30 research outputs found
Washout and Awakening Times after Inhaled Sedation of Critically Ill Patients: Desflurane Versus Isoflurane
In recent years, inhaled sedation has been increasingly used in the intensive care unit
(ICU). The aim of this prospective, controlled trial was to compare washout and awakening times
after long term sedation with desflurane and isoflurane both administered with the MIRUSâ„¢ system
(TIM GmbH, Koblenz, Germany). Twenty-one consecutive critically ill patients were alternately
allocated to the two study groups, obtaining inhaled sedation with either desflurane or isoflurane.
After 24 h study sedation, anesthetic washout curves were recorded, and a standardized wake-up
test was performed. The primary outcome measure was the time required to decrease the endtidal
concentration to 50% (T50%). Secondary outcome measures were T80% and awakening times (all
extremities moved, RASS −2). Decrement times (min) (desflurane versus isoflurane, median (1st
quartile—3rd quartile)) (T50%: 0.3 (0.3–0.4) vs. 1.3 (0.4–2.3), log-rank test P = 0.002; P80%: 2.5 (2–5.9)
vs. 12.1 (5.1–20.2), P = 0.022) and awakening times (to RASS −2: 7.5 (5.5–8.8) vs. 41.0 (24.5–43.0),
P = 0.007; all extremities moved: 5.0 (4.0–8.5) vs. 13.0 (8.0–41.25), P = 0.037) were significantly shorter
after desflurane compared to isoflurane. The use of desflurane with the MIRUSâ„¢ system significantly
shortens the washout times and leads to faster awakening after sedation of critically ill patients
Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients
(1) Background: Reliable ultrasonographic measurements of optic nerve sheath diameter
(ONSD) to detect increased intracerebral pressure (ICP) has not been established in awake patients
with continuous invasive ICP monitoring. Therefore, in this study, we included fully awake patients with and without raised ICP and correlated ONSD with continuously measured ICP values.
(2) Methods: In a prospective study, intracranial pressure (ICP) was continuously measured in
25 patients with an intraparenchymatic P-tel probe. Ultrasonic measurements were carried out three
times for each optic nerve in vertical and horizontal directions. ONSD measurements and ICP were
correlated. Patients with ICP of 2.0–10.0 mmHg were compared with patients suffering from an ICP
of 10.1–24.2 mmHg. (3) Results: In all patients, the ONSD vertical and horizontal measurement for
both eyes correlated well with the ICP (Pearson R = 0.68–0.80). Both measurements yielded similar
results (Bland-Altman: vertical bias: −0.09 mm, accuracy: ±0.66 mm; horizontal bias: −0.06 mm,
accuracy: ±0.48 mm). For patients with an ICP of 2.0–10.0 mmHg compared to an ICP of 10.1–24.2,
ROC (receiver operating characteristic) analyses showed that ONSD measurement accurately predicts elevated ICP (optimal cut-off value 5.05 mm, AUC of 0.91, sensitivity 92% and specificity
90%, p < 0.001). (4) Conclusions: Ultrasonographic measurement of ONSD in awake, spontaneously
breathing patients provides a valuable method to evaluate patients with suspected increased ICP.
