Abstract:
:The respiratory variations in the plethysmographic (PLET) waveform of the pulse oximeter during mechanical ventilation can be automatically quantified as the PLET variation index (PVI(®)). Like other dynamic variables, the PVI may provide useful information about fluid responsiveness but only when the patient is receiving fully controlled mechanical ventilation with no spontaneous breathing activity. However, a growing number of monitors that automatically measure and display the values of the PVI and other dynamic variables are being introduced into clinical practice. Using these monitors in spontaneously breathing patients may cause inadequately trained personnel to make erroneous decisions or may eventually lead to a total disregard of dynamic parameters altogether. The aim of this study is to call attention to the fact that excessive variations in the PVI during spontaneous ventilation, termed sPVI, should not be regarded as artifactual since they may be an early important sign of upper airway obstruction (UAO). Among the monitor screen shots that were stored for educational purposes, I have identified 4 screen shots of patients who were clinically diagnosed as having significant UAO. In all instances, UAO was associated with prominent variations in the PLET waveform. These variations were calculated as the difference between the maximal and minimal amplitudes of the PLET signal divided by either the maximal amplitude (sPVI) or by the mean of the 2 values (ΔPOP). The ranges of the measured ΔPOP and sPVI values during UAO were 28% to 42% and 25% to 39%, respectively. These values are 2 to 3 times higher than the range of 9.5% to 15% that was repeatedly found as the best threshold for the identification of fluid responsiveness in mechanically ventilated patients. In 2 of these cases, simultaneously measured values of the pulse pressure variation were high as well (19% and 34%), while the calculated pulsus paradoxus was 28 and 40 mm Hg. In 2 cases, the analog signals of impedance plethysmography and capnography persisted, despite the presence of clinically significant UAO. It is, therefore, suggested that monitoring the sPVI may be of great clinical importance in spontaneously breathing patients who are susceptible to develop UAO.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Perel Adoi
10.1213/ANE.0000000000000378subject
Has Abstractpub_date
2014-12-01 00:00:00pages
1288-92issue
6eissn
0003-2999issn
1526-7598pii
00000539-201412000-00015journal_volume
119pub_type
杂志文章abstract::Anecdotal reports suggest that soda lime and Baralyme brand absorbent can degrade inhaled anesthetics to carbon monoxide (CO). We examined the factors that govern CO production and found that these include: 1) The anesthetic used: for a given minimum alveolar anesthetic concentration (MAC)-multiple, the magnitude of C...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199506000-00021
更新日期:1995-06-01 00:00:00
abstract:BACKGROUND:The arterial pulse oximeter, which was introduced clinically in the 1970s, is a convenient, useful, and now ubiquitous anesthesia monitor. Unfortunately, although percent saturation of arterial hemoglobin is, along with cardiac output and concentration of hemoglobin, one of 3 components of oxygen delivery, i...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182166a26
更新日期:2011-06-01 00:00:00
abstract::The primary outcome of this 8-year retrospective review was the failure of spinal anesthetic (SA) in elective hip and knee joint arthroplasty surgery. Of 3542 SAs, a total of 135 failures were identified (3.8%). Factors associated with increased odds of failure were younger age (odds ratio [OR], 1.03; 95% confidence i...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0000000000004304
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Implementation of initiatives to increase anesthesia group productivity depends not just on anesthesia groups, but on operating room (OR) nursing administration. OR nursing directors may encourage organizational change based on the needs of their hospitals and nurses. These changes may differ from those that...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e31818874a8
更新日期:2008-12-01 00:00:00
abstract::An investigation was made of the analgesic effects of the subcutaneous coadministration of fentanyl, an opioid mu-agonist (15 micrograms/kg), clonidine, an alpha 2-agonist (100 micrograms/kg), and verapamil, a calcium channel blocker (10 mg/kg) in rats. Nociceptive sensitivity was assessed with hot-plate and tail-flic...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract:BACKGROUND:The intrathoracic blood volume index (ITBVI) and central venous pressure (CVP) are routinely used to predict fluid responsiveness in critically ill patients with acute circulatory failure (systolic blood pressure < 90 mm Hg or vasopressor requirement). However, they have never been compared. METHODS:In this...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e31817e6618
更新日期:2008-08-01 00:00:00
