British journal of anaesthesia
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During anaesthesia monitoring is used as part of a complex feedback-control system to keep the patient in a safe physiological 'envelope' and so is central to the conduct of a modern anaesthetic. The utility of basic monitoring is universally acknowledged and will never be assessed using randomized controlled trials. However, each time a new monitoring device is introduced, it can be assessed to see if it adds to the safety and effectiveness of anaesthetics. This review highlights some of the studies that have assessed new monitors in anaesthesia, critical care, and other areas of acute care.
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Cerebral microdialysis is a well-established laboratory tool that is increasingly used as a bedside monitor to provide on-line analysis of brain tissue biochemistry during neurointensive care. This review describes the principles of cerebral microdialysis and the rationale for its use in the clinical setting, including discussion of the most commonly used microdialysis biomarkers of acute brain injury. Potential clinical applications are reviewed and future research applications identified. Microdialysis has the potential to become an established part of mainstream multi-modality monitoring during the management of acute brain injury but at present should be considered a research tool for use in specialist centres.
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Alarms are used in many clinical applications, but they are often less than optimal because the design and implementation of alarms has not always taken the cognitive capacity and processing mechanisms of the user into account. As a result alarms are frequently too loud, irritating, confusing, badly designed, and too numerous, resulting in them often being turned off and hindering, rather than enhancing, task performance. ⋯ In each area some background is given and the implications for alarm design and implementation outlined. The conclusion is that there are some indications that alarm design and implementation takes account of relevant research data, but that there is still some way to go before these findings are fully integrated and the situation is improved upon further.
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Perioperative risk of death after general surgery is quoted as overall less than 1%. However, each individual's risk varies widely according to many identified factors with some having a significantly increased risk of a worse outcome. ⋯ This may be in part because of a lack of experience with the practicalities of perioperative optimization, and lack of knowledge in applying currently available tools. This article aims to try and address this deficit and increase awareness of how and when to utilize monitoring equipment to achieve optimal results for the patients we treat.
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Review Randomized Controlled Trial
Ondansetron does not reduce the shivering threshold in healthy volunteers.
Ondansetron, a serotonin-3 receptor antagonist, reduces postoperative shivering. Drugs that reduce shivering usually impair central thermoregulatory control, and may thus be useful for preventing shivering during induction of therapeutic hypothermia. We determined, therefore, whether ondansetron reduces the major autonomic thermoregulatory response thresholds (triggering core temperatures) in humans. ⋯ /b>. Ondansetron appears to have little potential for facilitating induction of therapeutic hypothermia.