The Urgency of Redifining Minimum Monitoring Standards in Anesthesia.

Anesthesiology is an intense discipline, which entails unexpected, often life threatening complications, requiring immediate recognition and prompt intervention. It is essential to have uniform standards of monitoring irrespective of location, duration and type of anesthesia. The Indian Society of Anesthesiologists (ISA) in 1998 started preparing guidelines suited for indian conditions and presented these in 1999. The 1999 ISA guidelines have outlived and there is an urgent need to update the currently applicable guidelines. These guidelines of ISA are under revision since April 2007. Keeping in view of developments in the field, medically complex patients, training methods of present day trainees and CPA needs, updated guidelines should include additional monitoring techniques and precautions.

Pulse Oximetry: A New Tool in Pulpal Vitality Testing.

Over the years, the thermal and electrical tests have been considered to be a suitable means of assessing the vascularity and vitality of the tooth pulp. Pulse oximetry is an effective, objective, oxygen saturation monitoring technique broadly used in medicine for recording blood oxygen saturation levels. It can also be used in endodontics for differential diagnosis of vital pulps and necrotic ones. However, there are some limitations inherent in the technology of pulse oximetry, such as the effect of increased acidity and metabolic rate, which causes deoxygenating of hemoglobin and changes in blood oxygen saturation, also movements of the body or probe can complicate readings. This test produces no noxious stimuli, therefore, apprehensive or distressed patients may accept it more readily than routine methods. A review of the literature and a discussion of the potential application of this system in endodontics is presented.

The Continuous Monitoring of Oxygen Saturation During Fiberoptic Bronchoscopy / 결핵

BACKGROUND: Flexible fiberoptic bronchoscopy(FFB) has become a widely performed technique for diagnosing and managing pulmonary disease because of its low complication and mortality rate. Since the use of FFB in p atients with severely depressed cardiorespiratory function is increasing and hypoxemia during the FFB can induce significant cardiac arrhythmias, the early detection and adequate management of hypoxemia during FFB is clinically important. METHODS: To evaluate the necessity of the continuous monitoring of the oxygen saturation(SaO2) during the FFB, the SaO2 was continuously monitored from the finger tip using pulse oximetry before, during and after the FFB in 379 patiets. The patients were then divided into two groups, those with and without hypoxemia (SaO2<90%). The baseline pulmonary function data and the clinical characteristics of the two groups were compared. RESULTS: The mean baseline SaO2 was 96.9+/-2.85%. An SaO2<90% was recorded at some point in 62(16.4%) out of 379 patients, with 12 out of 62 experiencing this prior to the FFB, in 37 out of 62 during the FFB, and in 13 out of 62 after the FFB. No differences were observed in the smoking and sex distribution between those with and without hypoxemia. The mean age was older in those with hypoxemia than those without. Significant differences were observed in the mean baseline SaO2 and the mean time for the procedure between the two groups. The FEV1 was significantly lower in those with hypoxemia, and both the FVC and FEV1/FVC also tended to decrease in this group. Managing hypoxemia included deep breathing in 20 patients, a supplemental oxygen supply in 39 patients, and the abortion of the procedure in 3 patients. CONCLUSIONS: These results suggest that the continuous monitoring of th oxygen saturation is necessary during fiberoptic bronchoscopy, and it should be performed in patients with a depressed pulmonay function in order for the early detection and adequate management of hypoxemia.

The Comparison of Buccal SpO2 and Finger SpO2 Accuracy in Patients with Moderate Defect in Pulmonary Function Test / 대한구급학회지

BACKGROUND: The reliability of pulse oxymetry probes when applied to the finger or toes may be compromised in certain patients. Other sites less subject to mechanical interference or a pathophysiologic decrease in pulse amplitude have been sought. In the patients with moderate defect (N=20) in pulmonary function test, we examined the accuracy of buccal and digital SpO2 (oxygen saturation of pulse oxymetry) monitoring. METHODS: SpO2 probe was placed firmly in the corner of the patient's mouth. Buccal and finger SpO2 and radial SaO2 (arterial oxygen saturation) were measured before the induction of anesthesia. The agreement between SaO2 and each SpO2 were calculated with the method outlined by Bland and Altman. RESULTS: Buccal SpO2 was higher than finger SpO2, but finger SpO2 agreed more closely with SaO2 (buccal; 97.9+/-1.89, finger; 94.5+/-2.48, radial; 93.73+/-2.73%). CONCLUSIONS: We conclude that buccal SpO2 monitoring may offer alternative when other sites aren't available. But, we suggest that buccal SpO2 should be further evaluated for the accuracy.