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PubMed2007

Brief review: Neuromuscular monitoring: an update for the clinician.

PURPOSE: To review established techniques and to provide an update on new methods for clinical monitoring of neuromuscular function relevant to anesthesia. SOURCE: A PubMed search of relevant article for the period 1985-2005 was undertaken, and bibliographies were scanned for additional sources. PRINCIPAL FINDINGS: There is no substitute for objective neuromuscular monitoring; for research purposes, mechanomyography (MMG) is the gold standard; however, the most versatile method in the clinical setting is acceleromyography since it can be applied at various muscles and has a long track record of clinical utility. Kinemyography is valid to monitor recovery of neuromuscular transmission at the adductor pollicis muscle (AP), whereas phonomyography is easy to apply to various muscles and shows promising agreement with MMG. Monitoring of the corrugator supercilii muscle (CS) may be used to determine the earliest time for tracheal intubation as it reflects laryngeal relaxation better than monitoring at the AP. Recovery of neuromuscular transmission is best monitored at the AP, since it is the last muscle to recover from neuromuscular blockade (NMB). If train-of-four (TOF) stimulation is used, a TOF-ratio > 0.9 should be the target before awakening the patient. If surgery or the type of anesthesia necessitates NMB of a certain degree, e.g., TOF-ratio = 0.25, monitoring of muscles which best reflect the degree of NMB at the surgical site is preferable. CONCLUSION: Objective methods should be used to monitor neuromuscular function in clinical anesthesia. Acceleromyography offers the best compromise with respect to ease of use, practicality, versatility, precision and applicability at various muscles. The CS is the optimal muscle to determine the earliest time for intubation, e.g., for rapid sequence induction.

Diaphragm↗
PubMed2002

[Narcotrend EEG monitoring during total intravenous anaesthesia in 4.630 patients].

INTRODUCTION: The Narcotrend is a new EEG monitor designed to measure the hypnotic component of anaesthesia; however, a major clinical evaluation is still missing. This prospective multicentre study was designed to investigate the feasibility of Narcotrend monitoring in a large number of patients under different clinical conditions and to define its impact on recovery times after propofol-based total intravenous anaesthesia. METHODS: After legal authority approval and patients'informed consent had been obtained, total intravenous anaesthesia was induced and maintained with propofol and an opioid analgesic at the discretion of the attending anaesthesiologist. In the first 10-15 patients of each centre the anaesthesiologist was blinded to the Narcotrend recordings and propofol was dosed according to clinical needs. In the following patients propofol was infused at a rate sufficient to achieve a target Narcotrend stage of D or E. With termination of propofol infusion,recovery times were recorded and analysed for the patients with or without Narcotrend monitoring; in addition, recovery times were analysed depending on the Narcotrend stage at the moment of termination of propofol infusion. RESULTS: In total, 4,630 adult patients were studied at 46 institutions, 521 without and 4,109 with Narcotrend monitoring. Demographic data and duration of anaesthesia were comparable. Emergence from anaesthesia was significantly shorter in Narcotrend monitored patients, e.g.opening eyes after 9.8+/-5.9 (mean+/-SD) vs.11.8+/-7.1 min. In addition,awakening was significantly more rapid when the propofol infusion was stopped at a lower level of hypnosis as indicated by Narcotrend monitoring, e.g.opening eyes after 7.1+/-4.5 min with stage C instead of 17.0+/-7.4 min with stage F. CONCLUSIONS: The EEG monitor Narcotrend can be used for adult patients of different ages and during various surgical procedures.Narcotrend monitoring facilitates a reduction of recovery times after propofol-based total intravenous anaesthesia,presumably by allowing for an individual titration of the propofol dosage. Moreover, it appears that the profile of recovery can be optimised when at the end of surgery,the propofol infusion is controlled to Narcotrend stage C instead of D, E, or F.

Adult↗
PubMed1994

[Plethysmechanomyography (PMG). A simple method for monitoring muscle relaxation].

