Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2012
The reliability of manual reporting of clinical events in an anesthesia information management system (AIMS).
Manual incident reports significantly under-report adverse clinical events when compared with automated recordings of intraoperative data. Our goal was to determine the reliability of AIMS and CQI reports of adverse clinical events that had been witnessed and recorded by research assistants. ⋯ AIMS yielded a sensitivity of 38 % (95 % confidence interval [CI] 8.5-75.5 %), while the sensitivity of CQI reporting was 13 % (95 % CI 0.3-52.7 %). The low sensitivities of the AIMS and CQI reports suggest that user-reported AIMS and CQI data do not reliably include significant clinical events.
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J Clin Monit Comput · Dec 2012
Case ReportsDetection of positional brachial plexus injury by radial arterial line during spinal exposure before neuromonitoring confirmation: a retrospective case study.
To demonstrate the potential usefulness of radial arterial line monitoring in detection of brachial plexus injury in spinal surgery. Multiple neuromonitoring modalities including SEPs, MEPs and EMG were performed for a posterior thoracicolumbar surgery. Radial arterial line (A-line) was placed on the right wrist for arterial blood pressure monitoring. ⋯ Loss of ulnar nerve SEPs and hand muscle MEPs with a cold hand on the right was noticed when neuromonitoring resumed after spine exposure. SEPs, MEPs, A-line readings and hand temperature returned after modification of the right arm position. Radial arterial line monitoring may help detect positional brachial plexus injury in spinal surgery when continuous neuromonitoring is interrupted during spine exposure in prone position.
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J Clin Monit Comput · Dec 2012
Case ReportsTranscranial Doppler monitoring of middle cerebral flow velocity in a patient with a ventriculoperitoneal shunt undergoing laparoscopy.
Laparoscopic surgery is possibly associated with a risk of intracranial pressure (ICP) increase due to pneumoperitoneum in patients with ventriculoperitoneal shunts (VPS). Invasive techniques for shunt pressure monitoring are not routinely used because of the possible complications. Transcranial Doppler (TCD) is a non-invasive, safe method which gives accurate information about blood-flow velocities in basal cerebral arteries and indirectly about the ICP. ⋯ We report the use of TCD for middle cerebral flow velocity monitoring in a patient with a VPS who underwent laparoscopic surgery. In the case we present, during 60 min of pneumoperitoneum, TCD showed a sustained, but not clinically significant increase of the Pulsatility Index, with a recorded maximum change of 31 %. We consider that the use of TCD may increase the safety of laparoscopic procedures in patients with preexisting VPS.
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J Clin Monit Comput · Dec 2012
Do waking salivary cortisol levels correlate with anesthesiologist's job involvement?
Anesthetists' work carries great responsibility and can be very stressful. Cognitive appraisal plays a central role in stress responses; however, little is known about the relationship between stress appraisal and biological markers of stress, particularly among anesthesiologists. Stress response may be associated with increased levels of systemic cortisol, which can be conveniently measured in saliva and used as a marker for the extent of stress. ⋯ Furthermore, high implicit job-stress was related to elevated cortisol only among anesthesiologists reporting large "mental distance" from work, which may represent limited job involvement related to burnout. Anesthesiologists with a low degree of job involvement who have high implicit job-stress associations have higher levels of waking salivary cortisol. Further studies are necessary to assess the impact of stress management techniques on anesthesiologists' personal and professional behavior as well as on the quality of medical care.
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J Clin Monit Comput · Dec 2012
Validation of a measurement to predict upper airway collapsibility during sedation for colonoscopy.
Techniques to quantify the effects of sedation on upper airway collapsibility have been used as research tools in the laboratory and operating room. However, they have not been used previously in the usual clinical practice environment of colonoscopy sedation. The propensity for upper airway collapsibility, quantified as the critical pharyngeal pressure (P(crit)), was hypothesized to correlate with the need for clinical intervention to maintain ventilation. ⋯ The CIS was not predicted by the transformed baseline or sedated P(crit) with or without including demographics associated with sleep apnea syndrome. Although the NAP technique showed the expected changes with sedation in this clinical situation, we did not find that it predicted the need for clinical intervention during endoscopy. Our study was not large enough to test for subpopulations in which the test might be predictive; further studies of these particular groups are needed to determine the clinical utility of the NAP measurement.