One Doctor 's Hope for Better Patient Monitoring

Anyone who has ever been a hospital patient on a general care floor should be familiar with the standard vital check routine in which a nurse enters the room every four- to six-hours to chart your blood pressure and other vital signs to monitor your condition. But what if your condition suddenly deteriorates in between those routine checks? Is there a better way to monitor these patients? Ashish Khanna, MD, an anesthesiologist and researcher at the Cleveland Clinic believes there is. "The problem with that approach is that we are essentially seeing our patients at a snapshot of time and ignoring large chunks of time where they are possibly showing signs of deterioration," Khanna told MD+DI. In a manuscript recently published by the Journal of Critical Care, Khanna described how challenging it is to predict episodes or severity of cardiorespiratory decompression in patients who appear to be in stable condition and staying on the general care floor. The paper also describes the protocol for an ongoing global trial that could go a long way toward better monitoring protocols to detect signs of deterioration earlier. The PRODIGY trial builds on an earlier study at Cleveland Clinic that Khanna was involved with. The investigators put all of the institution's post-surgical patients who were recovering on the general care floor on continuous monitoring but blinded the clinicians to the monitoring by covering up the device and silencing the monitor's alarms. &...
Source: MDDI - Category: Medical Devices Authors: Tags: Cardiovascular Tubing Source Type: news

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CONCLUSIONS: Targeting moderate or deep sedation did not reliably result in the intended sedation level. Targeting moderate sedation, however, resulted in a lower rate of total AREs and fewer patients had multiple AREs with no difference in procedural recall. As seen in previous reports, patients who achieved moderate sedation had less AREs than those who achieved deep sedation. Our study suggests that a target of moderate sedation provides adequate amnesia with less need for supportive airway interventions than a target level of deep sedation, despite the fact that it often does not result in intended sedation level. This...
Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Acad Emerg Med Source Type: research
Conclusion: As for patients scheduled for AAA repair, female, higher ASA, higher level of education, and symptom may be independent risk factors for preoperative anxiety, and symptom and higher BMI may predict preoperative depression. PMID: 30082526 [PubMed - in process]
Source: Chinese Medical Journal - Category: General Medicine Authors: Tags: Chin Med J (Engl) Source Type: research
BACKGROUND Currently, there is no gold standard for monitored anaesthesia care during oocyte retrieval. OBJECTIVE In our institution, the standard is a conscious sedation technique using a target-controlled infusion (TCI) of remifentanil, titrated to maintain a visual analogue pain score less than 30 mm. This protocol is well accepted by patients but is associated with frequent episodes of respiratory depression. The main objective of this study was to evaluate whether the addition of a continuous intravenous infusion of ketamine could reduce these episodes. DESIGN Controlled, randomised, prospective, double-blin...
Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Sedation Source Type: research
Discussion: Compared with sufentanil PCIA, oxycodone PCIA showed better analgesic effects, lower incidence of adverse complications, and less analgesic drug consumption during postoperative pain management.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research
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Source: Medscape Orthopaedics Headlines - Category: Orthopaedics Tags: Anesthesiology News Source Type: news
Surgical spine patients often arrive in the PACU with a pain score of 10 out of 10. When pain level is this high, it is very difficult to get it under control. The primary type of medication given for pain in the PACU is an opioid which is known to cause respiratory depression. Patients recovering from anesthesia frequently need to be prompted to breathe.
Source: Journal of PeriAnesthesia Nursing - Category: Nursing Authors: Tags: ASPAN National Conference Abstract Source Type: research
ConclusionsPatients with poor quality of recovery had the worst health status at D0. Evaluation at 3 months indicated similar rates of problems in EuroQol (except for pain/discomfort) and World Health Organization Disability Assessment Schedule 2.0 scores were similar.ResumoObjetivoA recuperação pós-operatória é um processo complexo com dimensões fisiológicas, funcionais e psicológicas. A qualidade da recuperação pós-operatória é considerada um resultado crucial após cirurgia e anestesia. O objetivo deste estudo foi avaliar e ...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
Conclusion: Both the groups were comparable with respect to demographic characteristics. Nalbuphine pretreatment significantly reduced the incidence (20% vs. 72%; respiratory rate = 0.294, 95% confidence interval: 0.160–0.496, P < 0.01) and severity of EM without any significant increase in the incidence of adverse effects. Nalbuphine 0.2 mg/kg IV pretreatment significantly reduces the incidence and severity of EM with side-effect profile comparable to saline placebo.
Source: Journal of Anaesthesiology Clinical Pharmacology - Category: Anesthesiology Authors: Source Type: research
The objective of this study was to investigate predictors of pain associated with computed tomographic arthrography of the shoulder.Materials and MethodsBefore shoulder arthrography, all participants were assessed with the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization Quality of Life Short Version Instrument (WHOQOL-BREF). The participants were nonrandomized into two groups: the anesthesia group, who underwent prior local infiltration anesthesia before shoulder arthrography, and the nonanesthesia group, who did not undergo prior local infiltration anesthesia. The pain levels at intraprocedu...
Source: Academic Radiology - Category: Radiology Source Type: research
This article also explores the non-interventional approaches such as analgesics and psychotherapy and invasive interventions such as nerve blocks, neuromodulation and spinal cord stimulators in treating PPCP as well as the need for further research to evaluate the efficacy of such treatments.
Source: Trends in Anaesthesia and Critical Care - Category: Anesthesiology Source Type: research
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