abstract::We studied 60 children undergoing elective surgery to evaluate the effect of interactions between vecuronium and isoflurane or halothane on the potency and duration of neuromuscular blockade, as measured by electromyography. Vecuronium was first administered by a logarithm-based cumulative method (14, 22, 35, 56, 89 m...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/00000539-199003000-00003
更新日期:1990-03-01 00:00:00
abstract:UNLABELLED:Diabetic patients are at increased risk of wound infection after major surgery, but the effect of perioperative glucose control on postoperative wound infection rates after surgery is uncertain. We tested the effect of an insulin infusion on perioperative neutrophil function in diabetic patients scheduled fo...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199905000-00008
更新日期:1999-05-01 00:00:00
abstract::We tested the hypothesis that once thermoregulatory vasoconstriction is triggered at a given core temperature during isoflurane anesthesia, redilation starts at a substantially higher core temperature. To avoid direct perception of cutaneous cooling and warming, we used epidural anesthesia and limited our thermal mani...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199310000-00027
更新日期:1993-10-01 00:00:00
abstract::The average duration of hospitalization after total knee arthroplasty (TKA) in the United States is 4-5 days. In this two-phase study we investigated the feasibility of converting TKA into an overnight-stay procedure using a continuous femoral nerve block provided at home through postoperative day 4. Nine of 10 patien...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000189562.86969.9f
更新日期:2006-01-01 00:00:00
abstract::Repeated conventional tracheal intubation attempts may contribute to patient morbidity. Critically-ill patients (n = 2833) suffering from cardiovascular, pulmonary, metabolic, neurologic, or trauma-related deterioration were entered into an emergency intubation quality improvement database. This practice analysis was ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000122825.04923.15
更新日期:2004-08-01 00:00:00
abstract::To compare unilateral spinal block produced with small doses of hyperbaric ropivacaine with that produced by 2 doses of hyperbaric levobupivacaine, we randomly allocated 91 ASA physical status I-II outpatients undergoing knee arthroscopy to receive unilateral spinal anesthesia with 7.5 mg of hyperbaric ropivacaine 0.5...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ANE.0000155265.79673.56
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:The safety and adverse event rate of supraglottic airway (SGA) devices for cesarean delivery (CD) is poorly characterized. The primary aims of this review were to determine whether the first-pass success was higher and time to insertion for SGA was faster than endotracheal intubation for elective CD. The sec...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,meta分析
doi:10.1213/ANE.0000000000004618
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:We studied the effects that the lung recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) have on the elimination of CO(2) per breath (Vtco(2,br)). METHODS:In 7 healthy and 7 lung-lavaged pigs at constant ventilation, PEEP was increased from 0 to 18 cm H(2)O and then decreased to 0 in steps...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181f0c2da
更新日期:2010-10-01 00:00:00
abstract:BACKGROUND:Sedatives and analgesics, in doses that alter consciousness in the intensive care unit (ICU), contribute to delirium and mortality. Pain, agitation, and delirium can be monitored in ICU patients. These symptoms were noted before (PRE) and after (POST) a protocol to alleviate undesirable symptoms. Analgesia a...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181d7e1b8
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:A predictive model that can identify patients who are at an increased risk for prolonged postanesthesia care unit (PACU) stay could help optimize resource utilization and case sequencing. Although previous studies identified some predictors, there is not a model that only utilizes various patients demographi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001827
更新日期:2017-05-01 00:00:00
abstract::Single channel recordings have shown that ketamine (Ket) decreases the open time of the nicotinic acetylcholine receptor channel (nAChR). The present experiments on simultaneous openings of the nAChRs of mouse myotubes investigate the interaction of Ket with the open as well as with the closed state of the channels. T...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199610000-00031
更新日期:1996-10-01 00:00:00
abstract:BACKGROUND:We evaluated the interaction of dopamine-proxymetacaine and dopamine- oxybuprocaine antinociception using isobolograms. METHODS:This experiment uses subcutaneous drug (proxymetacaine, oxybuprocaine, and dopamine) injections under the skin of the rat's back, thus simulating infiltration blocks. The dose-rela...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000002635
更新日期:2018-05-01 00:00:00
