Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2023
Comparative StudyA comparison of the NeurOs® and the INVOS 5100C® cerebral oximeter during variations of the partial pressure of carbon dioxide and fractional inspiratory concentration of oxygen.
This prospective method comparison study compared cerebral oxygen saturation (ScO2) measurement performance of the new cerebral oximeter (NeurOs®, Mespere LifeSciences, Ontario, Canada) in comparison to the established INVOS 5100C® (Medtronic, Boulder, USA) cerebral oximeter. We performed measurements during different levels of carbon dioxide pressure (PaCO2) during hyper- and hypoventilation and different levels of arterial oxygen saturation (SaO2) induced by variation of the inspiratory fraction of oxygen (FiO2). 59 anesthetized cardiac and vascular surgical patients were studied during hemodynamically stable conditions. Two versions of the NeurOs® oximeter were used in 39 and 20 patients, respectively: an older version with one bi-hemispherical sensor attached to the midline of the forehead and a newer version with two sensors that were attached to the left and right forehead. ⋯ The ScO2 measurement performance of the NeurOs® cerebral oximeter is not interchangeable with the INVOS® cerebral oximeter during variations of ventilation and oxygenation in elective cardiac or vascular surgical patients. The lack of reactivity to changes in ventilation (by variation of PaCO2) and oxygen delivery (by variation of FiO2) question the reliability of NeurOs® measurements to reflect changes in cerebral blood flow and cerebral oxygen balance. This holds true not only for different sensor positions at the forehead but also for different modes of penetration.
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J Clin Monit Comput · Jun 2023
Letter Case ReportsStimulation artefact on EEG trace with BIS monitoring during D-wave recording.
The D-wave reflects the corticospinal fibre potentials and is frequently recorded intraoperatively for intramedullary spinal tumours to ensure maximum safe resection. A 38-year-old male had an intramedullary spinal cord tumour surgically removed while being monitored with D-wave from a single distal electrode technique. ⋯ Regular spike artefacts were observed in the EEG signal recorded by the BIS® monitor during the application of the single-pulse transcranial electrical stimulus and were used as a visual indicator of stimulus delivery. Finally, we propose a novel method of confirming stimulus delivery during D-wave recording based on stimulation artefacts in the EEG signal recorded by the BIS® monitor.
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J Clin Monit Comput · Jun 2023
Sevoflurane consumption pattern by individual anaesthesiologists varies widely despite using the same high-end workstations in the same hospital.
Volatile anaesthetics are potent greenhouse gasses but contemporary workstations enable considerable savings while improving patient safety. Institutions may provide this technology to reduce the ecological footprint but proper training and motivation is required to maximize their ecologic and financial benefit. This study aims to compare the sevoflurane consumption of 22 anaesthesiologists in a medium sized hospital 4 years after flow-i workstations (Getinge, Sweden) entered into service, in three airway approaches: intubated patients, laryngeal mask ventilation, and mask anaesthesia. ⋯ The typical CO2 equivalent emissions (GWP20) per anaesthesiologist varied between 8.0 and 19.6 kg/45 min in intubated airways, between 7.9 and 16.3 kg/45 min in LMA, and between 3.6 and 22.3 kg/8 min in mask ventilation. Despite using the same workstations in the same hospital, the typical sevoflurane consumption differed dramatically between 22 anaesthesiologists. In addition to providing advanced workstations, proper education is required to achieve the behavior change needed to reduce the pollution and financial waste associated with volatile anaesthetics.
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J Clin Monit Comput · Jun 2023
Intradural extramedullary tumor location in the axial view affects the alert timing of intraoperative neurophysiologic monitoring.
Intraoperative neurophysiologic monitoring (IONM) reportedly helps prevent postoperative neurological complications following high-risk spinal cord surgeries. There are negative and positive reports about using IONM for intradural extramedullary (IDEM) tumors. We investigated factors affecting alerts of IONM in IDEM tumor surgery. ⋯ Alert is probably triggered during tumor resection for anterolaterally located tumors. Alerts during tumor resection procedures were more likely to be rescued than other procedures in IDEM tumor surgery.
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J Clin Monit Comput · Jun 2023
Clinical TrialChanges of the nociceptive flexion reflex threshold in patients undergoing cardiac surgery-a prospective clinical pilot study.
Opioid dosage for general anaesthesia and sedation relies on surrogate parameters such as heartrate and blood pressure. This implies the risk of both under- and overdosing. A promising tool to provide target-oriented opioid dosing is measuring the nociceptive flexion reflex threshold (NFRT). ⋯ Unless measurements are not prevented by technical issues NFRT-assessment appears to be a future tool to target analgesics in patients not able to self-report pain. Trial registration Study registration: DRKS00021617. https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID=DRKS00021617 (registered retrospectively).