Ideal evaluation of neuromuscular blockade can be done by mechanical or electromyographical registration of muscle contractions evoked by ulnar nerve stimulation. Unfortunately, devices needed for such registration are expensive or complicated to set up, and thus are not often used for routine monitoring in anaesthesia. In this study, we describe a simple and low-priced method permitting intra- and postoperative monitoring of neuromuscular blocking agents. The accuracy of plethysmomechanomyography (PMG) was evaluated by comparing simultaneous electromyographic (EMG) and plethysmographic measurements. METHODS. For plethysmographic registration of muscle response to nerve stimulation a simple infusion system is twisted there to five times around one hand and connected to an anaesthetic monitor via a pressure transducer. The drip chamber is fixed about 20 cm above the hand (Fig. 1). Then, the infusion system is then filled up-with physiologic saline solution and the clamp is nearly closed. Electric stimulation can be carried out using any nerve stimulator. Using this method, PMG mainly records the contractions of abductor digiti minimi muscle, but also partly those of the interossei. Evoked muscle contractions cause stretching of the infusion system, which leads to pressure changes proportional to the strength of contraction. The muscle response to "train-of-four" (TOF) stimulation of the ulnar nerve was recorded simultaneously by EMG and PMG in 11 patients (ASA class I or II) undergoing neurosurgical procedures and therefore requiring muscle relaxation. After induction of anaesthesia by injection of etomidate and fentanyl, supramaximal stimulation and control values (T0) were defined. Anaesthesia was maintained by supplementation with nitrous oxide/oxygen (1:2) and muscle relaxation was carried out with vecuronium. We used the integrated nerve stimulator of a Datex Relaxograph NMT-100 EMG monitor and proceeded to stimulate the ulnar nerve at the forearm with supramaximal strength. The PMG was registered by a Siemens Siredoc 220 printer connected to a Siemens Sirecust 1281 anaesthetic monitor. First twitch ratio (T1/T0) and TOF ratio (T4/T1) were calculated from these recordings. The EMG recordings were made by a Datex Relaxograph NMT-100 monitor, which automatically computes T1/T0 and T4/T1. The comparison of EMG and PMG values was carried out by simple linear regression. Statistical evaluation was performed using analysis of variance. RESULTS. A plethysmographically registered graph of the TOF-evoked muscle response is illustrated in Fig. 2. Simultaneous EMG and PMG recordings of onset and recovery from a nondepolarizing blockade are shown in Fig. 3. A strong positive correlation (P < 0.001) of EMG and PMG was found with correlation coefficients of 0.98 for T1/T0 and of 0.97 for T4/T1. The mean difference between values of both methods was 5%, maximally 18% (T1/T0) and 20% (T4/T1). CONCLUSIONS. Mechanomyography and EMG are well established methods of neuromuscular monitoring. Our data demonstrate that PMG provides a reliable measurement of neuromuscular transmission that correlates well with EMG. Since only materials of daily use in anaesthesia are needed, no substantial costs will arise when the plethysmographic method of measurement is used for routine anesthetic monitoring.

Adult↗
PubMed2000

Evaluation of a new module in the continuous monitoring of respiratory mechanics.

OBJECTIVE: Bedside monitoring of respiratory mechanics facilitates the use of lung protective ventilation in acute lung injury (ALI). We evaluated a new clinical monitor of respiratory mechanics. DESIGN: Prospective, in vitro and in vivo study. SETTING: University hospital. PATIENTS: Measurements were done using a lung model and in patients after cardiac surgery (n = 10) and in patients with ALI (n = 10). INTERVENTIONS AND MEASUREMENTS: The monitor provides continuous monitoring of pressure, flow and volume waveform and loop data, and automatically collected variables of respiratory mechanics. Breath-by-breath respiratory mechanics data and the automated variables obtained with the new monitor were compared with flow and pressure reference data. RESULTS: Waveform data comparison showed errors of less than 5% for most variables. Automatically recorded respiratory pressures and volumes showed good agreement within clinical standards when compared to reference (errors from 2.5% to 6.2%). Automatically recorded derived variables present poor agreement (errors from 8.1% to 158.3%). CONCLUSIONS: The waveform data of the new monitor is accurate. The value of the automatically derived variables is limited by the fact that inspiratory plateau pressure and plateau compliance have no direct physiological meaning. Nevertheless, in clinical monitoring much information can be derived from the waveform signals alone and from pressure-volume and flow-volume loops. These facilitate monitoring changes in respiratory mechanics in the ALI patient.

