Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2022
Memsorb™, a novel CO2 removal device part I: in vitro performance with the Zeus IE®.
Soda lime-based CO2 absorbents are safe, but not ideal for reasons of ecology, economy, and dust formation. The Memsorb™ is a novel CO2 removal device that uses cardiopulmonary bypass oxygenator technology instead: a sweep gas passes through semipermeable hollow fibers, adding or removing gas from the circle breathing system. We studied the in vitro performance of a prototype Memsorb™ used with a Zeus IE® anesthesia machine when administering sevoflurane and desflurane in O2/air mixtures. ⋯ To avoid FIO2 deviating substantially from the O2 concentration in the fresh gas, the O2 concentration in the fresh gas and sweep gas should match. Compared to the use of Ca(OH)2 based CO2 absorbent, inhaled agent waste is increased. The device is most likely to find its use integrated in closed loop systems.
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J Clin Monit Comput · Dec 2022
Randomized Controlled TrialThe effect of head position on glottic visualization with video laryngoscope and intubation success in obese patients who are not expected to have a difficult airway: a prospective randomized clinical study.
Intubation is required to maintain anesthesia in patients who are planned to undergo surgery under general anesthesia. One of the most important steps for successful intubation is to position head and neck appropriately. Sniffing position, head extension position, and neutral head position are the most known and used head and neck positions. ⋯ IDS score was found to be statistically significantly higher in the neutral head position compared to the other positions (p < 0.001, p < 0.001, respectively). In addition, the IDS score was statistically significantly higher in head extension position than in sniffing position (p = 0.016). This study is a randomized controlled trial of 150 patients investigating the impact of head position on glottic visualization and intubation success in obese patients when using Macintosh-like VL. The results show that sniffing position may be favored.
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J Clin Monit Comput · Dec 2022
Prospective validation of gas man simulations of sevoflurane in O2/air over a wide fresh gas flow range.
The use of inhaled anesthetics has come under increased scrutiny because of their environmental effects. This has led to a shift where sevoflurane in O2/air has become the predominant gas mixture to maintain anesthesia. To further reduce environmental impact, lower fresh gas flows (FGF) should be used. ⋯ During the first 15 min, MDPE and MDAPE were 7% [- 6, 28] and 13% [6, 32], respectively, and during the last 45 min - 1% [- 5, 5] and 5% [2, 9], respectively. In conclusion, Gas Man® predicts FETsevo in O2/air in adults over a wide range of FGF and vaporizer settings using different workstations with both MDPE and MDAPE < 10% during the first hour of anesthesia, with better relative performance for simulating maintenance than wash-in. In the authors' opinion, this degree of performance suffices for Gas Man® to be used to quantify the environmental impact of FGF reduction in real life practice of the wash-in and maintenance period combined.
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J Clin Monit Comput · Dec 2022
Validation of the Masimo O3™ regional oximetry device in pediatric patients undergoing cardiac surgery.
We assessed the accuracy of Masimo O3™ regional cerebral oxygen saturation (rSO2) readings by comparing them with reference values and evaluated the relationship between rSO2 and somatic tissue oxygen saturation (StO2) in children undergoing cardiac surgery. After anesthesia induction, pediatric sensors were applied to the forehead and foot sole, and rSO2 and StO2 values were monitored continuously. Before cardiopulmonary bypass (CPB), FIO2 was set to 0.2, 0.5, and 0.8 serially every 15 min. ⋯ According to multiple linear regression analysis, the application of CPB, FIO2, Hb level, and tip location of the central venous catheter influenced the bias (all P < 0.05). Furthermore, the correlation between rSO2 and StO2 was weak (r = 0.254). rSO2 readings by the Masimo O3™ device and pediatric sensor had good absolute and trending accuracies with respect to the calculated reference values in children undergoing cardiac surgery. rSO2 and StO2 cannot be used interchangeably. Clinical trial registration http://clinicaltrials.gov (number: NCT04208906).
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J Clin Monit Comput · Dec 2022
Review Case ReportsIntraoperative recording of laryngeal adductor reflex and cortical motor evoked potentials during jugular foramen schwannoma surgery: a case report and literature review.
Schwannoma, a tumor originating from the peripheral nervous system, may arise from the vagus nerve, although it is not very often. Injury of the vagus nerve by surgical attempts may have consequences that will seriously affect the patient's quality of life. In recent years, continuous monitoring of the laryngeal adductor reflex (LAR) has become a promising methodology for evaluating vagus nerve function intraoperatively. We refer to our experience changing our surgical strategy due to concurrent deterioration in LAR and CoMEPs intraoperatively. We also provide a literature review and summarize the current knowledge of this technique. ⋯ We conclude that LAR with vagal nerve CoMEPs are two complementary methods and provide reliable information about the functional status of the vagus nerve during surgery.