Multiparametric Monitor Research Articles

A fast and simple protocol to anaesthesia in chicken embryos.

Chicken embryos (CE) are an experimental model used as an important life science research tool worldwide, and then, adequate anesthetic protocols must be adopted to avoid the unjustifiable suffering of animals. Thus, our objective was to evaluate different anesthetic protocols in CEs using an easy inoculation route, the shell membrane (SM). We adopted the heart rate by pulse and the CE movements as a parameter of pain by assessing the vase in the chorioallantoic membrane (CAM) through the shell by a sensor of a multiparametric monitor. CEs were distributed into the following groups: (i) association of ketamine (5 mg/CE), midazolam (0.05 mg/CE) and morphine (0.15 mg/CE); (ii) ketamine (5 mg/CE) and xylazine (0.125 mg/CE); (iii) xylazine (0.0125 mg/CE) and morphine (0.15 mg/CE). The stress method used to test the anesthetic potential of the drugs was high temperature stimulation, keeping the CEs 10 cm from the fire of a Bussen nozzle for 30 s. In this experimental model, associations between different drugs decreased the pulse and the movement, indicating possible sedation. After treatment, the CE's submitted to the stress method had the heart rate and movements kept low in the groups ketamine-midazolam-morphine and ketamine-xylazine, while the non-drug-treated group increased heart rate. In a group treated with xylazine-morphine, the heart rate did not decrease, but the movement decreased after the stimulus. As the best results were the combinations of ketamine-midazolam-morphine and ketamine-xylazine, we recommend these associations for use in embryos in the final third of embryonic development in experimental protocols and euthanasia.

A New Device for Remote Monitoring of Vital Parameters in Acromegalic Patients: Pilot Study.

Acromegaly is a rare disease that results from growth hormone (GH) excess. Diabetes mellitus, hypertension,cardiomyopathy, and obstructive sleep apnoea syndrome( OSAS) are frequent complications. Identify a useful system to obtain a reliable remote monitoring of glucose and the most important vital parameters in the acromegalic subjects. Sixteen acromegalic patients (from 30 to 73 years old) were enrolled. We provided health monitor devices to the patients for continuous acquisition of physiological signals including twelve-lead electrocardiography (EKG) and nocturnal SpO2. At the same time, we applied on the same patients the blinded continuous glucose monitoring system(CGMS). The lowest saturation peaks at night (<80%) were achieved in patients with a known diagnosis of OSAS. A positive correlation was demonstrated between the lowest oxygen saturation values and the CGM peaks (pV <0,0001) and between the average values of oxygen saturation and CGM (pV<0,0003). Patients with a previous diagnosis of OSAS, obtained by polysomnography, showed on the multiparametric monitor recordings superimposable to their known condition. Instead we noticed a discordance in the two EKG recording: the wireless mode showed an irregular rhythm in 5/16 patients, which was not confirmed by the recording mode with cables. The health monitor device associated with CGM may be a new useful and versatile tool for fragile patients who can self-manage remote monitoring, and for physicians who can obtain real-time information for the clinical and therapeutic management of patients. It is also a useful tool for the follow-up of patients with OSAS. Moreover, once the interference of the OSAS is excluded, the CGM allows us to obtain a more reliable and accurate diagnosis of DM.

Regional Intravenous Anaesthesia (Bier's block) in Black-headed Vulture (Coragyps atratus) Submitted to Digit Amputation

Background: The Coragyps atratus flies long distances in search of food and has a marked behaviour of food competition. Since they are frequently found in areas of recent human occupation, they are subject to trauma, which may require surgical interventions. Locoregional blocks are used as part of a balanced-anaesthesia protocol and are currently being evaluated in birds, with brachial plexus block being the main technique described in the literature. However, to our knowledge, this is the first description of intravenous regional anaesthesia (Bier's block) in a vulture. Thus, we aim to report the use of Bier's block with 1% lidocaine, in a black-headed vulture submitted to digit amputation. Case: A black-headed vulture (Coragyps atratus), weighing 2 kg, was rescued and referred to the Veterinary Hospital due to its inability to fly. Physical examination revealed a swollen digit in the right pelvic limb. Radiographic examination confirmed the intermediate phalanx fracture of the 4th digit of the right pelvic limb with signs suggestive of advanced osteomyelitis. The animal was referred to surgery for amputation of the affected digit. Before surgery, water and food were withdrawn for 12 h. Pre-anaesthetic medication consisted of 1 mg/kg midazolam and 0.5 mg/kg morphine intramuscularly (IM). Anaesthetic induction was performed through face mask with isoflurane, followed by orotracheal intubation with a 3 mm-endotracheal tube. Anaesthesia was maintained with isoflurane through a non-rebreathing circuit in 100% oxygen. Using a multiparametric monitor, heart rate (HR), respiratory rate (RR), end-tidal CO2 (EtCO2), oxyhemoglobin saturation (SpO2), electrocardiography (ECG), systolic blood pressure (SBP) and core temperature (CT) were evaluated. Antisepsis of the right pelvic limb was performed and an elastic band was applied around the distal region of the affected tibia to serve as a tourniquet. A scalp vein set was used to access the lateral saphenous vein in the region distal to the tourniquet, and 5 mg/kg lidocaine 1% was injected intravenously. The patient remained stable during the procedure, with no need for analgesic rescue. The tourniquet was gradually released 40 min past its application, being completely removed after 45 min of surgery. The anaesthetic supply was interrupted, with extubation after 4 min; the patient had satisfactory anaesthetic recovery. Discussion: The present report describes the success in using the technique of intravenous regional anaesthesia with 1% lidocaine for digit amputation performed on a specimen of black-headed vulture. The pre-anaesthetic medication provided analgesia, satisfactory sedation for venoclysis, and anaesthetic induction without complications. Anaesthetic induction and maintenance in birds are preferably performed with inhaled anaesthetics, thus the choice of mask induction. Despite the reduction in RR soon after induction, the patient remained on spontaneous ventilation. Bier's block using 5 mg/kg lidocaine showed to be an easy and safe technique in vultures, but doses up to 6 mg/kg lidocaine are not associated with adverse effects in birds. The intravenous regional anaesthesia technique described in this manuscript promoted adequate analgesia for the digit amputation procedure in black-headed vultures and allowed hemodynamic stability without significant anaesthetic complications. Thus, the present report points to the potential use of this locoregional block in other birds. Keywords: locorregional block, lidocaine, anaesthesia. Título: Anestesia regional intravenosa (bloqueio bier) em urubu-de-cabeça-preta (Coragyps atratus) submetido à amputação de dígito. Descritores: bloqueio locorregional, lidocaína, anestesia.

