Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2013
Usefulness of perfusion index to detect the effect of brachial plexus block.
The traditional method to evaluate adequacy of the block for surgery is based on loss of sensory response to stimuli, which requires patient cooperation. Several methods have been described for objective assessment of the nerve block. The aim of the study was to investigate whether perfusion index (PI), a measure of peripheral perfusion from a pulse oximetry finger sensor, is a reliable and objective method for assessing the adequacy of infraclavicular blockade and to describe the time course of PI changes once peripheral nerve block has been achieved during surgery. ⋯ The perfusion index is a predictor of infraclavicular block success. The largest changes in PI occur 30 min after the block administration but significant changes in PI were detected 10 min after administration. Perfusion index monitoring may provide a highly valuable tool to quickly evaluate the success of regional anesthesia of the upper extremity in clinical practice.
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J Clin Monit Comput · Jun 2013
Randomized Controlled Trial Multicenter StudyGoal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study.
Perioperative hemodynamic optimisation improves postoperative outcome for patients undergoing high-risk surgery (HRS). In this prospective randomized multicentre study we studied the effects of an individualized, goal-directed fluid management based on continuous stroke volume variation (SVV) and stroke volume (SV) monitoring on postoperative outcomes. 64 patients undergoing HRS were randomized either to a control group (CON, n = 32) or a goal-directed group (GDT, n = 32). In GDT, SVV and SV were continuously monitored (FloTrac/Vigileo) and patients were brought to and maintained on the plateau of the Frank-Starling curve (SVV <10 % and SV increase <10 % in response to fluid loading). ⋯ Although not statistically significant, the proportion of patients with at least one complication (46 vs. 62 %), the number of postoperative complications per patient (0.65 vs. 1.40), the maximum sofa score (5.9 vs. 7.2), and the cumulative TISS score (69 vs. 83) tended to be lower. This multicentre study shows that fluid management based on a SVV and SV optimisation protocol is feasible and decreases postoperative wound infections. Our findings also suggest that a goal-directed strategy might decrease postoperative organ dysfunction.
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J Clin Monit Comput · Jun 2013
Review Historical ArticleIs pulse oximetry an essential tool or just another distraction? The role of the pulse oximeter in modern anesthesia care.
Since the discovery of anesthetic agents, patient monitoring has been considered one of the core responsibilities of the anesthesiologist. As depicted in Robert Hinckley's famous painting, The First Operation with Ether, one observes William Thomas Green Morton carefully watching over his patient. Since its founding in 1905, 'Vigilance' has been the motto of the American Society of Anesthesiologists (ASA). ⋯ This article reviews the available evidence for pulse oximetry. Further, it discusses contemporary issues, events, and perceptions that may help to explain how and why pulse oximetry may have been adopted as a standard of care despite the lack of supportive. Lastly, it discusses less obvious benefits of pulse oximetry that may have further implications on the future of anesthesia care and perhaps even automated anesthesia.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialUltrasound-guided radial arterial cannulation: long axis/in-plane versus short axis/out-of-plane approaches?
Arterial cannulation with ultrasound (US) guidance increases the success rate and reduces complications. US-guided vascular access has two main approaches: long axis in-plane (LA-IP) and short axis out-of-plane (SA-OOP) approaches. The purpose of this study was to compare performance time and possible complications between two techniques. ⋯ Posterior wall damage during arterial cannulation were found in 30 patients with SA-OOP Group (56 %) and 11 patients with LA-IP Group (20 %), (p < 0.05). In our study, the use of LA-IP approach during US-guided radial artery cannulation has higher success rate at first insertion. We also found LA-IP approach results in shorter cannulation time and decreased the incidence of complications.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialOutcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial.
Intraoperative goal directed fluid therapy (GDT) guided by an arterial pressure-based cardiac output system has been reported to improve gastrointestinal (GI) recovery in high-risk patients. This study evaluates the impact of this approach on GI recovery in low to moderate risk patients undergoing major abdominal surgery. IRB approved randomized controlled trial in low to moderate risk adults scheduled for major surgery. ⋯ The GDT group had faster return of GI function (p = 0.004) and higher quality of recovery scores. In low to moderate risk patients undergoing major abdominal surgery, intraoperative GDT guided by SVV optimization was associated with faster restoration of GI recovery and higher quality of recovery scores. These results suggest that outcome benefits related to the use of an intraoperative goal directed fluid protocol guided by SVV are not limited to high-risk patients.