abstract::We present a case of extreme hemodilution in which appropriately crossmatched blood was not available. A 53-year-old man was admitted to our hospital because of hemorrhagic shock due to multiple stab wounds. His blood type was B, Rh negative, and his intravascular fluid volume was maintained with balanced salt solutio...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181e668b8
更新日期:2010-11-01 00:00:00
abstract:UNLABELLED:Nitric oxide (NO) may play an important role in central and peripheral nociceptive processes. However, its contribution to peripheral antinociception is still not clear. In the present study, we investigated the effect of peripherally administered FK409, a spontaneous NO releaser, and its interaction with pe...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199802000-00028
更新日期:1998-02-01 00:00:00
abstract:BACKGROUND:We have previously reported that hemorrhagic shock decreases the minimum alveolar anesthetic concentration (MAC) of isoflurane but minimally alters the electroencephalographic (EEG) effect. In this study, we investigated the influence of endotoxemia on the EEG effect and the MAC of isoflurane. METHODS:Eight...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181c22146
更新日期:2010-01-01 00:00:00
abstract::The alpha 2-adrenergic receptor agonist dexmedetomidine produces an anesthetic state in a variety of species. Although its effects on cerebral blood flow and the electroencephalogram have been investigated, the effect of this drug on intracranial pressure (ICP) has not been reported previously. Dexmedetomidine therefo...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199208000-00014
更新日期:1992-08-01 00:00:00
abstract::Fire in the operating room is a rare but potentially devastating event. In this case report, we describe 2 separate fires of a Westmed heated humidification circuit. We conducted a detailed analysis of potential causes of the fires, including a simulation and series of experiments. Our conclusions were (1) a combinati...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181ee8092
更新日期:2010-12-01 00:00:00
abstract:UNLABELLED:The transient hyperemic response (THR) test has been used to assess cerebral autoregulation in anesthesia and intensive care. To date it has not been compared with the static autoregulation test for assessing graded changes in cerebral autoregulation. We compared the two tests during propofol, desflurane, an...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-200107000-00034
更新日期:2001-07-01 00:00:00
abstract::Computer-based measuring of the level of sedation and hypnosis is difficult and has proven to be challenging. The electroencephalogram (EEG) has been proposed as a potential method. Response entropy (RE) and state entropy (SE) are multifactor, dimensionless parameters of a new technology of EEG monitoring, and we inve...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/01.ane.0000217188.71710.47
更新日期:2006-06-01 00:00:00
abstract::Forty neonates delivered by cesarean section were studied, half being delivered of mothers in whom anesthesia was induced with midazolam (0.3 mg/kg intravenously) and half of mothers given thiopental (4 mg/kg). At delivery, blood samples from mother and the umbilical vein were drawn for determination of plasma concent...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1989-03-01 00:00:00
abstract::In this review article, we address issues related to using data from anesthesia information management systems (AIMS) to deliver near real-time alerts via AIMS workstation popups and/or alphanumeric pagers and post hoc reports via e-mail. We focus on reports and alerts for influencing the behavior of anesthesia provid...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000000677
更新日期:2015-09-01 00:00:00
abstract::The management of postoperative nausea and vomiting (PONV) remains a persistent problem. Despite the use of prophylactic antiemetics, breakthrough nausea and vomiting still frequently occur. There have been no published studies comparing dolasetron and ondansetron for the treatment of PONV. This was a prospective, ran...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ANE.0000144421.96275.D1
更新日期:2005-02-01 00:00:00
abstract:UNLABELLED:The Valsalva maneuver in the awake patient and the ventilation maneuver in the tracheally intubated anesthetized patient are two provocation methods to detect a patent foramen ovale (PFO) by means of contrast transesophageal echocardiography. In 60 patients undergoing posterior fossa surgery, a contrast agen...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200105000-00006
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:Patients with lung failure who undergo prone positioning often receive extended hemodynamic monitoring. We investigated the influence of modified prone positioning (135°) on the accuracy of pulse contour-derived calibrated cardiac index (CIPC) and uncalibrated cardiac index (CIVIG) in this patient population...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31827fe77e
更新日期:2013-04-01 00:00:00