Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2018
Effects of indigo carmine intravenous injection on oxygen reserve index (ORi™) measurement.
To retrospectively investigate the effects of indigo carmine intravenous injection on oxygen reserve index (ORi™) in 20 patients who underwent elective gynecologic surgery under general anesthesia. The study subjects were patients who underwent elective gynecologic surgery under general anesthesia between April 2016 and January 2017, and were administered a 5-ml intravenous injection of 0.4% indigo carmine for clinical purposes during surgery with ORi monitoring. Changes in ORi within 20 min after indigo carmine injection were observed. ⋯ The median lowest value of ORi was 0 (range 0-0.16) and the median time to reach the lowest value of ORi was 2 min (range 1-4 min) after injection. ORi values returned to pre-injection levels within 20 min in 13 of 19 patients, and the median time to return to pre-injection levels was 10 min (range 6-16 min) after injection. During ORi monitoring it is necessary to consider the rapid reduction in ORi after intravenous injection of indigo carmine.
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J Clin Monit Comput · Aug 2018
Observational StudyNon-invasive blood pressure monitoring with an oscillometric brachial cuff: impact of arrhythmia.
Arrhythmia-induced beat-to-beat variability of blood pressure (BP) is deemed to hinder the reliability of non-invasive oscillometric measurements (NIBP) but few data support this belief. We assessed the impact of arrhythmia on a NIBP device never tested for this purpose. We compared, in intensive care unit patients with and without arrhythmia, the agreement between three pairs of NIBP (Infinity™ Delta monitor, Dräger medical systems) and invasive readings. ⋯ The detection of hypotension (systolic invasive BP < 90 mmHg or mean invasive BP < 65 mmHg) or hypertension (systolic invasive BP > 140 mmHg) by NIBP was similar during arrhythmia and regular rhythm [areas under the receiver operating characteristic curves (AUCROC) of 0.88-0.92, p > 0.13]. The detection of a 10% increase in mean invasive BP after cardiovascular intervention was also associated with similar AUCROCs between the two groups. Provided that triplicates are averaged, the agreement between NIBP measured with the tested device and invasive measurements was not worse during arrhythmia than during regular rhythm.
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J Clin Monit Comput · Aug 2018
Usefulness of oxygen reserve index (ORi™), a new parameter of oxygenation reserve potential, for rapid sequence induction of general anesthesia.
The oxygen reserve index (ORi™) is a new parameter for monitoring oxygen reserve noninvasively. The aim of this study was to examine the usefulness of ORi for rapid sequence induction (RSI). Twenty adult patients who were scheduled for surgical procedures under general anesthesia were enrolled. ⋯ There was an SpO2 decline of 1% or more from the peak value after propofol administration in 13 patients, and 32.5 s (IQR 18.8-51.3) before the SpO2 decrease, ORi began to decline in 10 of the 13 (77%) patients. The ORi trends enable us to predict oxygenation reduction approximately 30 s before SpO2 starts to decline. By monitoring ORi, the incidence related to hypoxemia during RSI could be reduced.
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As the clinical advantages of vapor anesthesia (VA) for sedation of patients in ICU become more apparent, the ergonomics, economy and safety issues need to be better addressed. Here we describe the use of a new commercial digital in-line anesthetic vaporizer that can be attached to the inspiratory limb of a ventilator. If used with a simple, and easily assembled secondary circuit and anesthetic reflector, the circuit remains remote from the patient, the VA consumption approaches a physical minimum, VA level is controlled and monitored, and the tidal volume size is not limited.
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Inhaled anesthetics have been utilized mostly for general anesthesia in the operating room and oftentimes for sedation and for treatment of refractory status epilepticus and status asthmaticus in the intensive care unit. These contexts in the ICU setting are related to potential for prolonged administration wherein potential organ toxicity is a concern. ⋯ High dose inhaled agents are associated with postoperative cognitive dysfunction (POCD) and other situations. However, thus far no strong indication of problematic neuro or organ toxicity has been demonstrated after prolonged use of low dose volatile anesthesia.