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At least 1,567 records · Page 87Linked to original sources
PubMed1987

Fetal monitoring during emergency obstetric transport.

The practicality of fetal heart rate monitoring during fixed-wing transport of obstetric emergencies was evaluated. Fifty-seven transports were performed and 40 (70%) were monitored successfully with the electronic fetal heart rate monitor. External fetal heart rate monitoring was technically accomplished in 83% of monitored transports. Of the 40 patients monitored, 33 (83%) of the fetal heart rate tracings were considered useful for adequate evaluation of the fetal heart rate and contraction frequency. No patients had late decelerations during transport. At cabin pressures from 1100 feet to 7000 feet, fetal hypoxia as measured by late decelerations was not present in any patient.

Aircraft↗
PubMed1980

Transcutaneous oxygen monitoring of neonates during surgery.

Thirteen neonates who underwent surgery under general anesthesia were studied for a cumulative total of 30 hr of intraoperative transcutaneous oxygen (tcO2) monitoring. Simultaneous umbilical or radial arterial blood gas measurements were recorded frequently throughout each operation. A variety of drugs and anesthetics (including halothane) were used during surgery. PaO2 ranged from 27 to 390 mm Hg and PaCO2 ranged from 11 to 75 mm Hg. All patients but one required adjustment of inspired oxygen to correct abnormal values. In 11 of 13 patients there was close correspondence between PaO2 and PtcO2 (r = .92) in the absence of hypotension. In one patient, the transcutaneous electrode came loose, in another patient with edema the tcO2 monitor was unreliable both during and after surgery (r = .25). A low PtcO2/PaO2 ratio (.48) in one patient suggested decreased blood volume, and the ratio returned to normal (1.0) after a blood transfusion. The tcO2 monitor was the earliest indicator of airway compromise (extubation and kinked endotracheal tube) in two patients. The tcO2 monitor was reliable with inspired halothane of 1% or less. Since intraoperative blood gases fluctuate greatly and because of the risks of hypoxia and retrolental fibroplasia, it is important that frequent blood gas monitoring be routinely performed during neonatal surgery. In the non-edematous, normotensive patient, the tcO2 monitor is reliable and can provide an early indicator of intraoperative airway compromise, hypovolemia, hypoxemia, or hyperoxemia.

Humans↗
PubMed1992

Ambulatory monitoring of bladder pressure in low compliance neurogenic bladder dysfunction.

Upper tract dilatation is an important complication of neurogenic bladder dysfunction. Risk factors include incomplete bladder emptying with large residual volumes of urine and high tonic increases in bladder pressures during artificial filling. However, on natural bladder filling many of these patients do not have high tonic increases in detrusor pressures. We compared conventional urodynamic studies with ambulatory monitoring during natural bladder filling in 66 patients with low compliance neurogenic bladder dysfunction. There were marked differences in the tonic increase in bladder pressure during filling and in compliance during artificial bladder filling compared with ambulatory monitoring. Faster filling rates during artificial filling resulted in greater end filling pressures and lower compliance but the lowest increases in bladder pressure were found during ambulatory monitoring with natural bladder filling. During natural bladder filling significantly more patients had phasic changes in detrusor pressure; a high intensity of phasic activity during ambulatory monitoring correlated with high end filling pressures during artificial bladder filling. Upper tract dilatation was associated with large volumes of residual urine, high resting bladder pressures and low bladder compliance on filling at 100 ml. per minute. However, upper tract dilatation was most strongly associated with high intensity phasic pressure activity during natural bladder filling in combination with high residual urine volumes and high resting bladder pressures. On multivariate statistical analysis the intensity of phasic pressure activity during ambulatory monitoring was the best discriminator between patients with dilated and normal upper tracts. Our study has highlighted important differences in the results obtained by artificial filling cystometry and ambulatory monitoring during natural bladder filling. In particular, high increases in pressure did not occur during natural bladder filling, apparently being replaced by phasic activity. Within this group of patients who had the high risk factor of low bladder compliance measured during artificial bladder filling, a combination of greater residual urine volumes, greater resting pressures and greater phasic activity during natural bladder filling was found in patients with upper tract dilatation.

Adolescent↗
PubMed1991

Experiences with the Surgitek Art-1000 penile tumescence and rigidity monitor, and comparison with the RigiScan.

