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At least 235 records · Page 13Linked to original sources
PubMed2000

Monitoring of respiratory rate in postoperative care using a new photoplethysmographic technique.

OBJECTIVE: Photoplethysmography (PPG) is a non-invasive optical technique that measures variations in skin blood volume and perfusion. The PPG signal contains components that are synchronous with respiratory and cardiac rhythms. We undertook this study to evaluate PPG for monitoring patients' respiratory rate in the postoperative care unit, using a new prototype device. We compared it with the established technique, transthoracic impedance (TTI). METHODS: PPG signals from 16 patients (ASA classes 1-2, mean age 43 years) who were recovering from general anaesthesia after routine operations were recorded continuously for 60 minutes/patient. The respiratory synchronous part of the PPG signal was extracted by using a bandpass filter. Detection of breaths in the filtered PPG signals was done both visually and by using an automated algorithm. In both procedures, the detected breaths were compared with the breaths detected in the TTI reference. RESULTS: A total of 10,661 breaths were recorded, and the mean +/- SD respiratory rate was 12.3 +/- 3.5 breaths/minute. When compared with TTI, the rates of false positive and false negative breaths detected by PPG (visual procedure) were 4.6 +/- 4.5% and 5.8 +/- 6.5%, respectively. When using the algorithm for breath detection from PPG, the rates of false positive and false negative breaths were 11.1 +/- 9.7% and 3.7 +/- 3.8%, respectively, when compared to TTI. Lower respiratory rates increased the occurrence of false-positive breaths that were detected by the PPG using visual identification (p < 0.05). The same tendency was seen with the automated PPG procedure (p < 0.10). CONCLUSIONS: Our results indicate that PPG has the potential to be useful for monitoring respiratory rate in the postoperative period.

Adult↗
PubMed2005

The implementation of a postoperative care process on a neurosurgical unit.

The postoperative phase is a critical time for any neurosurgical patient. Historically, certain patients having neurosurgical procedures, such as craniotomies and other more complex surgeries, have been nursed postoperatively in the intensive care unit (ICU) for an overnight stay, prior to transfer to a neurosurgical floor. At the Hospital for Sick Children in Toronto, because of challenges with access to ICU beds and the cancellation of surgeries because of lack of available nurses for the ICU setting, this practice was reexamined. A set of criteria was developed to identify which postoperative patients should come directly to the neurosurgical unit immediately following their anesthetic recovery. The criteria were based on patient diagnosis, preoperative condition, comorbidities, the surgical procedure, intraoperative complications, and postoperative status. A detailed process was then outlined that allowed the optimum patients to be selected for this process to ensure patient safety. Included in this process was a postoperative protocol addressing details such as standard physician orders and the levels of monitoring required. Outcomes of this new process include fewer surgical cancellations for patients and families, equally safe, or better patient care, and the conservation of limited ICU resources. The program has currently been expanded to include patients who have undergone endovascular therapies.

Child↗
PubMed1995

[Postoperative care of neobladder using a detubularized intestinal segment].

Neobladder using a detubularized intestinal segment was constructed in 74 cystectomized patients between October 1986 and July 1994. There were 65 males (87.8%) and 9 females (12.2%) with an average age of 63 years (range 36 to 77 years). The mean follow-up period was 35 months (range 7 to 85). Problems of postoperative care assessed were continence, renal function, metabolic consequences, neoplasms and other complications. Moreover, the impact of these problems on the quality of life was evaluated by a self-administered questionnaire. Continence in the daytime was achieved in 70/74 (94.6%) patients. Nocturnal incontinence was noted in 15/74 (20.3%) patients. Serum BUN and creatinine levels were maintained within normal limits. Metabolic acidosis (base excess < -5.0 occurred in 7/74 (9.5%) patients, 4 patients of whom needed alkalizing agents. Colon adenomas in neobladder were found and resected in 3 patients. The other postoperative complications were stone formation in neobladder in 4 (5.4%), urethral stricture in 7 (9.5%) and ureteral stenosis in 3 (4.1%) patients respectively, which were satisfactorily corrected by endourological procedures. As to quality of life assessment, the majority was satisfied, whereas 11% of the patients reported emotional distress and limitations in the usual physical activities by nocturnal incontinence. Our finding suggest that nocturnal incontinence is the most important problem and we need longer follow-up to evaluate the problems of metabolic consequences and neoplasms of the urinary tract.

Adult↗