Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2013
Randomized Controlled Trial Multicenter StudyGoal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study.
Perioperative hemodynamic optimisation improves postoperative outcome for patients undergoing high-risk surgery (HRS). In this prospective randomized multicentre study we studied the effects of an individualized, goal-directed fluid management based on continuous stroke volume variation (SVV) and stroke volume (SV) monitoring on postoperative outcomes. 64 patients undergoing HRS were randomized either to a control group (CON, n = 32) or a goal-directed group (GDT, n = 32). In GDT, SVV and SV were continuously monitored (FloTrac/Vigileo) and patients were brought to and maintained on the plateau of the Frank-Starling curve (SVV <10 % and SV increase <10 % in response to fluid loading). ⋯ Although not statistically significant, the proportion of patients with at least one complication (46 vs. 62 %), the number of postoperative complications per patient (0.65 vs. 1.40), the maximum sofa score (5.9 vs. 7.2), and the cumulative TISS score (69 vs. 83) tended to be lower. This multicentre study shows that fluid management based on a SVV and SV optimisation protocol is feasible and decreases postoperative wound infections. Our findings also suggest that a goal-directed strategy might decrease postoperative organ dysfunction.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialUltrasound-guided radial arterial cannulation: long axis/in-plane versus short axis/out-of-plane approaches?
Arterial cannulation with ultrasound (US) guidance increases the success rate and reduces complications. US-guided vascular access has two main approaches: long axis in-plane (LA-IP) and short axis out-of-plane (SA-OOP) approaches. The purpose of this study was to compare performance time and possible complications between two techniques. ⋯ Posterior wall damage during arterial cannulation were found in 30 patients with SA-OOP Group (56 %) and 11 patients with LA-IP Group (20 %), (p < 0.05). In our study, the use of LA-IP approach during US-guided radial artery cannulation has higher success rate at first insertion. We also found LA-IP approach results in shorter cannulation time and decreased the incidence of complications.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialOutcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial.
Intraoperative goal directed fluid therapy (GDT) guided by an arterial pressure-based cardiac output system has been reported to improve gastrointestinal (GI) recovery in high-risk patients. This study evaluates the impact of this approach on GI recovery in low to moderate risk patients undergoing major abdominal surgery. IRB approved randomized controlled trial in low to moderate risk adults scheduled for major surgery. ⋯ The GDT group had faster return of GI function (p = 0.004) and higher quality of recovery scores. In low to moderate risk patients undergoing major abdominal surgery, intraoperative GDT guided by SVV optimization was associated with faster restoration of GI recovery and higher quality of recovery scores. These results suggest that outcome benefits related to the use of an intraoperative goal directed fluid protocol guided by SVV are not limited to high-risk patients.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialThe effects of DEX premedication on volatile induction of mask anesthesia (VIMA) and sevoflurane requirements.
We investigated the effect of intravenous premedication with single dose of dexmedetomidine (DEX) on volatile anesthetic induction time and sevoflurane requirements of anesthesia maintenance in adults by monitoring the bispectral index (BIS). Sixty adult patients with status of ASA I-II undergoing general anesthesia with endotracheal intubation were randomly divided into two groups: The first group; a control group (group C, n = 30) and the second group; DEX group (group D, n = 30). Each patient in group D was premedicated with intravenous DEX 0.5 μg/kg or placebo 10 min before the induction of anesthesia. ⋯ Analgesic requirement was noted in postoperative 24 h-period. The time to induction of anesthesia (p < 0.0001) and Etsevoflurane at 1 min (p < 0.05) were significantly lower in group D than in group C. Intravenous premedication with 0.5 μg/kg of DEX decreased the induction time by almost 75 % and provided a significant decrease in Etsevoflurane.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialComposite-, plain-auditory evoked potentials index and bispectral index to measure the effects of sevoflurane.
The composite auditory evoked potentials index (cAAI) uses both cortical electroencephalogram (EEG) and response to auditory stimuli, while the bispectral index (BIS) uses only the cortical EEG and auditory evoked potentials index (AAI) uses only response to auditory stimuli. We expected that the cAAI was more useful to monitor anesthetic effect of sevoflurane than the BIS and AAI. The present study compared the changes of cAAI, AAI, and BIS in different sevoflurane concentration. ⋯ The cAAI had the largest and AAI had the smallest inter-individual variation. In sevoflurane-nitrous oxide anesthesia, cAAI was inferior to AAI and BIS to discriminate different anesthetic effect. The cAAI had larger inter-individual variation than the AAI and BIS.