Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2008
Computerized recording of neuromuscular monitoring and the risk of residual paralysis at the time of extubation.
We tested whether a newly installed neuromuscular monitoring device (NMT) with a computerized anesthesia recording system, incorporated in all anesthesia stations, could enhance the commitment to objective neuromuscular monitoring in a teaching hospital anesthesia department. ⋯ Despite the presence of quantitative objective neuromuscular monitoring in all operating rooms, and the automatic data recording system, the rate of monitoring neuromuscular blockade was not high enough to rule out the potential risk of residual paralysis at the time of extubation.
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J Clin Monit Comput · Aug 2008
Non-invasive automated measurement of cardiac output during stable cardiac surgery using a fully integrated differential CO(2) Fick method.
To re-evaluate the accuracy and precision of a non-invasive method for measurement of cardiac output based on the differential CO(2) Fick approach using an automated change in respiratory rate delivered by a ventilator under control by a prototype measurement system. ⋯ Acceptable agreement with thermo- dilution during surgery was found, particularly where the ventilatory change involved an increase in respiratory rate from a lower baseline. This approach has potential to be readily integrated into modern anesthesia delivery platforms, allowing routine non-invasive cardiac output measurement.
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J Clin Monit Comput · Aug 2008
A measure of confidence in Bland-Altman analysis for the interchangeability of two methods of measurement.
Bland-Altman (B-A) analysis has largely replaced the correlation coefficient as the predominant tool for evaluating the interchangeability of two methods of clinical measurement. However, we contend that B-A analysis might lead to erroneous conclusions when the data range is small. We provide an example to illustrate this and explore a possible analysis technique to address this limitation.
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J Clin Monit Comput · Aug 2008
Postoperative discomfort (other than pain) - a neglected feature of postanesthesia patient care.
Patients may experience various kinds of discomfort other than pain during the immediate period following surgery and anesthesia. These complaints may not be dealt with, especially when they are shadowed by the more pressing need to alleviate pain. The issue of discomfort in the setting of an adult post anesthesia care unit (PACU) has not been adequately addressed. We assessed the extent of unreported distressing or unpleasant events among patients who had undergone general surgery or orthopedic procedures under standard general anesthesia and their recall 24 h afterwards. ⋯ Almost one-fourth of the patients undergoing general surgery and orthopedic procedures under general anesthesia suffered from postoperative discomfort other than pain. Of these, >90% recalled 24 h after surgery having had postoperative discomfort. PACU staff needs to inquire for and attempt reducing such events.
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Capnogram is often distorted due to aspiration of expired gas when a sidestream capnometer is used for non-intubated, spontaneously breathing condition. The purpose of this study was to make a flow-through capnometer without aspiration and to check if this capnometer precisely detected apnea during obstructive sleep apnea (OSA). ⋯ We concluded that the cap-ONE can record capnograms with minimum distortion and detect apnea reliably during OSA.