Adult↗
PubMed2002

Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how?

INTRODUCTION: This review is primarily based on peer-reviewed scientific publications and on the authors' experience in the field of intraoperative neurophysiology. The purpose is a critical analysis of the role of intraoperative neurophysiological monitoring (INM) during various neurosurgical procedures, emphasizing the aspects that mainly concern the pediatric population. Original papers related to the field of intraoperative neurophysiology were collected using medline. INM consists in monitoring (continuous "on-line" assessment of the functional integrity of neural pathways) and mapping (functional identification and preservation of anatomically ambiguous nervous tissue) techniques. We attempted to delineate indications for intraoperative neurophysiological techniques according to their feasibility and reliability (specificity and sensitivity). DISCUSSION AND CONCLUSIONS: In compiling this review, controversies about indications, methodologies and the usefulness of some INM techniques have surfaced. These discrepancies are often due to lack of familiarity with new techniques in groups from around the globe. Accordingly, internationally accepted guidelines for INM are still far from being established. Nevertheless, the studies reviewed provide sufficient evidence to enable us to make the following recommendations. (1) INM is mandatory whenever neurological complications are expected on the basis of a known pathophysiological mechanism. INM becomes optional when its role is limited to predicting postoperative outcome or it is used for purely research purposes. (2) INM should always be performed when any of the following are involved: supratentorial lesions in the central region and language-related cortex; brain stem tumors; intramedullary spinal cord tumors; conus-cauda equina tumors; rhizotomy for relief of spasticity; spina bifida with tethered cord. (3) Monitoring of motor evoked potentials (MEPs) is now a feasible and reliable technique that can be used under general anesthesia. MEP monitoring is the most appropriate technique to assess the functional integrity of descending motor pathways in the brain, the brain stem and, especially, the spinal cord. (4) Somatosensory evoked potential (SEP) monitoring is of value in assessment of the functional integrity of sensory pathways leading from the peripheral nerve, through the dorsal column and to the sensory cortex. SEPs cannot provide reliable information on the functional integrity of the motor system (for which MEPs should be used). (5) Monitoring of brain stem auditory evoked potentials remains a standard technique during surgery in the brain stem, the cerebellopontine angle, and the posterior fossa. (6) Mapping techniques (such as the phase reversal and the direct cortical/subcortical stimulation techniques) are invaluable and strongly recommended for brain surgery in eloquent cortex or along subcortical motor pathways. (7) Mapping of the motor nuclei of the VIIth, IXth-Xth and XIIth cranial nerves on the floor of the fourth ventricle is of great value in identification of "safe entry zones" into the brain stem. Techniques for mapping cranial nerves in the cerebellopontine angle and cauda equina have also been standardized. Other techniques, although safe and feasible, still lack a strong validation in terms of prognostic value and correlation with the postoperative neurological outcome. These techniques include monitoring of the bulbocavernosus reflex, monitoring of the corticobulbar tracts, and mapping of the dorsal columns. These techniques, however, are expected to open up new perspectives in the near future.

Brain Mapping↗
PubMed1998

Multimodal cerebral monitoring in comatose head-injured patients.

Monitoring of comatose patients in the neurosurgical intensive care unit (NICU) is constantly extended by the development of new methods for monitoring of cerebral function, metabolism and oxygenation. To simplify the interpretation of the rising number of parameters, and to avoid data overflow, a multimodal cerebral monitoring (MCM) system has been developed for the acquisition, display, on-line analysis and recording of physiological parameters from multiple bedside data sources. This article describes the technical details and the design of this computerized data acquisition system for variable applications in clinical patient monitoring and research. A Windows (Microsoft Corporation, Redmont, Washington) platform was equipped with an analog/digital converter board. Software for multimodal cerebral monitoring was developed using LabVIEW for Windows (National Instruments, Austin, Texas), a graphical programming system. Two software modules were created: One for the automatic acquisition of data, display of time dependent trend graphs, processing of on-line histograms, special functions for research, and storage of data in compatible format. The other module serves as an off-line monitor to display recorded data in various modalities. The MCM system has been used in 30 comatose patients with severe head injury. Mean time of MCM is 5.3 days (+/- 2.8 days), resulting in a total running time of the system of about 3800 hrs. Hardware and software proved to run stable and safe. The MCM system has become a valuable tool for monitoring of comatose patients. The simultaneous display of trend graphs of various monitoring parameters and the online processing of histograms improved the survey of the patient's condition in the ICU. Recorded data were analysed offline and contribute to a consecutively increasing data bank.

