Postanesthesia monitoring revisited: Frequency of true and false alarms from different monitoring devices

Wiklund, Lars; Hök, Bertil; Ståhl, Kristina; Jordeby-Jönsson, A

doi:10.1016/0952-8180(94)90056-6

Cited by 83 publications

(39 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is a common phenomenon occurring in 45% of intensive care patients 34 and accounting for 77% of alarms from pulse oximeters in the post-anesthesia care unit. 35 As algorithms for ''on-line'' quantitative PPG waveform analysis have only recently become available in new generation pulse oximeters (Masimo SET, Masimo Corporation, Irvine, CA, USA), waveforms were recorded without a real time waveform display and were subsequently analyzed ''off-line,'' by which time it was not possible to improve data signal quality. Although vascular disease and shock states may increase the likelihood of this phenomenon to some degree, both were a priori exclusion criteria in this study.…”

Section: Discussionmentioning

confidence: 99%

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Ginosar

Weiniger

Kurz

et al. 2009

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose We tested the hypothesis that the development of sympathectomy-mediated vasodilatation is dependent on the concentration rather than the dose of epidural local anesthetic administered. Methods Sixty subjects receiving lumbar epidural bupivacaine were randomised to one of three groups: A: 10 ml 0.5% (50 mg); B: 10 ml 0.25% (25 mg); and C: 40 ml 0.0625% (25 mg). Groups A and B had equal volume but a twofold difference in drug dose, while groups B and C had equal drug dose, but a fourfold difference in drug volume. At baseline and 5, 10, and 20 min following epidural bupivacaine administration, we assessed the following indices of sympathectomy: pulse oximeter perfusion index in the toe and finger, skin temperature in the toe and finger, and mean arterial pressure. We also assessed sensory level (pinprick, cold, and light touch) and motor block. Results There was an increase in the pulse oximeter perfusion index by 20 min of 280%, 303%, and 59% in groups A, B, and, C, respectively. There was a significant sympathectomy-mediated vasodilatation in the toe for both groups A (P = 0.002) and B (P \ 0.001) but not C (P = 0.22). Vasoconstriction in the finger was observed in group A only (P = 0.015) but not in group B (P = 0.09) or group C (P = 0.20). There were similar blood pressure changes and similar sensory changes in all groups. The intensity of motor block increased with increasing drug concentration. Conclusions Our observations suggest that drug concentration is more important than drug dose in determining the degree of sympathectomy following lumbar epidural local anesthesia. RésuméObjectif Nous avons teste´l'hypothe`se selon laquelle l'apparition d'une vasodilatation me´die´e par sympathectomie e´tait lie´e à la concentration plutôt qu'a`la dose d'anesthe´sique local pe´ridural administre´. Méthode Soixante patients recevant de la bupivacaı¨ne pe´ridurale lombaire ont e´te´randomise´s en trois groupes : A : 10 ml 0,5 % (50 mg); B : 10 ml 0,25 % (25 mg); et C : 40 ml 0,0625 % (25 mg). Les groupes A et B ont reçu un volume e´quivalent mais la dose de me´dicament e´tait double´e pour le groupe A, alors que les groupes B et C ont reçu une dose e´gale, mais le volume de me´dicament a e´teq uadruple´pour le groupe C. Nous avons e´value´les indices de sympathectomie suivants aux niveaux de base ainsi qu'a5 , 10 et 20 minutes apre`s l'administration de la bupivacaı¨ne pe´ridurale : indice de perfusion de l'oxyme`tre de pouls a`l'orteil et au doigt, tempe´rature cutane´e à l'orteil et au doigt, et tension arte´rielle moyenne. Nous avons e´galement e´value´le niveau sensoriel (piquˆre a`l'aiguille, froid et toucher le´ger) et le bloc moteur. Résultats Sur la base de l'indice de perfusion de l'oxyme`tre de pouls, nous avons observe´une vasodilatation 123Can J Anesth/J Can Anesth (2009) 56:213-221 DOI 10.1007 me´die´e par sympathectomie significative dans l'orteil pour les groupes A (P = 0,002) et B (P \ 0,001) mais pas dans le groupe C (P = 0,22). La vasoconstriction au doigt a e´teó bserve´e uniquement ...

