Automated Anesthesia Record Research Articles

Differential age effects of mean arterial pressure and rewarming on cognitive dysfunction after cardiac surgery.

Central nervous system dysfunction is a common consequence of otherwise uncomplicated cardiac surgery. Many mechanisms have been postulated for the cognitive dysfunction that is part of these neurologic sequelae. The purpose of our investigation was to evaluate the effects of mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) and the rate of rewarming on cognitive decline after cardiac surgery. Two hundred thirty-seven patients completed preoperative and predischarge neuropsychologic testing. MAP and temperature were recorded at 1-min intervals using an automated anesthesia record keeper. MAP area less than 50 mm Hg (time and degree of hypotension), as well as the maximal rewarming rate, were determined for each patient. Multivariable linear regression revealed that the rate of rewarming and MAP were unrelated to cognitive decline. However, interactions significantly associated with cognitive decline were found between age and MAP area less than 50 mm Hg on one measure, and between age and rewarming rate in another, identifying susceptibility of the elderly to these factors. Although MAP and rewarming were not the primary determinates of cognitive decline in this surgical population, hypotension and rapid rewarming contributed significantly to cognitive dysfunction in the elderly.

Differential Age Effects of Mean Arterial Pressure and Rewarming on Cognitive Dysfunction After Cardiac Surgery

Central nervous system dysfunction is a common consequence of otherwise uncomplicated cardiac surgery.Many mechanisms have been postulated for the cognitive dysfunction that is part of these neurologic sequelae. The purpose of our investigation was to evaluate the effects of mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) and the rate of rewarming on cognitive decline after cardiac surgery. Two hundred thirty-seven patients completed preoperative and predischarge neuropsychologic testing. MAP and temperature were recorded at 1-min intervals using an automated anesthesia record keeper. MAP area less than 50 mm Hg (time and degree of hypotension), as well as the maximal rewarming rate, were determined for each patient. Multivariable linear regression revealed that the rate of rewarming and MAP were unrelated to cognitive decline. However, interactions significantly associated with cognitive decline were found between age and MAP area less than 50 mm Hg on one measure, and between age and rewarming rate in another, identifying susceptibility of the elderly to these factors. Although MAP and rewarming were not the primary determinates of cognitive decline in this surgical population, hypotension and rapid rewarming contributed significantly to cognitive dysfunction in the elderly. (Anesth Analg 1995;81:236-42)

Automated anaesthesia record systems, observations on future trends of development

The introduction of electronic anaesthesia documentation systems was attempted as early as in 1979, although their efficient application has become reality only in the past few years. Today, documentation technology is offered by most of the monitor manufacturers and new systems are being developed by various working groups. The advantages of the electronic protocol are apparent: Continuous high quality documentation, comparability of data due to the availability of a anaesthesia data bank, reduction of the workload of the anaesthesia staff and availability of new additional information. Disadvantages of the electronic protocol have also been discussed. Typically, by going through the process of entering data on the course of the anaesthetic procedure on the protocol sheet, the information is mentally absorbed and evaluated by the anaesthetist. This mental processing of information may, however, be missing when the data are recorded fully automatically--without active involvement on the part of the anaesthetist. It seems that electronic anaesthesia protocols will be required in the near future. The advantages of accurate documentation and quality control in the presence of careful planning will outweight cost considerations. However, at this time, almost none of the commercially available systems have matured to a point where their purchase can be recommended without reservation. There is still a lack of standards for the subsequent exchange of data and a solution to a number of ergonomic problems still remains to be found.

Lack of documentation of severe transient bradycardia by an automated anesthesia record

From the *Department of Anesthesiology, Cedars Medical Center, Miami, FL, and tDepartment of Exercise and Sport Sciences, University of Arizona, Tucson, AZ. Received Mar 9, 1994, and in revised form May 2, 1994. Accepted for publication May 4, 1994. Address correspondence to Dr Feingold, 5310 Maggiore Street, Coral Gables, FL 33146. Feingold A, Galindo A, Feingold HE. Lack of documentation of severe transient bradycardia by an automated anesthesia record. J Clin Monit 1994;10:382-386

Eight year's experience with automated anesthesia record keeping: lessons learned--new directions taken.

For the past eight years, an automated anesthesia record keeping system, COMANDAS (COMputerized ANesthesia Data Acquisition System) has been used in the cardiovascular operating rooms at Mayo Clinic. The automated anesthesia record is designed to match the traditional hand-written record and becomes part of the official medical record. COMANDAS is interfaced with the physiologic monitor and mass spectrometer in each OR, and a number of other computers within the Mayo Medical Center. Since the introduction of COMANDAS over 24,000 surgical procedures have been charted. The anesthesia record is more complete, consistent in organization, and legible when compared to a hand-written record. Recently, it was determined that the computers and peripherals that make up COMANDAS were wearing out and that the vendors would no longer support or replace the equipment. A process to find a replacement for COMANDAS was then begun. Although the cardiovascular anesthesia group was satisfied with the automated anesthesia record, there were a number of areas in which improvement was desired. A systematic evaluation of the system was begun with a survey of the users. The majority of those surveyed felt that COMANDAS was a useful system which made parts of their job easier. The user interface, method of manual data entry, time to produce the record and difficulty learning the system were the source of the greatest dissatisfaction. Artifacts, networking, interfacing with other devices and computers were also issues for the replacement system. Most commercial systems were found wanting in one or more areas of significance. The most practical solution appeared to be the modification of a currently available intensive care unit patient data management system.

