending can be evaluated accurately from video information during acute hypoxia. ⋯ Video-based monitoring of HR, RR, and oxygen saturation may be performed with reasonable accuracy during acute hypoxic conditions in an anesthetized porcine hypoxia model using standard visible light camera equipment. However, the study was conducted during relatively low motion. A better understanding of the effect of motion and the effect of ambient light on the video photoplethysmogram may help refine this monitoring technology for use in the clinical environment.