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https://www.readbyqxmd.com/read/29239956/the-anesthesia-workstation-quo-vadis
#1
Jan F A Hendrickx, Andre M De Wolf
Ensuring adequate ventilation and oxygenation and delivering inhaled anesthetic agent to the patient remain core responsibilities of the anesthesia provider during general anesthesia. Because of the emphasis placed on physiology, pharmacology, clinical sciences, and administrative duties, the stellar anesthesia workstation technology may be underutilized by the anesthesia community. Target-controlled O2 and agent delivery and automated end-expired CO2 control have entered the clinical arena, with only cost, luddism, and administrative hurdles preventing their more widespread use...
December 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29200060/changing-default-ventilator-settings-on-anesthesia-machines-improves-adherence-to-lung-protective-ventilation-measures
#2
Sunny S Chiao, Douglas A Colquhoun, Bhiken I Naik, Jennie Z Ma, Edward C Nemergut, Marcel E Durieux, Randal S Blank, Katherine T Forkin
Perioperative lung-protective ventilation (LPV) can reduce perioperative pulmonary morbidity. We hypothesized that modifying default anesthesia machine ventilator settings would increase the use of intraoperative LPV. Default tidal volume settings on our anesthesia machines were decreased from 600 to 400 mL, and default positive end-expiratory pressure was increased from 0 to 5 cm H2O. This modification increased mean positive end-expiratory pressure from 3.1 to 5.0 cm H2O and decreased mean tidal volume from 8...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29199541/impact-of-temperature-on-the-narcotrend-index-during-hypothermic-cardiopulmonary-bypass-in-children-with-sevoflurane-anesthesia
#3
Nils Dennhardt, Christiane Beck, Dietmar Boethig, Sebastian Heiderich, Alexander Horke, Sebastian Tiedge, Martin Boehne, Robert Sümpelmann
BACKGROUND: During cardiopulmonary bypass (CPB) in children, anesthesia maintained by sevoflurane administered via the oxygenator is increasingly common. Anesthetic uptake and requirement may be influenced by the non-physiological conditions during hypothermic CPB. Narcotrend-processed EEG monitoring may, therefore, be useful to guide the administration of sevoflurane during this phase. OBJECTIVE: The objective of this prospective, clinical, observational study was to assess the correlation between body temperature, Narcotrend Index (NI) and administered sevoflurane in children during CPB...
December 1, 2017: Perfusion
https://www.readbyqxmd.com/read/29166810/anesthetic-management-of-amniotic-fluid-embolism-a-multi-center-retrospective-cohort-study
#4
Shiri Skolnik, Alexander Ioscovich, Leonid A Eidelman, Atara Davis, Anat Shmueli, Amir Aviram, Sharon Orbach-Zinger
INTRODUCTION: Amniotic fluid embolism (AFE) is a rare and potentially lethal obstetric complication, commonly occurring during labor, delivery, or immediately postpartum. There is a paucity of data regarding incidence, risk factors, and clinical management. Our primary objective in this study was to evaluate clinical presentation of AFE and delineate anesthesia management of these cases. METHODS: This 10 years retrospective multi-center cohort study was performed in five tertiary university-affiliated medical centers, between the years 2005 and 2015...
November 22, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29149877/key-bottlenecks-to-the-provision-of-safe-obstetric-anaesthesia-in-low-income-countries-a-cross-sectional-survey-of-64-hospitals-in-uganda
#5
Isabella Epiu, Agnes Wabule, Andrew Kambugu, Harriet Mayanja-Kizza, Jossy Verel Bahe Tindimwebwa, Gerald Dubowitz
BACKGROUND: Despite recent advances in surgery and anaesthesia which significantly improve safety, many health facilities in low-and middle-income countries (LMICs) remain chronically under-resourced with inability to cope effectively with serious obstetric complications (Knight et al., PLoS One 8:e63846, 2013). As a result many of these countries still have unacceptably high maternal and neonatal mortality rates. Recent data at the national referral hospitals in East Africa reported that none of the national referral hospitals met the World Federation of Societies of Anesthesiologists (WFSA) international standards required to provide safe obstetric anaesthesia (Epiu I: Challenges of Anesthesia in Low-and Middle-Income Countries...
November 17, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29134425/quick-reference-tidal-volume-cards-reduce-the-incidence-of-large-tidal-volumes-during-surgery
#6
Chirag K Shah, Angela Moss, William Henderson, Breandan Sullivan, Ana Fernandez-Bustamante
Ventilation with large tidal volumes (V T), greater than 10 ml/kg of predicted body weight (PBW), is associated with worse outcomes in critically ill and surgical patients. We hypothesized that the availability of quick reference cards with proposed V T ranges specific to gender and different heights would reduce the intraoperative use of large V T during prolonged abdominal surgery. We compared retrospectively the incidence of median V T used during prolonged (≥4-h-long) abdominal surgery before ("before") and after ("after") the quick reference V T cards were made available in all anesthesia machines in operating rooms of a single academic US medical center...
