Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2023
Review Meta AnalysisConfirming identification of the epidural space: a systematic review of electric stimulation, pressure waveform analysis, and ultrasound and a meta-analysis of diagnostic accuracy in acute pain.
To review the use of epidural electric stimulation test, pressure waveform analysis, and ultrasound assessment of injection as bedside methods for confirming identification of the epidural space in adults with acute pain, the PubMed database was searched for relevant reports between May and August 2022. Studies reporting diagnostic accuracy with conventional Touhy needles and epidural catheters were further selected for meta-analysis. Sensitivity and specificity were estimated using univariate logistic regression for electric stimulation and pressure analysis, and pooling of similar studies for ultrasound. ⋯ Risk of bias was significant and accuracy estimates must be interpreted with caution. Electric stimulation and pressure waveform analysis seem clinically useful, although they must be interpreted cautiously. In the future, clinical trials in patients with difficult anatomy will likely be most useful. Ultrasound requires further investigation.
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J Clin Monit Comput · Dec 2023
ReviewOptical crosstalk and other forms of light interference in pulse oximeter comparison studies.
Pulse oximeter accuracy is important for the quality and safety of patient care. Methodological errors occurring during pulse oximeter accuracy studies can confound results. One potential source of error during pulse oximeter comparison studies is optical interference due to sensor-to-sensor crosstalk. Optical crosstalk can occur whenever pulse oximeter sensors are tested in close proximity of one another, as occurs during pulse oximeter comparison studies. ⋯ Crosstalk and other forms of optical interference can corrupt pulse oximeter readings. Proper sensor placement and use of optical shielding of sensors are crucial steps to help protect the integrity of the data. Studies to further characterize crosstalk during pulse oximeter comparison studies are needed.
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J Clin Monit Comput · Dec 2023
Randomized Controlled Trial Observational StudyComparison of the effects of dexmedetomidine and propofol on the cardiovascular autonomic nervous system during spinal anesthesia: preliminary randomized controlled observational study.
Spinal anesthesia induces sympatholysis and is usually combined with dexmedetomidine or propofol which induce different hemodynamic changes. The purpose of this study was to compare the effect on autonomic nervous system between dexmedetomidine and propofol combined with spinal anesthesia. Patients aged 20-65 undergoing elective surgery under spinal anesthesia were randomly assigned to dexmedetomidine or propofol group. ⋯ The LF/HF ratio decreased in the dexmedetomidine group at T3. Dexmedetomidine showed slower heart rate and higher blood pressure than propofol when combined with spinal anesthesia, however, dexmedetomidine and propofol exhibited similar trends in HRV dynamics. Compared with the baseline within each group, both agents decreased LF, but only dexmedetomidine increased HF and decreased in the LF/HF ratio significantly.
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Perioperative medicine is changing, and its goals are expanding. More and more attention is paid to the surgical experience and the patient's quality of life. ⋯ However, creating perioperative programs capable of integrating traditional perioperative data with these scales is not easy. New technologies, particularly artificial intelligence, thanks to their ability to recognise, interpret, process or simulate human feelings, emotions and moods, could provide the necessary tools to combine all perioperative aspects, placing the patients and their needs at the centre of the process.
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J Clin Monit Comput · Dec 2023
Randomized Controlled TrialComparative analysis of signal accuracy of three SpO2 monitors during motion and low perfusion conditions.
To compare pulse oximetry performance during simulated conditions of motion and low perfusion in three commercially available devices: GE HealthCare CARESCAPE ONE TruSignal SpO2 Parameter, Masimo RADICAL-7 and Medtronic Nellcor PM1000N. After IRB approval, 28 healthy adult volunteers were randomly assigned to the motion group (N = 14) or low perfusion (N = 14) group. Pulse oximeters were placed on the test and control hands using random assignment of digits 2-5. ⋯ SpO2 measurement accuracy degraded for all three devices during motion as compared to non-motion. Accuracy also degraded during normal to low, very low, or ultra low perfusion and was more pronounced compared to the changes observed during simulated motion. While some statistically significant differences in individual measurements were found, the clinical relevance of these differences requires further study.