We compared real-time and nocturnal penile tumescence and rigidity monitoring with 2 different ambulatory rigidity and tumescence monitors: the Surgitek Art-1000 and the RigiScan devices. Real-time studies were performed in 5 patients with both devices used simultaneously. The results of the measurements with both monitors were rather identical, indicating that both devices are applicable in a satisfactory manner for real-time investigation. Within a short period 5 patients performed nocturnal monitoring at home with the Surgitek Art-1000 and RigiScan devices during 2 consecutive nights. The Surgitek Art-1000 device provided less reliable and less informative results when compared with the RigiScan monitor during these nocturnal measurements. It appears that problems with sizing and fixing of the passive sensing loops of the Surgitek Art-1000 device by the patient are the main cause of these disappointing results. We believe that when the loops are sized and fixed by the investigator, for example during nocturnal measurements in the hospital, the applicability will be more satisfying. This monitor seems not to be suitable for nocturnal measurements by the patient at home.

Equipment Design↗
PubMed1987

Improved preservation of facial nerve function with use of electrical monitoring during removal of acoustic neuromas.

Continuous spontaneous electromyographic activity and responses to electrical stimulation of the facial nerve in the surgical field were monitored in 48 patients undergoing primary removal of an acoustic neuroma. The operative and postoperative results in these patients were compared with the results in 48 patients who were matched for age and size of tumor and who underwent the same surgical procedure without intraoperative monitoring. Eighty-three percent of the patients had preoperative evidence of facial neuropathy, which was more severe with larger tumors. Postoperative facial nerve function was most accurately predicted on the basis of the extent of facial neuropathy on preoperative electrophysiologic testing. Anatomic preservation of the facial nerve in patients with large tumors was substantially improved in the monitored patients (67%) in comparison with those without monitoring (33%). No difference was noted in facial nerve function in the two groups of patients immediately postoperatively. By 3 months, the degree of improvement in the monitored group exceeded that in those who were not monitored, particularly in patients with medium-sized and large tumors.

Adult↗
PubMedDate not supplied

Assessment of a breath collection technique and portable breath hydrogen monitor for use in cats and dogs.

Until now the use of breath hydrogen testing in companion animal gastroenterology has been limited to academic institutions because of the expense of the equipment. Recently portable breath hydrogen monitors, designed for use in paediatric gastroenterology, have been developed. They may be suitable for use in veterinary medicine as an ancillary diagnostic aid but, before widespread use can be recommended, thorough validation is required. Hydrogen breath tests were conducted in five dogs and four cats, undergoing investigations for small intestinal disease. Breath samples were taken using a closed-flow collection system and concurrently analysed with a commercially available portable breath hydrogen monitor and a previously validated breath hydrogen monitor. In cats, sample collection was troublesome and complete studies could only be performed in two individuals. Good correlation was demonstrated between the readings of both monitors (rs=0.902 and 0.935 for dogs and cats respectively; P<0.002) but agreement was poor with significant under-read from the portable monitor. Our results demonstrate that more studies on validation and the generation of a reference range would be required before the use of this portable hydrogen monitor could be recommended.

Animals↗
PubMed1999

A field study to compare performance of stainless steel research monitoring wells with existing on-farm drinking water wells in measuring pesticide and nitrate concentrations.

Existing drinking water wells are widely used for the collection of ground water samples to evaluate chemical contamination. A well comparison study was conducted to compare pesticide and nitrate-N data from specially designed stainless steel research monitoring wells with data from nearby existing on-farm drinking water wells. Results could help to determine whether adequate information concerning ground water contamination can be obtained from existing drinking water wells for use in making pollutant control decisions. The study was conducted during 1993-1994 in the Little Coharie Watershed, a 158 square mile area located in the coastal plain of eastern North Carolina. Statistical analysis indicated that research monitoring wells provided a greater probability of detecting pesticides in ground water than existing on-farm wells. Atrazine was the most frequently detected pesticide found in all wells, followed in order by fluometuron, carbofuran, metolachlor, alachlor, carbaryl, butylate, chlorothalonil, linuron and simazine. Ninety-seven percent of all wells had observed concentrations of nitrate-N, ranging from 0.1 to 30.1 mg/L. There was not a significant difference between research wells and existing wells for monitoring nitrate-N. Based on results of this study, existing drinking water wells can be used for monitoring nitrate; however, specialized stainless steel monitoring wells should be used for monitoring pesticides in ground water.

Databases, Factual↗
PubMed1999

Intraoperative microdoppler monitoring for spinal dural arteriovenous fistulae.