November 13, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/29101953/catheterization-laboratory-structural-heart-disease-devices-and-transcatheter-aortic-valve-replacement
#7
REVIEW
Paul N Fiorilli, Saif Anwaruddin, Elizabeth Zhou, Ronak Shah
The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. An anesthesiologist is essential for these procedures in case of hemodynamic compromise. Interventionalists are becoming more familiar with transcatheter aortic valve replacement and the device has become smaller, both contributing to less complications...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29060565/gabor-based-automatic-spinal-level-identification-in-ultrasound
#8
Mohammad Ikhsan, Kok Kiong Tan, Ting Ting Oh, John Paul Lew, Ban Leong Sng
This paper presents an automatic lumbar spine level identification system based on image processing of ultrasound images. The goal is to aid anesthetists in identifying the correct spinal level during epidural anesthesia. Spine level identification is initiated by detecting the location of the sacrum using a classifier based on a support vector machine. Image stitching is then conducted to produce a panorama image of the spinal area. During this process, the location of spinal processes are enhanced using a Gabor filter and detected through template matching...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29049075/insight-into-our-technology-anesthesia-information-management-systems
#9
Allan F Simpao, Mohamed A Rehman
Anesthesia information management systems (AIMS) have evolved from simple, automated intraoperative record keepers in a select few institutions to widely adopted, sophisticated hardware and software solutions that are integrated into a hospital's electronic health record system and used to manage and document a patient's entire perioperative experience. AIMS implementations have resulted in numerous billing, research, and clinical benefits, yet there remain challenges and areas of potential improvement to AIMS utilization...
October 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29034250/the-modification-and-performance-of-a-large-animal-anesthesia-machine-tafonius-%C3%A2-in-order-to-deliver-xenon-to-a-horse
#10
Bruna Santangelo, Astrid Robin, Keith Simpson, Julie Potier, Michel Guichardant, Karine Portier
INTRODUCTION: Xenon, due to its interesting anesthetic properties, could improve the quality of anesthesia protocols in horses despite its high price. This study aimed to modify and test an anesthesia machine capable of delivering xenon to a horse. MATERIALS AND METHODS: An equine anesthesia machine (Tafonius, Vetronic Services Ltd., UK) was modified by including a T-connector in the valve block to introduce xenon, so that the xenon was pushed into the machine cylinder by the expired gases...
2017: Frontiers in Veterinary Science
https://www.readbyqxmd.com/read/29032903/single-shot-femoral-nerve-block-does-not-cause-long-term-strength-and-functional-deficits-following-anterior-cruciate-ligament-reconstruction
#11
Kelechi R Okoroha, Lafi Khalil, Edward K Jung, Robert A Keller, Nathan E Marshall, Moneer Abouljoud, Derek Chan, Vasilios Moutzouros
PURPOSE: To determine if patients treated with a single-shot femoral nerve block have strength and functional deficits at 9-month follow-up. METHODS: Forty-three patients who underwent primary anterior cruciate ligament reconstructions were randomized to receive either a preoperative single-shot femoral nerve block or local infiltration anesthesia for primary pain control. All patients underwent a standardized comprehensive rehabilitation program postoperatively...
October 9, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28960172/resting-state-functional-magnetic-resonance-imaging-for-surgical-planning-in-pediatric-patients-a-preliminary-experience
#12
Jarod L Roland, Natalie Griffin, Carl D Hacker, Ananth K Vellimana, S Hassan Akbari, Joshua S Shimony, Matthew D Smyth, Eric C Leuthardt, David D Limbrick
OBJECTIVE Cerebral mapping for surgical planning and operative guidance is a challenging task in neurosurgery. Pediatric patients are often poor candidates for many modern mapping techniques because of inability to cooperate due to their immature age, cognitive deficits, or other factors. Resting-state functional MRI (rs-fMRI) is uniquely suited to benefit pediatric patients because it is inherently noninvasive and does not require task performance or significant cooperation. Recent advances in the field have made mapping cerebral networks possible on an individual basis for use in clinical decision making...
September 29, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28936612/endotracheal-intubation-ultrasound-guided-versus-fiberscope-in-patients-with-cervical-spine-immobilization
#13
Moustafa Abdelaziz Moustafa, Emad A Arida, Ola M Zanaty, Sameh Fathy El-Tamboly
BACKGROUND: Ultrasound has growing applications in airway management during anesthesia. The aim of the present study was to evaluate the feasibility of real-time ultrasound-guided tracheal intubation in patients with cervical spine immobilization relative to fiberscope-guided tracheal intubation. PATIENTS AND METHODS: This randomized controlled study was carried out on 266 adult patients who have a rigid neck collar in place for cervical spine immobilization and were randomly allocated into two equal groups...
