Journal of clinical monitoring and computing
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J Clin Monit Comput · May 2021
Randomized Controlled TrialEffects of intraoperative positive end-expiratory pressure optimization on respiratory mechanics and the inflammatory response: a randomized controlled trial.
Applying lung protective mechanical ventilation (LPV) during general anaesthesia even in patients with non-injured lungs is recommended. However, the effects of an individual PEEP-optimisation on respiratory mechanics, oxygenation and their potential correlation with the inflammatory response and postoperative complications have not been evaluated have not been compared to standard LPV in patients undergoing major abdominal surgery. Thirty-nine patients undergoing open radical cystectomy were enrolled in this study. ⋯ Intraoperative PEEP-optimization resulted in significant improvement in gas exchange and pulmonary mechanics as compared to standard LPV. Whether these have any effect on short and long term outcomes require further investigations. Trial registration: Clinicaltrials.gov, identifier: NCT02931409.
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J Clin Monit Comput · Apr 2021
Randomized Controlled TrialPhotoplethysmography-derived approximate entropy and sample entropy as measures of analgesia depth during propofol-remifentanil anesthesia.
The ability to monitor the physiological effect of the analgesic agent is of interest in clinical practice. Nonstationary changes would appear in photoplethysmography (PPG) during the analgesics-driven transition to analgesia. The present work studied the properties of nonlinear methods including approximate entropy (ApEn) and sample entropy (SampEn) derived from PPG responding to a nociceptive stimulus under various opioid concentrations. ⋯ The result showed that low Ceremi (0 and 1 ng·ml-1) could be differentiated from high Ceremi (3 and 5 ng·ml-1) by ApEn and SampEn. Depending on the coefficient employed in algorithm: ApEn with k = 0.15 yielded the largest PK value (0.875) whereas SampEn gained its largest PK of 0.867 with k = 0.2. Thus, PPG-based ApEn and SampEn with appropriate k values have the potential to offer good quantification of analgesia depth under general anesthesia.
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J Clin Monit Comput · Apr 2021
Randomized Controlled TrialThe effect of audiovisual distraction on patient-controlled sedation under spinal anesthesia: a prospective, randomized trial.
Audiovisual distraction (AVD) has been used to augment or replace procedural sedation. We investigated whether AVD in patients having total hip (THA) or total knee arthroplasty (TKA) under spinal anesthesia would reduce self-administered propofol consumption during surgery. 50 participants were randomized equally into a patient-controlled sedation (PCS) group or AVD group. All participants were given a spinal block and a propofol PCS device prior to surgery. ⋯ Historical clinician-controlled usage of propofol demonstrated a median of 39.3 mcg/kg/min (29.2-51.2). There were few differences in the secondary outcome measures. The use of AVD did not reduce patient-controlled propofol consumption in patients having a THA or TKA surgery under spinal anesthesia.
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J Clin Monit Comput · Apr 2021
Randomized Controlled Trial Observational StudyA randomized controlled study on the visual grading of the glottis and the hemodynamics response to laryngoscopy when using I-View and MacGrath Mac videolaryngoscopes in super obese patients.
Videolaryngoscopes improve visualization of glottic in morbidly obese patients. Super-obesity is one of the risk factors influencing probability of difficult mask ventilation and difficult intubation. Super-obese (BMI > 50 kg/m2) patients should be intubated either with fiberscope awake intubation or with video laryngoscopes. ⋯ The POGO score was better for McGrath Mac than for I-view videolaryngoscope, however, both devices allowed for safe and effective intubation in super-obese patients. The hemodynamic response to videolaryngoscopy was similar between devices.
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J Clin Monit Comput · Feb 2021
Randomized Controlled TrialReverse Trendelenburg position applied prior to pneumoperitoneum prevents excessive increase in optic nerve sheath diameter in laparoscopic cholecystectomy: randomized controlled trial.
The aim of this randomized controlled trial was to determine whether applying the reverse Trendelenburg position before pneumoperitoneum has a preventive effect on increased intracranial pressure using optic nerve sheath diameter (ONSD) measurement as a noninvasive parameter. Seventy-nine patients were allocated to two groups according to whether pneumoperitoneum was applied in the supine position (group S, n = 40) or in the reverse Trendelenburg position (group RT, n = 39). The ONSD was measured at the following time points: T0: before anesthesia; T1: after endotracheal intubation; T2: after pneumoperitoneum in group S and after positioning in group RT; T3: after positioning in group S and after pneumoperitoneum in group RT; T4: 30 min after endotracheal intubation, and T5: after desufflation. ⋯ The number of patients with nausea was higher in group S (p = 0.027). The present study demonstrates that applying the reverse Trendelenburg position before pneumoperitoneum prevented an increase in the ONSD in patients undergoing laparoscopic cholecystectomy. Trial registration The trial was registered prior to patient enrollment at https://register.clinicaltrials.gov (NCT04224532, Date of the registration: January 8, 2020).