BACKGROUND: One of the most important goals in the surgical treatment of spinal dural arteriovenous fistulae is complete interruption of the flow in the fistula. To confirm complete interruption, we use intraoperative microdoppler monitoring. METHODS: Three patients with spinal dural arteriovenous fistulae with perimedullary venous drainage underwent surgical treatment using microdoppler monitoring. All of them suffered from congestive myelopathy before treatment. Microdoppler monitoring was performed on the perimedullary draining vein to detect the arterial spectrum before and after the interruption of the arteriovenous shunt. RESULTS: In all patients, an arterial spectrum was detected on the dorsal perimedullary vein. Sequential monitoring demonstrated the effects of each surgical procedure, which included epidural coagulation of the fistulae or intradural ligation of the retrogradely draining radiculomedullary veins. After complete interruption of the fistula, the arterial spectrum disappeared completely. In a patient with duplicated dural arteriovenous fistulae, the direction of the flow of the second arteriovenous shunt could be demonstrated by microdoppler monitoring combined with temporary clipping. This is especially useful in a complex case with duplicated fistulae. In all patients, postoperative angiography demonstrated complete disappearance of the arteriovenous fistulae. The patients all showed remarkable improvement with no therapeutic morbidity. CONCLUSION: Intraoperative microdoppler monitoring is an easily available and useful technique to safely confirm complete obliteration of spinal dural arteriovenous fistulae.

Adult↗
PubMed1975

Comparison of arrhythmia computer and conventional monitoring in coronary-care unit.

Conventional methods of monitoring arrhythmias impose heavy demands on staff and are unreliable. On-line arrhythmia computers have been developed to overcome these problems, but there has been no critical evaluation of the functioning of such a system in a clinical setting. A comparison was made of the efficacy of two methods of monitoring in detecting arrhythmias in sixty-four patients in a coronary-care unit. Half the patients were monitored by a commercially available arrhythmia computer; the other half were monitored by conventional means with a rate-triggered alarm system. More than 99 percent of episodes of potentially serious ventricular arrhythmias were detected by the computer; 95 percent of patients with these arrhythmias were treated immediately. In those monitored by conventional means, a large proporation of such arrhythmias were unrecognised: only 17 percent of affected patients received immediate antiarrhythmic therapy. In 30 percent, treatment was delayed for several hours, and none was given in 52 percent. False alarms occurred with both systems but were more readily recognised as such in the computer-monitored patients. It is concluded that an arrhythmia computer improves the standards of arrhythmia detection, leads to quicker institution of treatment, and diminishes the demand on skilled staff.

Adult↗
PubMed1989

Cerebral palsy among children born during the Dublin randomised trial of intrapartum monitoring.

In a randomised trial involving 13,079 liveborn children intrapartum care by electronic fetal heart rate monitoring, with scalp blood sampling when indicated, was associated with a 55% reduction in neonatal seizures. Reassessment, when aged 4, of the 9 children in the intensively monitored group and 21 in the control group who survived after neonatal seizures showed that 3 such children in each group had cerebral palsy. A fourth child in the intensively monitored group with cerebral palsy had had transient abnormal neurological signs during the neonatal period. 8 other children in the intensively monitored group and 7 in the control group who had not had abnormal neurological signs in the neonatal period also had cerebral palsy. 16 (78%) of the total of 22 cases of cerebral palsy had not shown clinical signs suggestive of intrapartum asphyxia. Thus, compared with intermittent intrapartum monitoring, intensive monitoring has little, if any, protective effect against cerebral palsy.

Asphyxia Neonatorum↗
PubMed1996

Intraoperative auditory monitoring in acoustic neuroma surgery.

Intraoperative auditory monitoring is a useful adjunct that is currently evolving. Near-field monitoring techniques such as electrocochleography and direct eighth nerve compound action potential are being used more frequently. The use of these two techniques is compared in 26 patients undergoing hearing preservation acoustic neuroma resection. Overall, 9 (35%) of the 26 patients had their hearing preserved. Three (23%) of the 13 with electrocochleography monitoring and 6 (46%) of the 13 with direct compound action potential monitoring had hearing preserved after surgery. Although there was a suggestion of improved results with direct compound action potential monitoring, the results were not statistically different. It was noted that lack of electrical response at the completion of the procedure (regardless of monitoring technique) was correlated with poor postoperative hearing, whereas the presence of a waveform at termination in no way predicted satisfactory postoperative hearing. The two techniques and their advantages and disadvantages are discussed.

Action Potentials↗
PubMed1998

Facial nerve monitoring in parotid surgery: the standard of care?

