Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 1998
A method for assessment of standards of care of anesthesia services in departments with different levels of resources.
In developing countries the standards of anesthesia care vary greatly between hospitals. In order to identify the urgent needs of disadvantaged hospitals, we compared three index hospitals in the greater Cairo area, one of which has excellent (category I), on intermediate (category II), and one with severely restricted resources (category III). Standards of care published by the American Society of Anesthesiologists (ASA) were used to develop a spreadsheet for documenting features of pre-, intra- and post-anesthetic care in patients undergoing tonsillectomies, a procedure commonly performed in all three hospitals. ⋯ Urgent help does not mean the need for sophisticated monitors or equipment only, but the establishment of practice standards first. Applying the priciples of modern management, we need to evaluate the structure, processes and outcome of anesthetic practice in developing countries in order to reengineer the way we provide help to anesthetic departments in developing nations. In this modest study we are presenting a means to evaluate the features and processes of the anesthesia services in developing countries.
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J Clin Monit Comput · Dec 1998
Comparative Study Clinical TrialMeasurement of blood concentration of indocyanine green by pulse dye densitometry--comparison with the conventional spectrophotometric method.
Pulse dye densitometry (PDD) uses two wavelengths (805 and 890 nm) in association with pulse oximetry to compute the arterial blood concentration ratio of indocyanine green (ICG) to hemoglobin (Hb). When Hb is measured in the usual way, this permits the PDD to compute cardiac output, plasma or blood volume, and liver blood flow following an intravenous injection of ICG. In this study, we evaluate the accuracy of the PDD calculation of dye concentration by comparing it with measurement of the dye concentration in blood (Cb) measured by the spectrophotometric cuvette method during dye clearance in patients. ⋯ These errors are of similar size to those associated with thermal cardiac output measurement, suggesting that PDD should be valuable clinically as a noninvasive tool especially since it provides values for blood volume and liver blood flow.
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J Clin Monit Comput · Dec 1998
The fast flush test--is the clinical comparison equivalent to its in vitro simulation?
An in vitro simulation of the fast flush (FL) test has previously been used to prove that the FL test-measures the dynamic response of entire the blood pressure monitoring system. This simulation has also been used to confirm that the FL test is equivalent to the "gold standard" test for determining dynamic response, namely the square wave (SW) test. The conditions of the in vitro simulation can be reproduced in vivo during cardiopulmonary bypass (CPB) and circulatory arrest. Therefore the present objective was to verify that the previous conclusions about the validity of the FL test, obtained from an in vitro model, are equally valid when applied to in vivo clinical conditions. A secondary objective was to determine whether the patient's arterial tree has any affect on the dynamic characteristics of fluid-filled manometers. ⋯ The clinical conditions during CPB and particularly during circulatory arrest duplicate the in vitro FL test simulation model. These results confirm the validity of the FL test in vivo as well as proving that the dynamic characteristics of a fluid-filled manometer are independent of the patient's vasculature.