Articles: monitoring.
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Control Clin Trials · Feb 1995
Randomized Controlled Trial Multicenter Study Clinical TrialThe SvO2 study: general design and results of the feasibility phase of a multicenter, randomized trial of three different hemodynamic approaches and two monitoring techniques in the treatment of critically ill patients. The SvO2 Collaborative Group.
Although the attainment of normal hemodynamic values has always been assumed to be the therapeutic target for critically ill patients, recent studies reported increased values in oxygen transport variables in survivors of high-risk surgery. It has been supposed that the higher values observed in survivors might indicate a physiological compensation for the increased metabolic requirements due to disease. ⋯ Two different monitoring systems are used to maintain the target: conventional Swan-Ganz catheter with scheduled samples of mixed venous O2 saturation, and optical catheter with continuous SvO2 evaluation. The aim of the study is to answer three questions regarding the hypothesis reported above: (1) Are results in postoperative patients applicable to other pathological groups? (2) Does continuous monitoring of SvO2 provide advantages over conventional hemodynamic monitoring? (3) Is a normal SvO2 rather than a supranormal CI a good and predictable therapeutic goal? We report herein the protocol of the study and the results of the pilot phase, which was conducted in 98 critically ill patients enrolled by 56 participating centers to evaluate the safety and feasibility of the proposed trial.
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Randomized Controlled Trial Clinical Trial
Post-herniorrhaphy pain in outpatients after pre-incision ilioinguinal-hypogastric nerve block during monitored anaesthesia care.
The objective of this study was to evaluate the effect of an ilioinguinal-hypogastric nerve block (IHNB) with bupivacaine 0.25% on the postoperative analgesic requirement and recovery profile in outpatients undergoing inguinal herniorrhaphy with local anaesthetic infiltration. Thirty consenting healthy men undergoing elective unilateral inguinal herniorrhaphy procedures were randomly assigned to receive an IHNB with either saline or bupivacaine according to a double-blind, IRB-approved protocol. All patients received midazolam, 2 mg iv, and fentanyl 25 microgram iv, prior to injection of 30 ml of either bupivacaine 0.25% or saline through the oblique muscle approximately 1.5 cm medial to the anterior superior iliac spine. ⋯ However, the pain visual analogue score at 30 min after entering the PACU was lower in the bupivacaine (versus saline) group (P < 0.05). Although the times to ambulation (86 +/- 18 vs 99 +/- 27 min) and being judged "fit for discharge" (112 +/- 49 vs 126 +/- 30 min) were similar in the two groups, the bupivacaine-treated (vs saline) patients required less oral analgesic medication after discharge (46% vs 85%). We concluded that the use of an ilioinguinal-hypogastric nerve block with bupivacaine 0.25% as an adjuvant during inguinal herniorrhaphy under monitored anaesthesia care decreased pain in the PACU and oral analgesic requirements after discharge from the day-surgery unit.
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Randomized Controlled Trial Clinical Trial
Double burst stimulation with submaximal current.
The present study evaluated responses to double burst stimulation (DBS) at supramaximal and submaximal currents in 30 adult patients. Usually, DBS is applied with supramaximal stimulation, but this may be quite uncomfortable for the awake patient. Therefore, the authors investigated whether it is possible to obtain an accurate assessment of significant residual neuromuscular blockade if the stimulus current is reduced to 30 mA. ⋯ The relations between control T4/T1 ratios determined by supramaximal TOF stimulation and D2/D1 ratios determined by supramaximal DBS3.3 and submaximal DBS3.3 were Y = 0.99X + 0.08 and Y = 1.01X + 0.04, respectively, and there was no statistical difference between the two regression lines. The same relation between T4/T1 ratios and D2/D1 ratios by DBS3.2 were Y = 0.69X + 0.05 and Y = 0.72X + 0.02, respectively, and there was no significant difference. It is concluded that evaluation of the response to DBS at 30 mA has the same reliability as evaluation with supramaximal current.
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Randomized Controlled Trial Clinical Trial
Monitoring of anticoagulation in aprotinin-treated patients during heart operation.
Since aprotinin has become extensively used during cardiopulmonary bypass the maintenance of safe anticoagulation is a concern. Aprotinin affects anticoagulation measurement by the activated clotting time. Therefore, a reliable new measurement is needed to monitor anticoagulation during cardiopulmonary bypass. ⋯ However, the activated clotting time measurement was prolonged more by heparin when aprotinin was present (p < 0.05), whereas high-dose thromboplastin and high-dose thrombin measurements were not. Moreover, these measurements were faster and more dependable than the activated clotting time. Therefore, high-dose thromboplastin time and high-dose thrombin time seem to be reliable for monitoring anticoagulation when aprotinin is used during cardiopulmonary bypass.
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Anesthesia and analgesia · Sep 1994
Randomized Controlled Trial Clinical TrialEffects of end-tidal gas monitoring and flow rates on hemodynamic stability and recovery profiles.
This study was designed to evaluate the impact of routine end-tidal anesthetic gas monitoring on the intraoperative hemodynamic stability and early recovery profile in 253 consenting ASA physical status I-III patients undergoing elective otolaryngologic procedures with isoflurane or enflurane anesthesia. Patients were randomly assigned to one of six treatment groups: Group I, monitored high-flow isoflurane; Group II, unmonitored high-flow isoflurane; Group III, monitored low-flow isoflurane; Group IV, unmonitored low-flow isoflurane; Group V, monitored low-flow enflurane; or Group VI, unmonitored low-flow enflurane. After a standardized induction sequence, anesthesia was maintained by administering variable concentrations of isoflurane or enflurane in an air/oxygen mixture at two different total gas flow rates (0.7 L/min or 3.5 L/min, respectively). ⋯ Intraoperative hemodynamic stability was assessed in each patient and reported as the average error from the preincisional (baseline) MAP, average absolute error from the baseline MAP, coefficients of variation for HR, systolic, diastolic, and MAP values, and ET anesthetic concentrations. Recovery times from discontinuation of the volatile drug until awakening, following commands, and postanesthesia care unit (PACU) discharge were recorded. The six study groups had similar intraoperative MAP and HR values, coefficients of variation, and numbers of episodes of hypertension, hypotension, tachycardia, and bradycardia.(ABSTRACT TRUNCATED AT 250 WORDS)