Normal fluctuation of physiologic cardiovascular variables during anesthesia and the phenomenon of “smoothing”

With the advent of automated anesthesia record keeping devices, concern has arisen that "abnormal" values will appear in the record and possibly lead to medicolegal compromise. A retrospective review of automated records from a series of anesthesia cases was undertaken to determine if abnormal values do occur, how frequent they are, and whether they cause problems. A total of 14,826 (4,942 each) noninvasive heart rate, systolic, and diastolic blood pressure readings from 118 case printouts generated by a Diatek Arkive Patient Information Management System (63 cases) or a Datascope Datatrac record keeper (55 cases) were recorded. The study sample covered a broad range of surgical operations, anesthetic procedures, and patient ages and medical histories. During these 118 anesthetics, the majority of readings of all three variables fell within normal ranges (defined for this study as 80 to 180 and 50 to 110 mm Hg for systolic and diastolic blood pressures, respectively, and 60 to 140 beats/min for heart rate). During the anesthetics, 3.6% of the systolic pressure readings, 13.25% of the diastolic readings, and 4.25% of the heart rate readings were recorded outside these ranges. No serious intraoperative or postoperative anesthesia complications were associated with these out-of-range readings, nor would they be expected in a sample of this size, since serious anesthetic complications are rare. This preliminary observation of one person's experience may help address the concern associated with allowing high and low blood pressure and heart rate readings to be automatically recorded "unsmoothed." In medicolegal situations, it should also begin to demonstrate that such fluctuations are neither uncommon nor abnormal, and that a true record of these readings should be neither a cause for concern nor an opportunity for medicolegal exploitation.

A real-time anesthesia record keeping system using video.

A real-time, Automated Anesthesia Record Keeping (AARK) system was constructed using commercially available video hardware. This system can acquire all of the information that is presented visually to an anesthesiologist directly from monitor screens. The information is recorded on VHS format tape. Use of such a system avoids the need for digital processing while capturing all waveforms, trends, data messages and numerics. Since the data are stored directly to tape, subsequent data analysis can be accomplished. This system can be used with virtually any medical monitor.

Automated anaesthesia records

Although the anaesthesia record was the normal method for keeping an account of the anaesthetist's interaction with the patient (Beecher, 1940), it was given a low priority in what has always been one of the more actionoriented medical specialties. For a long time, it was used as an aide-mOmoire for the anaesthetist. Today, the growing complexity of pharmacological interventions with the patient demand more sophisticated physiological monitoring, which has created the necessity for a legible, well-documented, complete and informative anaesthesia record. In recent times, there have been considerable advances in health-care delivery, especially in the postoperative period. This has made the anaesthetist's personal record even more important, as the record becomes 'common property' as a profile of the physiological state of the patient. This lays profound emphasis on the quality, clarity, accuracy and visual form of the presentation of the data in these records. If anaesthesia monitoring is compared to cockpit monitoring in an aircraft, the anaesthesia record can be considered as the black box--a vital source of information. This chapter presents an account of the purpose and clinical use of the automated anaesthesia record, its contribution to quality patient care, and the frequently debated issue of the merits and demerits of these records. To give an overview of a current automated anaesthesia recording system, we have provided a short technical description of an anaesthesia charting system developed in Erasmus University, which has been used in the Thorax Centre of the Academic Hospital, Rotterdam for more than ten years by every anaesthetist as an 'electronic secretary', taking down the minutes of the interaction between the anaesthetist and the patient.

The Automated Anesthesia Record and Alarm Systems

The Automated Anesthesia Record and Alarm Systems

The clinical use of the Ohmeda Automated Anesthesia Record Keeper integrated in the Modulus II Anesthesia System. A preliminary report.

While performing his complex array of tasks, the anesthesiologist is also responsible for maintaining an anesthetic record. Up to now, this has been done by hand. The clinical use of automated anesthesia record keeping is presently evaluated. The anesthesia records generated by the Ohmeda Automated Anesthesia Record Keeper integrated in the Modulus II Anesthesia System is compared to hand written records. The differences between the two records of identical patients are quantified as erroneous or missing data. With the criteria adapted, we found significant and clinically relevant differences which stress the importance of automated record keeping.

What is minimal monitoring?

The definition of what constitutes minimal monitoring rests not so much on a scientific analysis of physiologic variables and their specificity, sensitivity, and predictiveness, but more on a usage pattern in a given community or country. In the United States, the minimal monitoring standards accepted in the majority of institutions and used for routine anesthesia care of patients not classified as high risk include (1) the alert anesthesiologist or nurse anesthetist observer, (2) an electrocardiogram, (3) a blood pressure measuring device, and (4) an oxygen analyzer in the breathing circuit. To this basic cluster of monitors can be added a finger plethysmograph, a neuromuscular junction monitor, a temperature probe, and an esophageal/precordial stethoscope which are used in many communities. In the near future we expect to see a capnograph and a pulse oximeter added to this list, and later on the automated anesthesia record.

The automated anesthesia record.

Many phases of modern anesthesia keep the anesthetist too busy to obtain and plot physiologic data or to record anesthetic events. Yet the anesthesia record serves as a log book, a clinical management tool, a trend and pattern plotter, as well as a medical-legal document. If these functions are important, an automated anesthesia recording system is needed for charting the data reliably and accurately. Automating the anesthesia record also lays the ground work for abstracting the data and generating records with specific information sought by the anesthetist, the physicians in the recovery room and intensive care unit, the administrators of the hospital, as well as representatives with interest in medical-legal problems.