Recent reports have suggested that the incidence of permanent facial nerve paralysis or paresis after surgery for benign parotid tumors is between 3% and 5%. The intraoperative use of nerve-integrity monitors has been advocated to reduce the incidence of facial nerve paralysis. The purpose of this study was to compare postoperative facial nerve function after monitored and unmonitored parotid surgical procedures. The charts of 69 consecutive patients with parotid lesions who underwent surgery from 1987 to 1996 were retrospectively surveyed. Sixteen high-risk patients were excluded from the study. The study group consisted of 53 patients (33 unmonitored and 20 monitored) who underwent lateral parotidectomy for mobile tumors of the superficial lobe of the parotid gland. No patient demonstrated permanent facial paralysis. In 9 patients (17%), transient nerve paralysis developed: 5 (15%) of the 33 patients who underwent lateral parotidectomy without the use of a nerve-integrity monitor and 4 (20%) of the 20 patients who underwent lateral parotidectomy with the use of a nerve-integrity monitor. Nerve-integrity monitoring is optional for mobile parotid tumors of the superficial lobe.

Facial Nerve↗
PubMed1986

Noninvasive monitoring in emergency resuscitation.

The transcutaneous oxygen (PtcO2) monitoring technique uses a Clark electrode applied noninvasively to the skin surface. To obtain PtcO2 values that respond rapidly to physiologic changes, the electrode is heated to 44 to 45 C. Since its introduction in 1972, the PtcO2 sensor has become standard for monitoring oxygenation of neonates in respiratory distress. However, when applied to critically ill or injured adult patients, PtcO2 values often are much lower than arterial oxygen (PaO2) values. The explanation for this is that PtcO2 reflects not only arterial oxygen tension, but also cardiac output and oxygen delivery. Thus, during low-cardiac-output shock states, PtcO2, values are low, even when PaO2 is normal or high. PtcO2 monitoring in adults thus is useful in assessing oxygen delivery. Comparison to an arterial blood gas can easily differentiate whether a low PtcO2 value might be due to hypoxia or to low cardiac output. Other noninvasive monitors (conjunctival oxygen, pulse oximeter, transcutaneous CO2, end-tidal CO2) also show promise. In the emergency department, PtcO2 monitoring is useful in assessing the presence and severity of shock and hypoxia and as a physiologic monitor for titrating resuscitation.

Emergencies↗
PubMed2003

Patient monitoring in the London Daily/Nocturnal Hemodialysis Study.

BACKGROUND: Patient monitoring involves real-time surveillance of patients while they dialyze at home by a staff member ("monitor") at a centralized location. Monitoring is designed to ensure patient safety, patient compliance with treatment, and automatic collection of treatment data. METHODS: In the London Daily/Nocturnal Hemodialysis Study, 14 nocturnal hemodialysis (HD) patients were monitored from 13 to 602 sessions for a total of 4,096 patient-nights. Alarm data were collected and analyzed. RESULTS: The number of alarms per night ranged from 0 to 54, with an average of 1.31 +/- 2.81, resulting in a total of 5,351 registered alarms. Three hundred twenty-two calls because of nonresponse or slow response to alarms were made to patients' homes, but no calls to designated contact persons or emergency medical services were required. Arterial and venous pressure alarms were the most common type of alarm and were caused primarily by the patient obstructing blood tubing. The average number of alarms per night decreased significantly over time as patients gained experience with nocturnal HD, from a maximum of 1.98 +/- 3.31 alarms/night during the first month at home to a low of 0.74 +/- 1.63 alarms/night by the final month of follow-up. Each progressive decrease from month 3 through month 18 was statistically significantly lower than the value at month 1. CONCLUSION: Monitoring is essential for the initial 3 months of nocturnal HD therapy until the HD team is convinced the patient is stable and compliant. Thereafter, monitoring is necessary only if medically indicated.

Adult↗
PubMed1991

Use of the fistula assessment monitor to detect stenoses in access fistulae.

Twenty-three unselected hemodialysis patients with functioning access arteriovenous fistulae were studied prospectively to determine the best technique for detecting stenoses within the fistulae. Combined clinical assessment and fistula assessment monitoring were compared with transbrachial angiography. Fistula assessment monitoring was more accurate (96%) than combined clinical assessment (accuracy, 52%) in stenosis detection. Complications of angiography occurred in 17% of patients; there were no complications of fistula assessment monitoring. Fistula assessment monitoring was better than combined clinical assessment in predicting clinical outcome for arteriovenous fistulae over 6 months and was as good as angiography. Routine fistula assessment monitoring could reduce inappropriate angiography and detect clinically significant silent stenoses. It is an ideal method for monitoring arteriovenous access fistulae.