show abstract

Section: Discussionmentioning

confidence: 99%

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Ginosar

Weiniger

Kurz

et al. 2009

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…2 In its bronchiolitis guidelines, the American Academy of Pediatrics emphasized the uncertain role for CPOx in the inpatient setting, citing risk of prolonged hospital stay resulting from "perceived need for supplemental oxygen." 3 Studies in adults have also highlighted the contribution of CPOx to alarm counts on units, [4][5][6][7][8] which the Joint Commission has emphasized as a patient safety issue. 9,10 Despite evidence highlighting the limitations and lack of value, CPOx 12 emphasizing the lack of evidence and waste involved in its widespread use.…”

Section: Discussionmentioning

confidence: 99%

Using Quality Improvement to Reduce Continuous Pulse Oximetry Use in Children With Wheezing

Schondelmeyer¹,

Simmons²,

Statile³

et al. 2015

Pediatrics

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: Clinicians commonly use continuous pulse oximetry (CPOx) for hospitalized children with respiratory illnesses. The Choosing Wisely initiative recommended discontinuing CPOx for children on room air. We used quality improvement methods to reduce time on CPOx in patients with wheezing.METHODS: Our project took place on 1 unit of a children's hospital. We developed consensus-based criteria for CPOx discontinuation. Interventions included education, a checklist used during nurse handoff, and discontinuation criteria incorporated into order sets. We collected data on a second unit where we did not actively intervene to assess for secular trends and negative consequences of shorter monitoring. We followed time until medically ready, ICU transfers, hospital revisits, and medical emergency team calls on both units. We tracked the impact of interventions by using run charts and statistical process control charts.

show abstract

“…During postoperative care, respiratory status can be assessed, for example, with capnometry, pulse oximetry, oxygen saturation (SpO2) measurements, blood gas measurements, subjective clinical assessment and intermittent, manual measurements of respiratory rate [5,9]. The problems with current methods are that they have poor accuracy, precision, low patient tolerance and they are liable to false alarms [10,11]. Additionally, they are slow and especially subjective methods are unreliable and give inconsistent results [12].…”

Section: Introductionmentioning

confidence: 99%

Continuous Postoperative Respiratory Monitoring with Calibrated Respiratory Effort Belts: Pilot Study

Seppänen

Alho

Vakkala

et al. 2017

Biomedical Engineering Systems and Technologies

View full text Add to dashboard Cite

Abstract. Postoperative respiratory complications are common in patients after surgery. Respiratory depression and subsequent adverse outcomes can arise from pain, residual effects of drugs given during anaesthesia and administration of opioids for pain management. There is an urgent need for a continuous, realtime and non-invasive respiratory monitoring of spontaneously breathing postoperative patients. For this purpose, we used rib cage and abdominal respiratory effort belts for the respiratory monitoring pre-and postoperatively, with a new calibration method that enables accurate estimates of the respiratory airflow waveforms even when breathing style changes. Five patients were measured with respiratory effort belts and mask spirometer. Preoperative measurements were done in the operating room, whereas postoperative measurements were done in the recovery room. We compared five calibration models with pre-and postoperative training data. The postoperative calibration approach with two respiratory effort belts produced the most accurate respiratory airflow waveforms and tidal volume, minute volume and respiratory rate estimates. Average results for the best model were: coefficient of determination R 2 was 0.91, tidal volume error 5.8 %, minute volume error 8.5 % and BPM (Breaths per Minute) error 0.21. The method performed well even in the following challenging respiratory cases: low airflows, thoracoabdominal asynchrony and hypopneic events. It was shown that a single belt measurement can be sufficient in some cases. The proposed method is able to produce estimates of postoperative respiratory airflow waveforms to enable accurate, continuous, real-time and noninvasive respiratory monitoring postoperatively. It provides also potential to optimize postoperative pain management and enables timely interventions.

show abstract

Postanesthesia monitoring revisited: Frequency of true and false alarms from different monitoring devices

Cited by 83 publications

References 12 publications

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Using Quality Improvement to Reduce Continuous Pulse Oximetry Use in Children With Wheezing

Continuous Postoperative Respiratory Monitoring with Calibrated Respiratory Effort Belts: Pilot Study

Contact Info

Product

Resources

About