Brain Injuries↗
PubMed2005

Methodological scheme for designing the monitoring of genetically modified crops at the regional scale.

According to EC regulations the deliberate release of genetically modified (GM) crops into the agro-environment needs to be accompanied by environmental monitoring to detect potential adverse effects, e.g. unacceptable levels of gene flow from GM to non-GM crops, or adverse effects on single species or species groups thus reducing biodiversity. There is, however, considerable scientific and public debate on how GM crops should be monitored with sufficient accuracy, discussing questions of potential adverse effects, agro-environmental variables or indicators to be monitored and respective detection methods; Another basic component, the appropriate number and location of monitoring sites, is hardly considered. Currently, no consistent GM crop monitoring approach combines these components systematically. This study focuses on and integrates spatial agro-environmental aspects at a landscape level in order to design monitoring networks. Based on examples of environmental variables associated with the cropping of Bt-Maize (Zea maize L.), herbicide-tolerant (HT) winter oilseed rape (Brassica napus L.), HT sugar beet (Beta vulgaris L.), and starch-modified potato (Solanum tuberosum L.), we develop a transferable framework and assessment scheme that comprises anticipated adverse environmental effects, variables to be measured and monitoring methods. These we integrate with a rule-based GIS (geographic information system) analysis, applying widely available spatial area and point information from existing environmental networks. This is used to develop scenarios with optimised regional GM crop monitoring networks.

Beta vulgaris↗
PubMed2006

On-line adaptive and nonlinear process monitoring of a pilot-scale sequencing batch reactor.

This article describes the application of on-line nonlinear monitoring of a sequencing batch reactor (SBR). Three-way batch data of SBR are unfolded batch-wisely, and then a adaptive and nonlinear multivariate monitoring method is used to capture the nonlinear characteristics of normal batches. The approach is successfully applied to an 80 L SBR for biological wastewater treatment, where the SBR poses an interesting challenge in view of process monitoring since it is characterized by nonstationary, batchwise, multistage, and nonlinear dynamics. In on-line batch monitoring, the developed adaptive and nonlinear process monitoring method can effectively capture the nonlinear relationship among process variables of a biological process in a SBR. The results of this pilot-scale SBR monitoring system using simple on-line measurements clearly demonstrated that the adaptive and nonlinear monitoring technique showed lower false alarm rate and physically meaningful, that is, robust monitoring results.

Bioreactors↗
PubMed2005

A descriptive evaluation of routine complete blood count monitoring in patients receiving anticoagulation therapy.

CONTEXT: The most prevalent side effect associated with warfarin therapy is bleeding. Routine monitoring of laboratory tests, such as complete blood counts (CBC), may provide theoretical benefit in this patient population as a means of detecting occult bleeding through hemoglobin values that decrease compared to baseline. OBJECTIVE: To describe the clinical outcomes associated with routine CBC monitoring in a large, diverse sample of anticoagulated patients. DESIGN: Forty-seven month retrospective, observational study. SETTING: Large non-profit, group-model health maintenance organization with a centralized clinical pharmacy anticoagulation service that routinely orders baseline CBCs on all patients enrolled in the service with follow up CBCs repeated at 3 months and yearly thereafter. PATIENTS: Patients continuously enrolled in the anticoagulation service for warfarin therapy monitoring for at least one year between January 1, 2000 and December 5, 2003. MAIN OUTCOME MEASURES: Medical records were reviewed to determine clinical outcomes associated with hemoglobin decreases of > or =2.0 gm/dL. Clinical outcomes included both overt and occult bleeding events and a determination of major or minor bleeding in these events. RESULTS: Of the 4033 patients included in the analysis, 578 (14.3%) experienced at least one decrease in hemoglobin > or =2.0 gm/dL. Occult bleeding was confirmed in 121 patients (3.0% of all patients monitored) with a decrease of hemoglobin > or =2.0 gm/dL but only 13 of these patients (0.3% of all patients monitored) experienced major bleeding. The annual detection rate of occult bleeding through routine CBC monitoring was 0.8%. CONCLUSIONS: Although routine CBC monitoring provides some utility in detecting occult bleeding, the yield of clinically important decreases in hemoglobin detected was low. For most anticoagulated patients, routine CBC monitoring appears to be clinically unnecessary.