December 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28915967/the-concept-of-protective-nerve-stimulation-for-ultrasound-guided-nerve-blocks
#14
Martin Ertmer, Edda Klotz, Jürgen Birnbaum
Regional plexus and nerve blocks are a common technique in modern anesthesia. Since ultrasound machines are available in many departments, the role of nerve stimulation is highly discussed and different approaches to perform the blocks are taken into account. Common technique for electrical nerve stimulation is searching for a stimulating threshold of 0.4-0.5mA using an impulse width of 0.1ms. We present our hypothesis of using all possible information with a new concept of protective nerve stimulation together with first data supporting our theory...
September 2017: Medical Hypotheses
https://www.readbyqxmd.com/read/28883203/machine-learning-models-of-post-intubation-hypoxia-during-general-anesthesia
#15
Philipp Sippl, Thomas Ganslandt, Hans-Ulrich Prokosch, Tino Muenster, Dennis Toddenroth
Fine-meshed perioperative measurements are offering enormous potential for automatically investigating clinical complications during general anesthesia. In this study, we employed multiple machine learning methods to model perioperative hypoxia and compare their respective capabilities. After exporting and visualizing 620 series of perioperative vital signs, we had ten anesthesiologists annotate the subjective presence and severity of temporary post-intubation oxygen desaturation. We then applied specific clustering and prediction methods on the acquired annotations, and evaluated their performance in comparison to the inter-rater agreement between experts...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28840160/investigation-of-data-driven-optical-neuromonitoring-approach-during-general-anesthesia-with-sevoflurane
#16
Gabriela Hernandez-Meza, Meltem Izzetoglu, Ahmet Sacan, Michael Green, Kurtulus Izzetoglu
Anesthesia monitoring currently needs a reliable method to evaluate the effects of the anesthetics on its primary target, the brain. This study focuses on investigating the clinical usability of a functional near-infrared spectroscopy (fNIRS)-derived machine learning classifier to perform automated and real-time classification of maintenance and emergence states during sevoflurane anesthesia. For 19 surgical procedures, we examine the entire continuum of the maintenance-transition-emergence phases and evaluate the predictive capability of a support vector machine (SVM) classifier during these phases...
October 2017: Neurophotonics
https://www.readbyqxmd.com/read/28836107/neural-network-classifier-for-automatic-detection-of-invasive-versus-noninvasive-airway-management-technique-based-on-respiratory-monitoring-parameters-in-a-pediatric-anesthesia
#17
Jorge A Gálvez, Ali Jalali, Luis Ahumada, Allan F Simpao, Mohamed A Rehman
Children undergoing general anesthesia require airway monitoring by an anesthesia provider. The airway may be supported with noninvasive devices such as face mask or invasive devices such as a laryngeal mask airway or an endotracheal tube. The physiologic data stored provides an opportunity to apply machine learning algorithms distinguish between these modes based on pattern recognition. We retrieved three data sets from patients receiving general anesthesia in 2015 with either mask, laryngeal mask airway or endotracheal tube...
August 23, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28832896/end-tidal-control-vs-manually-controlled-minimal-flow-anesthesia-a-prospective-comparative-trial
#18
A J Wetz, M M Mueller, K Walliser, C Foest, S Wand, I F Brandes, R M Waeschle, M Bauer
BACKGROUND: To ensure safe general anesthesia, manually controlled anesthesia requires constant monitoring and numerous manual adjustments of the gas dosage, especially for low- and minimal-flow anesthesia. Oxygen flow-rate and administration of volatile anesthetics can also be controlled automatically by anesthesia machines using the end-tidal control technique, which ensures constant end-tidal concentrations of oxygen and anesthetic gas via feedback and continuous adjustment mechanisms...
November 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28809679/automatic-localization-of-the-needle-target-for-ultrasound-guided-epidural-injections
#19
Mehran Pesteie, Victoria Lessoway, Purang Abolmaesumi, Robert N Rohling
Accurate identification of the needle target is crucial for effective epidural anesthesia. Currently, epidural needle placement is administered by a manual technique, relying on the sense of feel, which has a significant failure rate. Moreover, misleading the needle may lead to inadequate anesthesia, post dural puncture headaches and other potential complications. Ultrasound offers guidance to the physician for identification of the needle target, but accurate interpretation and localization remain challenges...
August 11, 2017: IEEE Transactions on Medical Imaging
https://www.readbyqxmd.com/read/28752483/testing-of-anesthesia-machines-and-defibrillators-in-healthcare-institutions
#20
Lejla Gurbeta, Zijad Dzemic, Tamer Bego, Ervin Sejdic, Almir Badnjevic
To improve the quality of patient treatment by improving the functionality of medical devices in healthcare institutions. To present the results of the safety and performance inspection of patient-relevant output parameters of anesthesia machines and defibrillators defined by legal metrology. This study covered 130 anesthesia machines and 161 defibrillators used in public and private healthcare institutions, during a period of two years. Testing procedures were carried out according to international standards and legal metrology legislative procedures in Bosnia and Herzegovina...
September 2017: Journal of Medical Systems
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