Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2016
Case ReportsPermanent upper trunk plexopathy after interscalene brachial plexus block.
Interscalene brachial plexus block (IBPB) has been widely used in shoulder surgical procedures. The incidence of postoperative neural injury has been estimated to be as high as 3 %. We report a long-term neurologic deficit after a nerve stimulator assisted brachial plexus block. ⋯ Severe brachial plexopathy was probably due to a local anesthetic having been administrated through the perineurium and into the nerve fascicles. Severe brachial plexopathy is an uncommon but catastrophic complication of IBPB. We propose a clinical algorithm using ultrasound guidance during nerve blocks as a safer technique of regional anesthesia.
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J Clin Monit Comput · Feb 2016
ReviewJournal of Clinical Monitoring and Computing 2015 end of year summary: anesthesia.
Clinical monitoring is an essential part of the profession of anesthesiology. It would therefore be impossible to review all articles published in the Journal of Clinical Monitoring and Computing that are relevant to anesthesia. Because other reviews will address monitoring of the respiratory and cardiovascular system, the current review will limit itself to topics uniquely related to anesthesia. The topics are organized according to the chronological order in which an anesthetic proceeds: secure the airway; ventilate and deliver anesthetic gases; monitor vital organ function and anesthetic depth; and ensure analgesia during/after emergence from anesthesia (locoregional anesthesia and pain control).
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J Clin Monit Comput · Feb 2016
Transient stop-flow arm arterial-venous equilibrium pressure measurement: determination of precision of the technique.
Transient stop-flow arm arterial-venous equilibrium pressure (Pmsf-arm) is a validated technique for measuring the mean systemic filling pressure (Pmsf). Pmsf is a functional measure of the effective intravascular volume status. This study aims to assess the precision of the Pmsf-arm measurement. ⋯ Averaging two, three and four measurements the CE improves to 4 % (±1 %), 3 % (±1 %) and 3 % (±1 %) respectively, and the LSC was reduced to 10 % (±4 %), 8 % (±3 %) and 7 % (±3 %) respectively. One measurement of Pmsf-arm can reliably detect changes on Pmsf-arm of 14 %. The precision of Pmsf-arm technique improves when averaging two or three measurements.
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J Clin Monit Comput · Feb 2016
In-line positioning of ultrasound images using wireless remote display system with tablet computer facilitates ultrasound-guided radial artery catheterization.
Ultrasound-guided procedures may be easier to perform when the operator's eye axis, needle puncture site, and ultrasound image display form a straight line in the puncture direction. However, such methods have not been well tested in clinical settings because that arrangement is often impossible due to limited space in the operating room. We developed a wireless remote display system for ultrasound devices using a tablet computer (iPad Mini), which allows easy display of images at nearly any location chosen by the operator. ⋯ Success rate was significantly higher (100 vs. 70 %, P = 0.02) and catheterization time significantly shorter (28.5 ± 7.5 vs. 68.2 ± 14.3 s, P < 0.001) with the tablet method as compared to the conventional method. An ergonomic straight arrangement of the image display is crucial for successful and quick completion of ultrasound-guided arterial catheterization. The present remote display system is a practical method for providing such an arrangement.
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J Clin Monit Comput · Feb 2016
Evaluation of the Microstat™ sublingual PCO2 monitor in ambulatory patients.
Physicians often need to measure arterial PCO2 in clinical practice. Arterial blood gas sampling is typically available only in hospitals and may be unpleasant for patients. Minimally invasive techniques for measuring PCO2 offer the potential for overcoming these limitations. ⋯ The MicroStat sublingual PCO2 monitor over-estimates arterial PCO2 with wide limits of agreement. Test-retest repeatability was poor. Use of sublingual PCO2 monitoring with the MicroStat monitor cannot currently replace blood gas sampling.