Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2019
Optimizing intraoperative administration of propofol, remifentanil, and fentanyl through pharmacokinetic and pharmacodynamic simulations to increase the postoperative duration of analgesia.
Titrating an intraoperative anesthetic to achieve the postoperative goals of rapid emergence and prolonged analgesia can be difficult because of inter-patient variability and the need to provide intraoperative sedation and analgesia. Modeling pharmacokinetics and pharmacodynamics of anesthetic administrations estimates drug concentrations and predicted responses to stimuli during anesthesia. With utility of these PK/PD models we created an algorithm to optimize the intraoperative dosing regimen. ⋯ To dosing regimen from clinical scenario 2 greatly increased the fentanyl dosing regimen and greatly decreased the remifentanil infusion rate with no change to the propofol infusion rate. The results from this preliminary analysis of the optimization algorithm appear to imply that it can operate as intended. However a clinical study is warranted to determine to what extent the optimization algorithm determined optimal dosing regimens can maximize the postoperative duration of analgesia without delaying the time to emergence in a clinical setting.
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J Clin Monit Comput · Dec 2019
Evaluation and application of a method for estimating nasal end-tidal O2 fraction while administering supplemental O2.
This paper describes a method for estimating the oxygen enhanced end-tidal fraction of oxygen (FetOe), the end-tidal fraction of oxygen (FetO2) that is raised by administering supplemental oxygen. The paper has two purposes: the first is to evaluate the method's accuracy on the bench and in volunteers; the second purpose is to demonstrate how to apply the method to compare two techniques of oxygen administration. The method estimates FetOe by analyzing expired oxygen as oxygen washes out of the lung. ⋯ This paper has demonstrated that the method estimates FetO2 enhanced by administering supplemental oxygen with clinically insignificant differences. This paper has also shown that PFO can obtain FetO2 similar to CFO using approximately one-third of the oxygen volume. After evaluating this method, we conclude that the method provides useful estimates of nasal FetO2 enhanced by supplemental oxygen administration.
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J Clin Monit Comput · Dec 2019
Letter Case ReportsBilateral erector spinae plane block with single injection.
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J Clin Monit Comput · Dec 2019
Clinical TrialSynchronized mandibular movement and capnography: a novel approach to obstructive airway detection during procedural sedation-a post hoc analysis of a prospective study.
Perioperative complications related to obstructive sleep apnea still occur despite the use of partial pressure end-tidal CO2[Formula: see text] and pulse oximetry. Airway obstruction can complicate propofol sedation and a novel monitor combining mandibular movement analysis with capnography may facilitate its detection. Patients scheduled for sleep endoscopy were recruited and monitored with standard monitoring, [Formula: see text] and Jaw Activity (JAWAC) mandibular movement sensors. ⋯ The RESDA algorithm, which is based on the combination of capnography with mandibular movement assessment of respiratory effort, can more rapidly alarm anesthetists of airway obstruction during propofol sedation than [Formula: see text] alone. However, [Formula: see text] pulse oximetry, and clinical monitoring are still required. Trial Registry numbers: ClinicalTrial.gov (NCT02909309) https://clinicaltrials.gov/ct2/show/NCT02909309 .