Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2014
Randomized Controlled TrialUse of a decision support system improves the management of hemodynamic and respiratory events in orthopedic patients under propofol sedation and spinal analgesia: a randomized trial.
Decision support systems (DSSs) have been successfully implemented into clinical practice offering clinical suggestions and treatment options with excellent results in various clinical settings. Although their results appeared promising, showing that DSSs can increase anesthesiologists' vigilance and patient safety during surgery, DSSs have never been used before to help anesthesiologists in identifying critical events in patients under spinal analgesia with sedation. We have developed and clinically evaluated a DSS for this specific task. ⋯ The number of critical events/h occurring and the duration of surgery were similar in both groups. The number of hypoxemia episodes was significantly less (P = 0.036) in the DSS group (0.7 ± 1.0 vs. 1.4 ± 2.2 for the Control Group). The DSS tested in this trial could help the clinician to detect and treat critical events more efficiently and in a shorter length of time.
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J Clin Monit Comput · Feb 2014
Randomized Controlled TrialAutomated titration of propofol and remifentanil decreases the anesthesiologist's workload during vascular or thoracic surgery: a randomized prospective study.
Closed loop target-control infusion systems using a Bispectral (BIS) signal as an input (TCI Loop) can automatically maintain intravenous anesthesia in a BIS range of 40-60 %. Our purpose was to assess to what extent such a system could decrease anesthesia workload in comparison to the use of a stand alone TCI system manually adjusted to fit the same BIS range of 40-60 % (TCI Manual). Patients scheduled for elective vascular or thoracic surgery were randomized to the TCI Loop or TCI Manual method for administering propofol and remifentanil during both induction and maintenance of general anesthesia. ⋯ Mean arterial pressure was lower with TCI Manual (78 ± 6 vs. 88 ± 13 mmHg, p < 0.001). The number of times the anesthesiologist watched the controller or BIS monitor (p < 0.05) and the number of manual adjustments (p < 0.001) performed in each group was lower with TCI Loop group during induction and maintenance of anesthesia. An automated controller strikingly frees the anesthesiologist from manual intervention to adjust drug delivery.