Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2015
A Handy EEG Electrode Set for patients suffering from altered mental state.
Although electroencephalography (EEG) is an important diagnostic tool for investigating patients with unexplained altered mental state (AMS), recording of emergency EEG is not a clinical routine. This is mainly due to the cumbersome electrode solutions. A Handy EEG Electrode Set consists of ten EEG, two EOG, two ground and two commutative reference hydrogel-coated silver wire electrodes attached to a thin polyester carrier film. ⋯ In following 12 cases, the sensitivity and specificity for detecting EEG abnormality based on the Handy EEG Electrode Set recordings were 83 and 100 %, respectively. The Handy EEG Electrode Set proved to be easy to use and to provide valuable information for the neurophysiological evaluation of a patient suffering from AMS. However, further studies with larger number of patients are warranted to clarify the true diagnostic accuracy and applicability of this approach.
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J Clin Monit Comput · Dec 2015
An improvised pressure gauge for regional nerve blockade/anesthesia injections: an initial study.
High injection pressure is one of the warning signs of intraneural injection, with animal models suggesting pressures higher than 69 or 176 kPa as high risk, and is normally detected subjectively and inaccurately. We describe a system improvised from common clinical components that uses Boyle's law to objectively measure injection pressure. The objectives of the study were to (1) Validate our improvised pressure gauge (IPG) by comparing the injection pressure as calculated by Boyle's law against the measured pressure and (2) Use the IPG to measure the range of injection pressures by two groups of anesthetic professionals using the "syringe feel" technique. ⋯ Anesthesiologists exceeded the threshold of 69 kPa in 18 of a total of 60 attempts whereas anesthetic assistants exceeded the threshold in 30 attempts out of 60 attempts. Anesthetic assistants exerted a higher overall pressure of 80 kPa compared to 51 kPa for anesthesiologists-this was statistically significant (p = 0.027). Our improvised system is easily and rapidly assembled from common clinical equipment and shows promise as a monitor for inadvertent intraneural injection.
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J Clin Monit Comput · Dec 2015
Evaluation of near infrared spectroscopy for detecting the β blocker-induced decrease in cerebral oxygenation during hemodilution in a swine model.
β blockers reduce cerebral oxygenation after acute hemodilution and may contribute to the incidence of stroke when used perioperatively. The goal of the study was to investigate whether cerebral tissue oxygenation using near infrared spectroscopy can detect the β blocker-induced decrease in cerebral oxygenation depending on the severity of hemodilution and/or the dose of β blockers. Animals were anesthetized with 2% isoflurane and randomly assigned to a landiolol or esmolol group. ⋯ Landiolol at 40 µg/kg/min was almost equivalent in potency to 200 µg/kg/min esmolol for decreasing HR before hemodilution. Based on the TOI, short-acting β blockers reduced cerebral oxygenation in a dose-dependent manner during hemodilution, and oxygenation returned to the baseline level after drug infusion was stopped. TOI may be useful for identification of a decrease in cerebral oxygenation for patients receiving β blockade during surgery associated with major bleeding.
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J Clin Monit Comput · Oct 2015
Case ReportsTrans-cranial motor evoked potential detection of femoral nerve injury in trans-psoas lateral lumbar interbody fusion.
Trans-psoas lateral lumbar interbody fusion (LLIF) is frequently associated with neurological complications, limiting its value as a less invasive procedure. The routine use of EMG neuromonitoring has been inadequate to detect iatrogenic injuries; significant postoperative deficits have gone undetected by EMG. An effective way to monitor for these intraoperative neurological events is not yet well established. ⋯ These cases contribute to the developing perception that stand-alone EMG nerve monitoring is not adequate for trans-psoas surgery. The addition of MEP may improve the sensitivity of IONM during trans-psoas surgery. Multimodality IONM may offer the opportunity to intervene on evolving iatrogenic nerve injuries, and may reduce the incidence of adverse postoperative findings.
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The primary end point when treating acute shock is to restore blood circulation, mainly by reaching macrocirculatory parameters. However, even if global haemodynamic goals can be achieved, microcirculatory perfusion may remain impaired, leading to cellular hypoxia and organ damage. Interestingly, few methods are currently available to measure the adequacy of organ blood flow and tissue oxygenation. ⋯ Several technologies allow the estimation of CO2 content from different body sites: vascular, tissular (in hollow organs, mucosal or cutaneous), and airway. These tools remain poorly evaluated, and some are used but are not widely used in clinical practice. The present review clarifies the physiology of increasing tissue CO2 during hypoperfusion and underlines the specificities of the different technologies that allow bedside estimation of tissue CO2 content.