Aged↗
PubMed1976

The relationship of hospital-acquired infection to invasive intrapartum monitoring techniques.

A 6 month survey of hospital-acquired uterine infection was done on the obstetric service of the Los Angeles County-University of Southern California (LAS-USC) Medical Center to determine the impact of the duration of monitoring upon the incidence of maternal infection. There were significantly more infections among the population monitored and in women undergoing cesarean section. In diminishing order, the incidence of infection was: cesarean section monitored, 90 of 223 (40.4 per cent); cesarean section not monitored, 56 of 271 (20.4 per cent); elective repeat cesarean section, 1 of 21 (5 per cent); vaginal delivery monitored, 33 of 1,236 (2.7 per cent); and vaginal delivery not monitored, 49 of 3,445 (1.4 per cent). In comparing those patients with infection and those free of infection following equivalent routes of delivery, there was no statistical difference in the duration of monitoring. These results suggest that the interval of monitoring alone is not a significant clinical factor in the development of maternal soft-tissue pelvic infection in a high-risk obstetric population.

California↗
PubMed1982

Ten-year experience of intrapartum fetal monitoring in Los Angeles County/University of Southern California Medical Center.

During the 10-year period from 1970 to 1979, a total of 115,096 deliveries occurred at the Los Angeles County/University of Southern California Medical Center. Of these, 47,567 patients (41.3%) were monitored during labor and delivery. The intrapartum monitoring technique was initially introduced in late 1969. The monitoring rate increased gradually from 18% in 1970 to 74% in 1979. The perinatal mortality rate during this 10-year period was 24.4/1,000. The perinatal mortality rate decreased in an inverse proportion to the monitoring rate. The main portions of the decrease in perinatal mortality rate were in the intrapartum and neonatal death rates. Both the fetal death rate and the neonatal death rate were significantly lower in the monitored patients than in those who were not monitored. This was irrespective of the fact that most high-risk patients were included in the monitored group. The cesarean section rate during this period increased slightly from 9.3% in 1970 to 12.3% in 1979. The primary cesarean section rate increased from 6.4% in 1970 to 8.7% in 1979. These findings suggest the beneficial role of intrapartum fetal monitoring and its association with diminished perinatal losses.

California↗
PubMed1982

Fetal monitoring in a community hospital: analysis of health maintenance organization, fee-for-service, and clinic populations.

This paper was a review of 2,210 deliveries in a community hospital in which electronic fetal monitoring was used. Patients were evaluated from three different types of group practices-health maintenance organization, fee-for-service, and clinic populations. Electronic fetal monitoring was used in 48%, 41%, and 70% of these groups, respectively. The respective cesarean section rates were 13%, 20%, and 10%. Monitored and nonmonitored, high- and low-risk groups were identified. A higher cesarean section rate for cephalopelvic disproportion was found in the monitored groups. However, this difference was most marked in the fee-for-service group. Perinatal morbidity and mortality results did not differ significantly among the three groups despite differences in electronic fetal monitoring use and cesarean section rates. The use of electronic fetal monitoring did not correlate with the cesarean section rate. Reasonable perinatal morbidity and mortality are compatible with relatively high electronic fetal monitoring rates (70%) and low cesarean section rates (10%). Within certain groups, use of electronic fetal monitoring may increase the cesarean section rate because of an increased diagnosis of cephalopelvic disproportion.

Attitude of Health Personnel↗
PubMed1985

Factors involved in the interpretation of fetal monitor tracings.

