Diastolic dysfunction associated with peri- and post-operative complications. Propofol and cardiovascular depression. Some studies report that propofol worsens diastolic function, others report improvement.
Assess the efficacy of ultrasound, a more accessible point of care modality, to describe the dimensions of the epidural space. Determine the reliability of ultrasound for measuring cervical and lumbar epiduralspaces for ESIs in chronic pain patients and compares these to MRI measurement.
Vertebral compression fractures (VCF) from trauma, osteoporosis, or pathologic reasons are a significant cause of severe pain and decreased functionality, both of which pose a considerable functional and financial burden to the patient.
SVV is the change in stroke volume during inspiration and expiration due to changes in intrathoracic pressure and consequent variations in venous return. SVV to assess fluid status and guide intraoperative fluid management. SVV utility was established using TV of 8 ml/kg while ARDSNet recommendations suggest 6 ml/kg is preferable.
Pulse oximetry is a ubiquitous measurement in health care used to assess oxygen perfusion status and guide oxygen therapy. There is ongoing discussion as to whether pulse oximetry measurements are accurate in patients with darker skin colors. A recent study showed higher rates of occult hypoxemia in Black patients compared to White patients, based on selfreported race. This report triggered an FDA Safety Communication emphasizing the interpretation and limitations of pulse oximetry particularly in monitoring of patients with COVID-19 infections. Race is not binary. There is a wide range of graded skin colors. We investigated this issue by evaluating correlations between skin color and occult hypoxemia using a retrospective review and a more discriminating assessment of skin color.
Continuous BP monitoring is essential to intraoperative care, as hypotensive events can significantly increase the risk of AKI, MI, and mortality post-op1,2 . The Hypotension Prediction Index (HPI) is a novel algorithm derived from machine learning that gives anesthesiologists the ability to predictive hypotensive events. The HPI derived from intra-arterial catheter monitoring has been shown to predict hypotensive events with sensitivity and specificity >80%3 . However, the utility and accuracy of the HPI when derived from non-invasive monitoring techniques, such the ClearSight finger cuff, have yet to be examined. This study seeks to compare the intraarterial catheter-derived HPI vs the ClearSight finger cuff-derived HPI, to see if it is viable tool for anesthesiologists to use when non-invasive monitoring is not indicated.
Maintaining accurate measurements ofsedation in the ICU are essential forpatient comfort, safety, and clinicaloutcomes. Current clinical sedation scales, such asthe Richmond Agitation-Sedation Scale(RASS) suffer from subjectivity and poorinter-rater reliability. Processed EEGs (pEEGs) may providea more objective and reliable alternativeto assess depth of sedation in ICUpatients. In this study, we conducted a systematicliterature review on 3 major pEEGs(Masimo Sedline, Bispectral Index, andNarcotrend) and their correlation withgold standard clinical sedation scales.
The ideal end-tidal concentration of anesthetic dose for a patient under general anesthesia is dynamic and depends on factors. At present, no individual brain function monitoring device has been shown to be substantially superior. Prior studies have attempted to compare the performance of these devices, but a lack of space and common placement locations compromises interpretation. The aim of this protocol is to examine the concordance between processed EEG indices (BIS and PSI) and anesthesia provider assessments across a range of anesthetic depths using a custom engineered interface box.
Split thickness skin grafts (STSG) are required for severe burns and pain is the most common cause of distress within the first year of the injury. Postoperative pain is challenging due to the painful surgical procedure performed and the dressing changes required. Poor pain control is concerning, as it has been associated with PTSD, anxiety, depression, and long-term alterations in pain processing. Currently, opioids are widely used to manage postoperative pain. While adequate pain control is essential, high dose and/ or prolonged use of opioids can also cause adverse effects to delay recovery, including sedation and tolerance. Neuraxial anesthesia administered intraoperatively is one approach to decrease postoperative pain and opioid use.
Electroencephalogram (EEG) monitoring has the potential to become a robust tool to characterize anesthetic depth. The goal is to develop a streamlined neuromonitoring tool that would allow clinicians to make real-time assessments and to titrate anesthetic delivery. Anesthetic overdosing can cause postoperative delirium and mortality, while underdosing can cause intraoperative awareness and pain. Of particular interest is excessively deep anesthesia, which is reflected by a burst suppression pattern on EEG monitors. Fortunately, proprietary algorithms have been developed to transform the raw EEG waveforms into a dimensionless number that quantifies the patient’s level of consciousness. Examples of these monitors are the Bispectral Index (BIS) monitor and the Sedline monitor which produces patient state index (PSI) values.
Question: How do the PSI (SedLine) and BIS perform in the setting of imminent burst suppression during general anesthesia?
