Articles: monitoring.
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Comparative Study Clinical Trial Controlled Clinical Trial
Assessment of accelerography with the TOF-GUARD: a comparison with electromyography.
The TOF-GUARD is a new device for monitoring the neuromuscular function using acceleration measurement. It is quick and easy to apply and does not require a rigid support for the arm. ⋯ The levels at intubation as well as at full recovery of the patients can be assessed equally by the two monitors. Thus, the TOF-GUARD is a reliable clinical monitor in daily anaesthesia practice.
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This article discusses some of the routine as well as more specialized monitoring devices available. In thoracic surgery monitoring may be even more challenging because the surgery itself may involve manipulation of the airways, the pulmonary as well as cardiovascular systems. The anesthesiologist must have a full understanding of the required monitoring devices and decide which if any special techniques are needed depending on the surgical procedure and the patient's preoperative condition.
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We describe a novel index derived from the auditory evoked potential, the auditory evoked potential index, and we compare it with latencies and amplitudes related to clinical signs of consciousness and unconsciousness. Eleven patients, scheduled for total knee replacement under spinal anaesthesia, completed the study. The initial mean (SD) value of the auditory evoked potential index was 72.5 (11.2). ⋯ From all parameters studied, Na latencies had the greatest overlap between successive awake and asleep states. The auditory evoked potential index and Nb latencies had no overlap. The consistent changes demonstrated suggest that the auditory evoked potential index could be used as a reliable indicator of potential awareness during propofol anaesthesia instead of latencies and amplitudes.
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J. Thorac. Cardiovasc. Surg. · Nov 1997
Benefit of neurophysiologic monitoring for pediatric cardiac surgery.
Pediatric patients undergoing repair of congenital cardiac abnormalities have a significant risk of an adverse neurologic event. Therefore this retrospective cohort study examined the potential benefit of interventions based on intraoperative neurophysiologic monitoring in decreasing both postoperative neurologic sequelae and length of hospital stay as a cost proxy. ⋯ Interventions based on neurophysiologic monitoring appear to decrease the incidence of postoperative neurologic sequelae and reduce the length of stay. Inasmuch as the break-even cost for neurophysiologic monitoring is more than four times the actual average charge, both patients and hospital may profit from this service. Because this study was not a truly randomized clinical trial, unintentional statistical bias may have occurred and caution is urged in interpreting the magnitude of apparent intergroup outcome differences.
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Am. J. Respir. Crit. Care Med. · Nov 1997
Comparative StudyComparison of train-of-four and best clinical assessment during continuous paralysis.
Train-of-four (TOF) monitoring is recommended in published guidelines during use of continuous-infusion neuromuscular blocking agents (NMB) in the intensive care unit (ICU). To test that recommendation, dual protocols were established in a medical ICU after intensive nursing education. Paralyzed patients received either TOF monitoring with a goal of three twitches or best clinical assessment while receiving atracurium by continuous infusion. ⋯ The time to clinical recovery was no different between groups (50 +/- 10 versus 45 +/- 12 min). Two complications occurred in the TOF group, with pulmonary emboli despite prophylaxis and an unrecognized cerebrovascular accident in one patient each. We conclude that careful titration of NMB using clinical bedside markers should remain the standard of care with these drugs.