Sustained erroneous near-infrared cerebral oxygen saturation in alert icteric patient with vanishing bile duct syndrome during and after liver transplantation: A case report

Monitoring cerebral oxygenation using a near infrared spectroscopy (NIRS) device is useful for estimating cerebral hypoperfusion and is available during liver transplantation (LT). However, high serum bilirubin concentration can interfere with NIRS because bilirubin absorbs near infrared light. We report a patient who underwent LT with a diagnosis of vanishing bile duct syndrome, whose regional cerebral oxygen saturation (rSO₂) remained below 15% even with alert mental status and SpO2₂ value of 99%. The rSO₂ values were almost fixed at the lowest measurable level throughout the intra- and postoperative period. We report a case of erroneously low rSO₂ values during the perioperative period in a liver transplant recipient which might be attributable to skin pigmentation rather than higher serum bilirubin concentration.

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.

Anesthetic management of a patient with bilateral common carotid and subclavian arteries occlusion using cerebral oximetry monitoring: A case report

The common carotid artery is an artery which supplies the head and neck with oxygenated blood. Although unilateral common carotid artery occlusion or bilateral internal carotid artery occlusion have been reported, the incidence of both common carotid artery occlusion is very rare. As previous report which reviewed 5400 carotid duplex ultrasonograms, 2.5% of internal carotid artery occlusion, 0.24% of unilateral common carotid artery occlusion and none of bilateral common carotid artery occlusion were reported. Common carotid and subclavian arteries are important in the blood supply to the vasculatures of head and upper extremities. Bilateral common carotid artery occlusion might be a cause of stroke, transient ischemic attack or other neurologic sequalae. Cerebral oximetry is a simple method of measuring regional cerebral oxygen saturation (rSO2), which appears to reflect changes in cerebral perfusion and it has been increasingly applicated in many clinical situations such as vascular surgeries involving head/ neck and operations adopting cardiopulmonary bypass. This case describes a successful anesthetic management in a patient with occlusion of bilateral common carotid and subclavian arteries using continuous cerebral oxygenation monitoring during laparoscopic cholecystectomy.

Repercussões oxi-hemodinâmicas do banho no paciente em estado crítico adulto hospitalizado: revisão sistemática / Repercusiones de la oxigenación hemodinámicas en el baño en el paciente en estado crítico adulto hospitalizado: revisión sistemática / Hemodynamic oxygenation effects during the bathing of hospitalized adult patients critically ill: systematic review

OBJETIVOS: identificar evidências científicas sobre as repercussões oxi-hemodinâmicas do banho no paciente adulto internado em estado crítico; verificar a possibilidade de estabelecimento de critérios para indicação do banho nesse paciente, com base em repercussões oxi-hemodinâmicas nas diferentes situações clínicas. MÉTODOS: Revisão sistemática da literatura primária e secundária, sem recorte temporal ou idiomático. Utilizada estratégia PIO: P (problema) = "Intensive Care Units" e variações; I (intervenção) = banho e variações; O (desfecho) = "Hemodynamic Phenomena" / "Oxygen Consumption" e variações. Fontes: bases de dados CINAHL, DEDALUS; EMBASE, COCHRANE, LILACS, PubMed/MEDLINE; bibliotecas das Escolas de Enfermagem da Universidade Federal Fluminense e Universidade Federal do Rio de Janeiro; referências cruzadas e; artigos relacionados do Pubmed e ISI. RESULTADOS: De 44597 referências restaram seis quase-experimentos. Durante o banho, a saturação venosa mista de oxigênio declinou consideravelmente do baseline, restabelecendo-se 30 minutos após. CONCLUSÃO: Condições que aumentam o risco: banho em menos de quatro horas após a cirurgia cardíaca, posicionamento prolongado em decúbito lateral e tempo de banho superior a 20 minutos: manutenção da temperatura da água em 40°C, para proteção.

OBJECTIVES: To identify scientific evidence on the impact of hemodynamic oxygenation of the bathing in the adult patient hospitalized in critical condition; to verify the possibility of establishing criteria for the indication of the bathing in that patient, based on hemodynamic effects of oxygenation in different clinical situations. METHODS: Systematic review of primary and secondary literature, without restriction of time or language. PIO strategy used: P (problem) = "Intensive Care Units" and variations, I (intervention) = bathing and variations; O (result) = "Hemodynamic Phenomena" / "Oxygen Consumption" and variations. Sources: CINAHL databases, Dedalus, EMBASE, COCHRANE, LILACS, PubMed / MEDLINE; libraries of Nursing Schools, Fluminense Federal University and Federal University of Rio de Janeiro; cross references, and, articles from PubMed and ISI. RESULTS: Of 44,597 references six quasi-experiments remained. During the bathing, mixed venous oxygen saturation declined significantly from baseline, being restored 30 minutes later. CONCLUSION: The conditions that increase risk are: bathing less than four hours after cardiac surgery, prolonged lateral decubitus positioning, and, bathing time exceeding 20 minutes: maintenance of water temperature at 40 ° C, for protection.

OBJETIVOS: identificar evidencias científicas sobre las repercusiones de la oxigenación hemodinámica del baño en el paciente adulto internado en estado crítico; verificar la posibilidad de establecimiento de criterios para indicación del baño en ese paciente, con base en repercusiones de oxigenación hemodinámica en las diferentes situaciones clínicas. MÉTODOS: Revisión sistemática de la literatura primaria y secundaria, sin recorte temporal o idiomático. Se utilizó la estrategia PIO: P (problema) = "Intensive Care Units" y variaciones; I (intervención) = baño y variaciones; O (resultado) = "Hemodynamic Phenomena" / "Oxygen Consumption" y variaciones. Fuentes: bases de datos CINAHL, DEDALUS; EMBASE, COCHRANE, LILACS, PubMed/MEDLINE; bibliotecas de las Escuelas de Enfermería de la Universidad Federal Fluminense y Universidad Federal de Rio de Janeiro; referencias cruzadas y; artículos relacionados del Pubmed y ISI. RESULTADOS: De 44597 referencias restaron seis casi-experimentos. Durante el baño, la saturación venosa mixta de oxígeno declinó considerablemente del baseline, restableciéndose 30 minutos después. CONCLUSIÓN: Condiciones que aumentan el riesgo: baño menos de cuatro horas después de la cirugía cardíaca, posicionamiento prolongado decúbito lateral y tiempo de baño superior a 20 minutos: manutención de la temperatura del agua en 40°C, para protección.

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.

Midazolam as Premedication for Upper Gastrointestinal Endoscopy / 대한소화기내시경학회지

The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.