Additionally, it provides a potential tool for rapid assessment of ICP at the bedside and to identify
patients at risk for a poor neurological outcome
Detection of heart rate using smartphone gyroscope data: a scoping review
Heart rate (HR) is closely related to heart rhythm patterns, and its irregularity can imply serious health problems. Therefore, HR is used in the diagnosis of many health conditions. Traditionally, HR has been measured through an electrocardiograph (ECG), which is subject to several practical limitations when applied in everyday settings. In recent years, the emergence of smartphones and microelectromechanical systems has allowed innovative solutions for conveniently measuring HR, such as smartphone ECG, smartphone photoplethysmography (PPG), and seismocardiography (SCG). However, these measurements generally rely on external sensor hardware or are highly susceptible to inaccuracies due to the presence of significant levels of motion artifact. Data from gyrocardiography (GCG), however, while largely overlooked for this application, has the potential to overcome the limitations of other forms of measurements. For this scoping review, we performed a literature search on HR measurement using smartphone gyroscope data. In this review, from among the 114 articles that we identified, we include seven relevant articles from the last decade (December 2012 to January 2023) for further analysis of their respective methods for data collection, signal pre-processing, and HR estimation. The seven selected articles’ sample sizes varied from 11 to 435 participants. Two articles used a sample size of less than 40, and three articles used a sample size of 300 or more. We provide elaborations about the algorithms used in the studies and discuss the advantages and disadvantages of these methods. Across the articles, we noticed an inconsistency in the algorithms used and a lack of established standardization for performance evaluation for HR estimation using smartphone GCG data. Among the seven articles included, five did not perform any performance evaluation, while the other two used different reference signals (HR and PPG respectively) and metrics for accuracy evaluation. We conclude the review with a discussion of challenges and future directions for the application of GCG technology
Periphere Regionalanästhesie oder Allgemeinanästhesie – eine individuelle Risiko-Nutzen-Abwägung
Zusammenfassung. Die periphere Regionalanästhesie ist der aktuelle Goldstandard der Opioid-sparenden perioperativen Analgesie vornehmlich für Operationen an Schulter, Armen und Beinen. Sowohl die korrekte Indikationsstellung nach individueller Risiko-Nutzen-Abwägung als auch die Anlage bedürfen gut ausgebildeter Anästhesieärztinnen und -ärzte. Die Nervenblockaden werden mittels direkter Ultraschallkontrolle in Kombination mit peripherer Nervenstimulation durchgeführt. Die postoperative Betreuung der Patientinnen und Patienten setzt geschultes Personal voraus.
Peripheral Regional Anaesthesia for Perioperative Analgesia
Abstract. Peripheral regional anaesthesia is the actual gold standard of opioid-sparing perioperative analgesia and is mainly used for surgery of the shoulder, arm and leg. Well-trained anaesthesiologists are the prerequisite for the correct individual risk-benefit assessment and the performance of the nerve blocks using a combination of ultrasound guidance and peripheral nerve stimulation (dual guidance). The postoperative care of the patients requires trained staff.
Résumé. L’anesthésie régionale périphérique est l’étalon-or de l’analgésie péri-opératoire qui permet d’économiser les opioïdes de préférence lors d’opérations de l’épaule, des bras et des jambes. On a besoin d’anesthésistes bien formés pour faire une correcte évaluation individuelle des risques et des avantages et pour effectuer les blocs nerveux au moyen d’ultrasons et d’un stimulateur nerveux. Les soins postopératoires des patients nécessitent un personnel formé
Nicht-invasive Therapieansätze bei akuten und chronischen Rückenschmerzen
Zusammenfassung. Die Therapie von Rückenschmerzen, speziell die medikamentöse Schmerztherapie mit Opioiden, führt bei der behandelnden Ärztin/beim behandelnden Arzt oft zum Dilemma. Spezifische Rückenschmerzen werden durch gezielte Bildgebung diagnostiziert und operativ oder medikamentös erfolgreich therapiert. Im Gegensatz dazu können bei nicht-spezifischen Rückenschmerzen unbegründete Bildgebung, zweifelhafte Operationsindikationen und unkontrollierte Medikamentengabe die Schmerzen verstärken. Hier ist die Aufrechterhaltung der Aktivität und die Bewegungstherapie zentral für die Therapie. Beim Einsatz von Opioiden verhält es sich ähnlich. Opioide sind potente Medikamente zur kurzfristigen Schmerztherapie. Langzeitanwendung kann die Schmerzen verstärken und Störungen im Hormonhaushalt mit Einschränkungen der Lebensqualität und Libido bewirken. Ausserdem haben Opioide ein Gewöhnungs- und Suchtpotenzial. Eine Opioidtherapie, wenn überhaupt, sollte nur nach frustraner Nicht-Opioid-Therapie, zeitlich begrenzt (möglichst kürzer als vier Wochen) und nach klaren Richtlinien erfolgen.
