Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2020
Ultrasonographic measurement of the ligamentum flavum at different angles in the lateral tilt position.
The aim of this study was to take ultrasonographic measurements of the length of the ligamentum flavum (LF), the LF-skin distance and the interspinous distance, which are critical for the application of neuraxial anaesthesia, with volunteers in the sitting position and with lateral tilt of the operating table at different angles to evaluate whether the target structures in neuraxial anaesthesia can be better visualised with the lateral tilt position and to determine whether or not these measurements change at different angles. The study included 29 volunteers. For the measurements, the operation table was first set into the neutral position and the length of the LF, the skin-LF distance and the interlaminar distance were measured at between L1-S1 spaces with a paramedian oblique sagittal approach with a linear ultrasound probe. ⋯ In the ultrasonographic measurements of the skin-LF distance, at L3-4 and L4-5 intervertebral interspaces, there was a statistically significant increase. With lateral tilt applied to the table, there was determined to be an increase in ultrasonographic measurements of the LF length in the lumbar intervertebral interspaces. Therefore, for neuraxial blocks applied in the sitting position, the procedure may be facilitated with lateral tilt of the operating table.
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J Clin Monit Comput · Aug 2020
Randomized Controlled Trial Comparative StudyComparison between two mathematical methods to estimate arterial occlusion pressure and tourniquet effectiveness in lower limb surgery: a prospective, randomized, double blind, comparative study.
The effectiveness of two different methods for calculating the arterial occlusion pressure (AOP) to set tourniquet inflation pressures were assessed in patients underwent knee arthroscopy. Eighty patients were included in this study. Tourniquet inflation pressure was set by adding 20 mmHg of safety margin above the AOP value which was calculated by either the Tuncali et al. formula or Hong-yun Liu et al. formula. ⋯ Also, there was no significant difference in surgeon rating of the bloodlessness of the surgical field, at the start, middle and end of surgery. Hong-yun Liu et al. mathematical formula was found to be less effective than Tuncali et al. formula to estimate the least effective tourniquet pressure in lower limb surgery and we might consider it invalid to be used in the lower limb. Clinical trials registration number: NCT03706859 (Clinicaltrials.gov) and registration date: January, 2019. https://clinicaltrials.gov/ct2/show/NCT03706859.
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J Clin Monit Comput · Aug 2020
Changes in cerebral and renal oxygenation during laparoscopic pyloromyotomy.
Although a laparoscopic approach may be preferred over open procedures for abdominal surgery, there are limited data on the effect of laparoscopic procedures on cerebral and renal oxygenation in neonates and young infants. Here, we evaluated the effect in neonates and infants. In this two-center prospective observational study, we evaluated changes in cerebral and renal regional oxygen saturation (rSO2) in infants during laparoscopic pyloromyotomy. ⋯ Similarly, the increase in fractional tissue oxygen extraction (FTOE) was only statistically significant for cerebral FTOE (0.18 ± 0.12 to 0.23 ± 0.16, p = 0.037). No change in hemodynamic or respiratory parameters was found. Although there was a decrease in cerebral rSO2 and increase in cerebral FTOE during pneumoperitoneum, the values did not decrease below those noted before anesthetic induction.
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J Clin Monit Comput · Aug 2020
Comparative StudyA comparison of controlled ventilation with a noninvasive ventilator versus traditional mask ventilation.
After induction, but before intubation, many general anesthesia patients are manually bag-mask ventilated. The objective of this study was to determine the efficacy of bag-mask ventilation (MkV) of an anesthetized patient versus mask ventilation using a noninvasive ventilator (NIV). We hypothesized that feedback-controlled, mask ventilation via NIV is more efficacious and safer. ⋯ It can deliver more optimal tidal volumes with the operator utilizing only one hand. The airway pressures are fixed at safe limits during a period where the goal is to reach a maximal level of oxygenation prior to intubation. Over-ventilation or over-pressurization of the airway is not a concern with NIV since the pressures are maintained well within safe thresholds to avoid injury.
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J Clin Monit Comput · Aug 2020
Observational StudyDifferentiation of skin incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram.
Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic trocar insertion, and their difference. ⋯ Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic trocar insertion. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and trocar insertion.