In order to study how physicians choose to use electronic fetal monitoring and interpret tracings, we administered a questionnaire to which 107 practicing obstetricians and 11 experts in electronic fetal monitoring responded. Sixty-one (57%) of the respondents monitored more than half of their deliveries (high users). In comparison to the less frequent users of electronic fetal monitoring (low users), they showed more positive attitudes toward electronic fetal monitoring and were nearly always more likely to perform cesarean sections on hypothetical patients described in the questionnaire. These differences appeared to be due to the high users' higher estimate of danger to the fetus. We also found that most physicians were generally more likely to perform a cesarean section on a high-risk mother than a low-risk mother with the same tracing. The majority of high and low users and nearly all of the experts, however, felt that antepartum risk factors are not of value in deciding what to do about an abnormal tracing. We conclude that there is wide variation in the way in which obstetricians use, interpret, and act on electronic fetal monitoring tracings. Some of these differences may be due to differing attitudes toward electronic fetal monitoring, differences in interpretation of electronic fetal monitoring tracings, and differences in the way obstetricians incorporate maternal risk factors into their decision-making.

Attitude of Health Personnel↗
PubMed1992

Non-invasive optical monitoring of cerebral blood oxygenation in the foetus and newborn: preliminary investigation.

Near infra-red spectroscopy was applied as a non-invasive and continuous technique for the in vivo monitoring of blood and tissue oxygenation in human neonates. Monitoring of cerebral blood oxygenation in the wavelength range 775-904 nm was carried out on preterm infants after inducing a transient mild hypoxic change; the measurements were performed either by the transmission or reflection (backscattering) mode of monitoring. The results of these investigations were used to assess the application of the technique to foetal monitoring. A series of foetal monitoring studies was performed to investigate the influence of maternal contractions on foetal cerebral blood oxygenation. Although only changes in haemoglobin concentration can be monitored at present, the results suggest that near infra-red monitoring could provide a non-invasive, real-time monitoring method in intensive neonatal and intrapartum care.

Brain↗
PubMed1993

Long-term oral antibiotics for acne: is laboratory monitoring necessary?

BACKGROUND: The role of laboratory monitoring in patients receiving long-term oral antibiotics for acne vulgaris has not been clearly defined. OBJECTIVE: The purpose of our study was (1) to evaluate the literature for objective evidence on the value of routine laboratory monitoring of the asymptomatic patient receiving oral antibiotics for acne and (2) to determine the utilization of laboratory monitoring of these patients by Connecticut dermatologists. METHODS: We surveyed Connecticut dermatologists by phone and inquired about the laboratory monitoring performed in patients receiving long-term oral tetracycline, minocycline, or erythromycin for acne. RESULTS: Eight published studies reported a total of 777 patients who had laboratory monitoring at various frequencies while receiving oral antibiotics for acne. Only one adverse drug reaction (ADR) was detected in a patient in whom mild hyperbilirubinemia developed. Of the 75 Connecticut dermatologists who participated in our survey, 48 (64%) perform some laboratory monitoring; 29% do so routinely, and 35% under special circumstances. CONCLUSION: Our literature review does not support routine laboratory monitoring in all patients who receive long-term oral antibiotics for acne; rarely does such screening detect an ADR and thus does not justify the cost of such testing. A relatively small proportion of Connecticut dermatologists check laboratory tests more frequently than appears necessary; in our opinion, laboratory monitoring should be limited to patients who may be at higher risk for an ADR.

Acne Vulgaris↗
PubMedDate not supplied

Sidestream end-tidal carbon dioxide monitoring during helicopter transport.

INTRODUCTION: End-tidal carbon dioxide (EtCO(2)) monitoring is standard of care for intubated patients. Sidestream technology also allows EtCO(2) monitoring in non-intubated patients. This is the first study to evaluate the feasibility of monitoring sidestream EtCO(2) on intubated and non-intubated patients during helicopter transport. SETTING: An air medical transport program serving two level 1 trauma centers. METHODS: In this prospective observational study, sidestream EtCO2 was monitored in 100 consecutive patients transported by helicopter. Flight nurses rated the difficulty posed by various factors of sidestream monitoring. An experienced flight nurse and a clinical engineer evaluated waveforms and EtCO(2) values. RESULTS: Only 1 of the 100 transported patients required a change from sidestream to mainstream EtCO(2) monitoring. Moisture was noted in the tubing of two patients, and one was changed to mainstream. Eleven patients had occluded nares but were not changed to mainstream monitoring. On a 5-point Likert scale, responses to statements regarding difficulty with length of tubing, patient tolerance, and interference with patient care produced mean scores of 0.5 (range, 0-3). Responses regarding difficulty securing the cannula yielded a mean score of 0.7 (range, 0-3). Of 1,685 (99%) recorded EtCO(2) values, 1,668 met pre-established criteria for "consistent." Alveolar plateaus were identified in 81 of 94 (86%) patient waveforms by the flight nurse and 73 of 94 (78%) patient waveforms by the clinical engineer. CONCLUSION: Sidestream EtCO(2) monitoring is feasible during air medical transport of both intubated and non-intubated patients. The mechanism was easy to use, and consistent numeric values and waveforms with alveolar plateaus were obtained in a large majority of readings.