Noninvasive Treatments for Acute and Chronic Back Pain
Abstract. The therapy of back pain – especially the medication with opioids – can be challenging for the treating physician. Specific back pain can often be diagnosed by imaging and successfully treated by surgery or medication. In contrast, nonspecific back pain can be worsened by inappropriate imaging, questionable surgical indications and uncontrolled drug use. For the therapy of nonspecific back pain, maintaining daily activity and exercise therapy is central. Opioids are effective drugs for short-term use. However, long-term use often leads to opioid-induced hyperalgesia and hormonal dysfunction with decreased quality of life and libido. Furthermore, opioids can lead to abuse and addiction. After an ineffective treatment with non-opioids, opioids may be given for a limited time period (if possible shorter than four weeks) according to international guidelines.
Traitements non invasifs des maux de dos aigus et chroniques
Résumé. La thérapie du mal de dos – en particulier la médication avec des opioïdes – peut être un défi pour le médecin traitant. Les douleurs dorsales spécifiques peuvent souvent être diagnostiquées par imagerie et traitées avec succès par chirurgie ou par médicaments. Par contraste, les douleurs dorsales non spécifiques peuvent être aggravées par une imagerie inappropriée, des indications chirurgicales douteuses et une utilisation incontrôlée des médicaments. Pour le traitement des douleurs dorsales non spécifiques, le maintien de l’activité quotidienne et la thérapie par l’exercice sont essentiels. Les opioïdes sont des médicaments efficaces à court terme. Cependant, l’utilisation à long terme entraîne souvent une hyperalgésie induite par les opioïdes et un dysfonctionnement hormonal avec une diminution de la qualité de vie et de la libido. En outre, les opioïdes peuvent entraîner un abus et une dépendance. Après un traitement inefficace avec des non-opioïdes, les opioïdes peuvent être administrés pendant une période limitée (si possible inférieure à quatre semaines), selon des directives claires
Detection of heart rate using smartphone gyroscope data: a scoping review
Heart rate (HR) is closely related to heart rhythm patterns, and its irregularity can imply serious health problems. Therefore, HR is used in the diagnosis of many health conditions. Traditionally, HR has been measured through an electrocardiograph (ECG), which is subject to several practical limitations when applied in everyday settings. In recent years, the emergence of smartphones and microelectromechanical systems has allowed innovative solutions for conveniently measuring HR, such as smartphone ECG, smartphone photoplethysmography (PPG), and seismocardiography (SCG). However, these measurements generally rely on external sensor hardware or are highly susceptible to inaccuracies due to the presence of significant levels of motion artifact. Data from gyrocardiography (GCG), however, while largely overlooked for this application, has the potential to overcome the limitations of other forms of measurements. For this scoping review, we performed a literature search on HR measurement using smartphone gyroscope data. In this review, from among the 114 articles that we identified, we include seven relevant articles from the last decade (December 2012 to January 2023) for further analysis of their respective methods for data collection, signal pre-processing, and HR estimation. The seven selected articles' sample sizes varied from 11 to 435 participants. Two articles used a sample size of less than 40, and three articles used a sample size of 300 or more. We provide elaborations about the algorithms used in the studies and discuss the advantages and disadvantages of these methods. Across the articles, we noticed an inconsistency in the algorithms used and a lack of established standardization for performance evaluation for HR estimation using smartphone GCG data. Among the seven articles included, five did not perform any performance evaluation, while the other two used different reference signals (HR and PPG respectively) and metrics for accuracy evaluation. We conclude the review with a discussion of challenges and future directions for the application of GCG technology.ISSN:2297-055