Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2014
Comparative StudyElevated preoperative blood pressure predicts the intraoperative loss of SSEP neuromonitoring signals during spinal surgery.
Intraoperative neuromonitoring of somatosensory evoked potentials (SSEPs) can allow identification of evolving neurologic deficit. However, SSEP deterioration is not always associated with postoperative deficit. Transient physiologic changes, including a decrease in blood pressure (BP), can result in signal deterioration, defined as a decrease in waveform amplitude of[50 %seen without neurologic deficit. ⋯ While the presence of preoperative elevated BP predicts SSEP abnormality (p = 0.0039), a diagnosis of hypertension does not. Elevated BP, not a hypertension diagnosis, is associated with intraoperative loss of SSEP signals. This effect of elevated BP on SSEPs may be due to the larger associated intraoperative BP decline.
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J Clin Monit Comput · Apr 2014
Controlled Clinical TrialEnd-tidal versus manually-controlled low-flow anaesthesia.
During low-flow manually-controlled anaesthesia (MCA) the anaesthetist needs constantly adjust end-tidal oxygen (EtO2) and anaesthetic concentrations (EtAA) to assure an adequate and safe anaesthesia. Recently introduced anaesthetic machines can automatically maintain those variables at target values, avoiding the burden on the anaesthetist. End-tidal-controlled anaesthesia (EtCA) and MCA provided by the same anaesthetic machine under the same fresh gas flow were compared. ⋯ In MCA patients the number of manual adjustments to stabilize EtAA and EtO2 were 137 and 107, respectively; no adjustment was required in EtCA. Low-flow anaesthesia delivered with an anaesthetic machine able to automatically control EtAA and EtO2 provided the same clinical stability and avoided the continuous manual adjustment of delivered sevoflurane and oxygen concentrations. Hence, the anaesthetist could dedicate more time to the patient and operating room activities.