Adolescent↗
PubMed2005

Monitoring glycemic control: the cornerstone of diabetes care.

BACKGROUND: Diabetes mellitus is associated with significant morbidity and mortality and escalating costs, and its prevalence is increasing to epidemic proportions. Studies have consistently documented the importance of glycemic control in delaying the onset and decreasing the incidence of both the short- and long-term complications of diabetes. Although glycemic control is difficult to achieve and challenging to maintain, its impact on disease outcomes is well worth the effort. OBJECTIVE: This article reviews the importance of monitoring and tightly controlling blood glucose concentrations in patients with diabetes and the methods and tools available for achieving these goals. METHODS: This clinical review was developed using 102 a MEDLINE search of the literature from 1990 to 2005 using the terms diabetes, glucose control, glucose monitoring, A(1c), and hypoglycemia. RESULTS: The complications of diabetes can be prevented or sharply curtailed through tight glycemic control, which requires frequent monitoring of blood glucose levels, careful attention to diet and exercise, and the use of medications. The progressive nature of diabetes imposes the need for frequent and regular monitoring, leading to data-driven adjustments to therapy to maintain optimal glucose levels. Failure to achieve glycemic control is often the result of a failure to educate the patient about how to monitor blood glucose levels and the importance of accuracy in doing so. CONCLUSIONS: Tight glycemic control requires an 102 educated and motivated patient, an appropriate treatment regimen, vigilant monitoring, and a close partnership between the patient and a multidisciplinary team of health care professionals to ensure accurate monitoring and appropriate actions. The growing array of monitoring devices contributes to this effort by providing increased convenience and accuracy.

Algorithms↗
PubMed2006

Intraoperative somatosensory evoked potential monitoring during anterior cervical discectomy and fusion in nonmyelopathic patients--a review of 1,039 cases.

BACKGROUND CONTEXT: Intraoperative somatosensory evoked potential (SSEP) monitoring has been shown to reduce the incidence of new postoperative neurological deficits in scoliosis surgery. However, its usefulness during cervical spine surgery remains a subject of debate. PURPOSE: To determine the utility of intraoperative SSEP monitoring in a specific patient population (those with cervical radiculopathy in the absence of myelopathy) who underwent anterior cervical discectomy and fusion (ACDF) surgery. STUDY DESIGN: Retrospective review. PATIENT SAMPLE: A total of 1,039 nonmyelopathic patients who underwent single or multilevel ACDF surgery. The control group (462 patients) did not have intraoperative SSEP monitoring, whereas the monitored group (577 patients) had continuous intraoperative SSEP monitoring performed. OUTCOME MEASURE: A new postoperative neurological deficit. METHODS: SSEP tracings were reviewed for all 577 patients in the monitored group and all significant signal changes were noted. Medical records were reviewed for all 1,039 patients to determine if any new neurological deficits developed in the immediate postoperative period. RESULTS: None of the patients in the control group had any new postoperative neurological deficits. In the monitored group there were six instances of transient SSEP changes (1 due to suspected carotid artery compression; 5 thought to be due to transient hypotension) which resolved with the appropriate intraoperative intervention (repositioning of retractors; raising the arterial blood pressure). Upon waking up from anesthesia, one patient in the monitored group had a new neurological deficit (partial central cord syndrome) despite normal intraoperative SSEP signals. CONCLUSIONS: ACDF appears to be a safe surgical procedure with a low incidence of iatrogenic neurological injury. Transient SSEP signal changes, which improved with intraoperative interventions, were not associated with new postoperative neurological deficits. An intraoperative neurological deficit is possible despite normal SSEP signals.

Adult↗