Use of esophageal or precordial stethoscopes by anesthesia providers: Are we listening to our patients?

Prielipp, Richard C.; Kelly, Jeffrey S.; Roy, Raymond C.

doi:10.1016/0952-8180(95)00027-f

Cited by 32 publications

(6 citation statements)

References 26 publications

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“…11 On the other hand, the stethoscope has been defended as a simple and inexpensive instrument which extends the senses of anaesthesists, who are in fact the most important monitor in themselves. 10,27…”

Section: Discussionmentioning

confidence: 99%

Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial

Somri¹,

Matter²,

Hadjittofi³

et al. 2017

Journal of Clinical Pediatric Dentistry

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Section: Discussionmentioning

confidence: 99%

Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial

Somri¹,

Matter²,

Hadjittofi³

et al. 2017

Journal of Clinical Pediatric Dentistry

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“…Although esophageal stethoscopes have been used for 60 years for continuous auscultation during general anesthesia [4,15,16,17], studies investigating phonocardiographic data as intraoperative hemodynamic parameters or continuous monitoring modalities are still limited. In our previous study, we suggested that intra-operative monitoring of phonocardiogram may provide useful information for non-invasive hemodynamic index [8].…”

Section: Discussionmentioning

confidence: 99%

Beat-to-Beat Tracking of Pulse Pressure and Its Respiratory Variation Using Heart Sound Signal in Patients Undergoing Liver Transplantation

Park

Moon

Kim

et al. 2019

JCM

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Purpose: To investigate the possibility of esophageal phonocardiography as a monitor for invasively measured pulse pressure (PP) and its respiratory variation (PPV) in patients undergoing liver transplantation. Methods: In 24 liver transplantation recipients, all hemodynamic parameters, including PP and PPV, were measured during five predetermined surgical phases. Simultaneously, signals of esophageal heart sounds (S1, S2) were identified, and S1–S2 interval (phonocardiographic systolic time, PST) and its respiratory variation (PSV) within a 20-s window were calculated. Beat-to-beat correlation between PP and its corresponding PST was assessed during each time window, according to the surgical phases. To compare PPV and PSV along with 5 phases (a total of 120 data pairs), Pearson correlation was conducted. Results: Beat-to-beat PST values were closely correlated with their corresponding 3360 pairs of PP values (median r = 0.568 [IQR 0.246–0.803]). Compared with the initial phase of surgery, correlation coefficients were significantly lower during the reperfusion period (median r = 0.717 [IQR 0.532–0.886] vs. median r = 0.346 [IQR 0.037–0.677]; p = 0.002). The correlation between PSV and PPV showed similar variation according to the surgical phases (r = 0.576 to 0.689, p < 0.05, for pre-reperfusion; 0.290 to 0.429 for the post-reperfusion period). Conclusions: Continuous monitoring of intraoperative PST with an esophageal stethoscope has the potential to act as an indirect estimator of beat-to-beat arterial PP. Moreover, PSV appears to exhibit a trend similar to that of PPV with moderate accuracy. However, variation according to the surgical phase limits the merit of the current results, thereby necessitating cautious interpretation.

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“…It took an average of 87 additional seconds to obtain an accurate capnography value compared to PTS auscultation. Second, when placed correctly, the PTS provides immediate acoustic feedback about upper airway caliber and airflow . This is particularly important, as partial or complete airway obstruction is the most common serious sedation‐related adverse event during propofol sedation in children .…”

Section: Discussionmentioning

confidence: 99%

The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children

Boriosi

Zhao

Preston

et al. 2019

Pediatric Anesthesia

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Background: Monitoring of ventilation with capnography or a stethoscope is recommended because the detection of ventilatory abnormalities can be significantly delayed by the use of pulse oximetry alone in patients receiving supplemental oxygen.The aim of this study was to evaluate the diagnostic performance of the pretracheal stethoscope with pulse oximetry and capnography in detecting adverse respiratory events during propofol sedation in nonintubated children. We hypothesized that use of the pretracheal stethoscope would facilitate earlier detection of adverse respiratory events. Methods:This was a prospective observational study of children undergoing procedural sedation at a pediatric sedation program. A pretracheal stethoscope, pulse oximetry, and nasal capnography were attached at the discretion of the sedation nurse and provider to monitor ventilation. Results:We enrolled 104 patient encounters (mean recorded time, SD 8.3 ± 5.3 minutes) from February, 2015 to March, 2017. The pretracheal stethoscope was the first monitor to detect adverse events in 64% (25/39) of patients compared to 18% (7/39) for capnography and 15% (6/39) for pulse oximetry. Auscultation performed best at detecting upper airway obstruction but capnography and pulse oximetry performed best at detecting hypoventilation. The positive predictive value for detecting a true ventilation abnormality and 95% CI of the pretracheal stethoscope, pulse oximetry, and capnography was 100% (90%-100%), 18% (10%-31%), and 27% (18%-38%), respectively. The negative predictive value and 95% CI of the pretracheal stethoscope, pulse oximetry, and capnography was 88% (82%-92%), 68% (59%-75%), and 70% (61%-78%), respectively. Limitations are short observation time, nonstandardized application of respiratory monitors, and too much focus on auscultation. Conclusion:A pretracheal stethoscope in conjunction with capnography and pulse oximetry detects most sedation-related adverse events first. Auscultation performed best at detecting upper airway obstruction but capnography and pulse oximetry performed best at detecting hypoventilation. K E Y W O R D S anesthesia, auscultation, capnography, oximetry, propofol, stethoscopes S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Boriosi JP, Zhao Q, Preston A, Hollman GA. The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children.

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Use of esophageal or precordial stethoscopes by anesthesia providers: Are we listening to our patients?

Cited by 32 publications

References 26 publications

Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial

Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial

Beat-to-Beat Tracking of Pulse Pressure and Its Respiratory Variation Using Heart Sound Signal in Patients Undergoing Liver Transplantation

The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children

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