Angiography↗
PubMed1982

[Electroencephalographic findings during open heart surgery. Automatic analysis in relation to parameters of anesthesia and use in intraoperative monitoring of cerebral function].

It is generally agreed upon by experts that EEG monitoring of brain function during open heart surgery is of the utmost importance in preventing postoperative neurological and psychopathological consequences. Up to now, however, this monitoring has not been performed on a large scale: (1) it is a very time-consuming task for the clinical neurophysiologist: (2) the anesthetist does not generally possess enough knowledge of this part of neurophysiology to get more than only a rough impression of the alterations of brain function during these procedures. To improve this situation we developed an automatic method to monitor brain function: the results of period-amplitude analysis of the EEG are continuously related to a number of important parameters--blood pressure, temperature, anesthesia. The way this is done resembles to a large degree the procedure which the neurophysiologist uses to judge the EEG during monitoring. The system generates warning and alerting signals, which also indicate the kind of disturbance when a marginal situation occurs. The anesthetist may take measures within 1 min to restore the condition. This is in complete agreement with the needs of anesthesiology. By means of a special function keyboard the anesthetist uses the system interactively and introduces all the necessary information which is needed for the proper functioning of the warning system (kind and quantity of different anesthetics and other drugs). At the end of the procedure the total information about the EEG, patient parameters and anesthetic measures are plotted in graphical form and printed as a table for documentation purposes which to a large degree may do away with the usual documentation. The introduction of this automatic monitoring system opens the way to a large scale use of EEG monitoring during open heart surgery.

Anesthesia, General↗
PubMed2003

[French national survey of the use of monitoring devices during cardiopulmonary bypass in 2001].

OBJECTIVES: To study the different monitoring devices used during cardiopulmonary bypass (CPB) and to determine the factors, which may influence the choice of these equipments. STUDY DESIGN: Survey. METHODS: A postal questionnaire was send to the 66 French cardiac surgery centres. Results have been analysed about the economic status (public health service or private institution) and the business of the centre (less than 500, between 500 to 800 and more than 800 cardiopulmonary bypass/year). RESULTS: The rate of answer reached 73%. In 40% of centres, the cardiovascular perfusionist was not alone during the procedure. The percentage of centres using a checklist was 80%, a neurologic monitoring 42%, anaesthesia depth monitoring 40%, venous reservoir level detector 52%, arterial line bubble detector 38%, cardioplegia circuit bubble detector 6%, transoesophageal echocardiography 48%, pipe's temperature monitoring 90%; oxymetry 44%, capnography 25%, SvO2 98%, blood gas analysis outside the OR 46% and computer records 35%. No difference was observed between public and private institution for these latter devices. However, a significant difference was noticed among the low, intermediate and highly busy centres for the use of checklist, the EEG monitoring, the pipe and water circuit temperature monitoring, capnography and location of the biologic analysers. CONCLUSION: Equipments were not similar among the different French cardiac surgery centres. Furthermore, the French practice seems different from American, UK and Australian's one. These results highlight the need of establishing French guidelines, which are absent.

Blood Pressure Determination↗
PubMed1986

[French survey on anesthesia systems and peroperative respiratory monitoring equipment].

A national inquiry has been carried out in France. It concerned the anaesthetic systems and respiratory monitoring equipment in use at the moment, as well as that wished for. The equipment in use was very stereotyped: an open system with a respirator, for the most volumetric, and with a safety O2/N2O mixer. Monitoring is carried out with the pressure gauges and the measure of expiratory volume; only two thirds of the equipment had an alarm. The O2 and CO2 analysers were little used. Expired CO2 monitoring was only carried out in teaching hospitals and in big centres. Apart from this, the equipment was independent of the hospital and the type of surgery carried out. As for anaesthetic systems, 53% of centres would like obtain open systems, 15% closed systems; 32% did not answer. This increase in number of closed systems is not significant. However, a very strong wish for respirators with flow rate control and safety O2/N2O mixers was observed, whilst the safety parameters of these mixers were open to discussion. Respiratory monitoring was not just confined to the mechanical aspects, as 65% of centres wished to monitor FIO2. The big centres and the teaching hospitals were interested by the expiratory CO2 monitoring. This inquiry showed the interest in respiratory safety in operating theatres. Further studies should confirm or not the increasing interest in closed systems.

Anesthesia, Closed-Circuit↗