International journal of clinical monitoring and computing最新文献

The aim of the study was to investigate whether peripheral nerve dysfunction can influence the applicability of the DATEX Relaxograph in diabetics. Sixty two patients (43 diabetics, 19 non-diabetics) undergoing ophthalmosurgical procedures under general anesthesia were tested. The distal motor latency (DML) of the ulnar nerve served as a graduation tool for peripheral nerve dysfunction. The patients were divided in three groups: non-diabetics (group 1), diabetics with DML < 3.8 msec (group 2), diabetics with DML > 3.8 msec (group 3). Relaxometry was performed by stimulating the right ulnar nerve near the wrist, and the evoked response (EMG) was obtained from the hypothenar muscle. Calibration of the device (i.e. supramaximal stimulation within the given current range of a maximum of 70 mA) was carried out successfully in most patients of group 1 and 2 (94.7% and 85.7% respectively). In contrast to that calibration could be carried out in only 40.9% of the patients of group 3 (P < 0.01 vs. group 1 and 2). Consequently in a high percentage (59.1%) of the patients of group 3 relaxometry had to be performed in an uncalibrated manner. The results substantiate the hypothesis that peripheral nerve dysfunction can restrict the applicability of the Relaxograph in diabetics.

Routine application of 'rule of thumb' parameter sets in clinical practice pushes model visions to the background, including the complete framework of assumptions, simplifications, suppositions and conditions. But: models can be very strong tool, when applied selectively--that means, with a clear idea of destination, definition, parameter selection and verification. This article discusses universal issues of modelling--based on ventilation mechanics models in intensive care medicine.

Background: Systems for computerization of anesthesia records have typically been 'stand-alone' computers many times connected to monitoring devices in the operating theater. A system was developed and tested at LDS Hospital in Salt Lake City, Utah, USA that was an integral part of the Health Evaluation through Logical Processing (HELP) hospital information system.

Methods: The system was evaluated using time and motion studies to assess impact of the system on the anesthesiologists use of time, an assessment for completeness of the anesthesia record was conducted, and a questionnaire was used to assess anesthesiologists attitudes. Timing studies were performed on 44 surgical cases before computerization and 41 surgical cases after computerization. For both before and after computerization, about 80% of procedures were D&C, vaginal hysterectomy, laparoscopy, tubal ligation, or A&P repair.

Results: The study showed a major reduction in time required for charting from 20.4% to 13.4% which was statistically significant (p = 0.0001). Other significant factors were a reduction in the time spent scanning the entire area which dropped from 10.5% to 5.6% (p = 0.001), patient preparation time increased from 10.1% to 13.1% (p = 0.02), the time spent arranging equipment increased from 6.4% to 8.1%, and the average time spent on non-anesthesia activities increased from 6.3% to 11.3%. The computerized anesthesia record was more legible, and complete than the manual record. The overall assessment of computer charting by anesthesiologists questionnaire was positive. The computerized anesthesia charting was preferred by the anesthesiologists, who, after one or two training sessions, used the system on their own.

Conclusions: It appears that having a computerized anesthesia charting system that is an integral part of a hospital information system not only saves anesthesiologists charting time, but also improves the quality of the record and was well accepted by busy private practice anesthesiologists.

To survey the routine use of bedside multivariable monitors in monitoring cardiac postoperative patients, 23 experienced anesthesiologists and cardiac surgeons were first asked to list which variables and what limit alarms they used. Then they defined to what extent the variables' values were allowed to deviate before therapeutic actions were needed. Typically, limit alarms were applied to heart rate and end-tidal CO2. For clinical assessment of a patient's state, the clinicians usually observed the heart rate and the systemic arterial blood pressures, but placed less emphasis on the pulmonary arterial pressures. Clinicians had similar opinions on alert limits for monitoring less extensive physiological deviations and on alarm limits for warning of a critical situation. Person-to-person tolerance of suboptimal monitored values varied. No correlation was found between the limit values and how long these values were tolerated without therapeutic response. However, the inquiry provided information on setting limits for alerts and alarms, and on experienced clinicians' decision-making during postoperative intensive care of cardiac patients.