Braquial Plexus Block and Lumbosacral Epidural in a South American Coati (Nasua nasua)

Background: The South American coatis (Nasua nasua) are capable of adapting to different habitats, which allowed them to exchange between domestic and wild areas, increasing the occurrence of traumas. Procedures performed in this species demand anesthetic protocols that take comorbidities into account and cause minimal cardiorespiratory depression as well as rapid recovery. It is in such context that locoregional anesthesia has become an essential tool. Thus, we aim to report the use of two techniques of locoreginal block: brachial plexus block and lumbosacral epidural block, in a Nasua nasua submitted to osteosynthesis of the radius and caudectomy due to trauma.Case: A adult male coati weighing 2.3 kg was referred to the Veterinary Medical Teaching Hospital of the Universidade Federal do Paraná (UFPR) - Setor Palotina with a history of trauma. Physical examination showed crackling in the radius and ulnar region, and also abnormal angulation in the distal portion of the tail. After taking x-rays, fractures were confirmed in the distal radius and in the distal portion of the tail. The patient was referred for surgery. After 8 h of water and food withdrawal, the animal was premedicated with a combination of ketamine (10 mg/kg), midazolam (0.3 mg/kg) and methadone (0.2 mg/kg), intramuscularly (IM). Induction of anesthesia was performed with propofol titrated to effect (total dose 4 mg/kg) and anesthesia was maintained with isoflurane in spontaneous ventilation using a non-rebreathing circuit (Baraka). It was evaluated heart rate (HR), respiratory rate (RF), end-tidal CO2 (EtCO2), expired isoflurane fraction (FE´Iso), oxyhemoglobin saturation (SpO2), electrocardiography (ECG), systolic blood pressure (SBP) and core temperature (CT) using a multiparametric monitor. After the stabilization period, the animal was positioned in lateral recumbence. A subscapular brachial plexus block was performed with bupivacaine (0.2 mL/kg) using a peripheral nerve stimulator to ensure the correct perineural deposition of the local anesthetic. During anesthesia, rescue analgesia was administered when there was a 20% increase in HR, RR or SBP compared to baseline values. Thus, in this case, two rescues with fentanyl (2 µg/kg) were necessary. The animal remained stable and, at the end of the first procedure, he was placed in ventral recumbence, with the hindlimbs pulled cranially in order to locate the lumbosacral space. Epidural injection was performed with lidocaine (0.18 mL/kg). Rescue analgesia was not necessary during the caudectomy procedure. The procedure had a total duration of 3 h and extubation occurred 3 min after inhalation anesthesia withdrawal. At the end of the surgery, the animal was medicated with meloxicam (0.1 mg/kg) and methadone (0.2 mg/kg). Two h after the end of the surgery, the animal was able to feed again.Discussion: The literature is scarce regarding anesthetic techniques in the Nasua nasua species, especially in the context of locoregional anesthesia. In this report, the protocol used as pre-anesthetic medication was considered satisfactory. Brachial plexus block is a safe technique for desensitizing the forelimb for surgical procedures distal to the scapulohumeral joint. Despite some morphological differences in the spinal anatomy of coatis, there was no difficulty in identifying the epidural space or inserting the needle. The absence of complications, and the hemodynamic stability during the anesthesia period, combined with the satisfactory recovery of the patient points to the success of the techniques used in the present report.

Intravenous Application of Metronidazole, Ceftriaxone and Enrofloxacin in Dogs Anesthetized with Isoflurane: Impact of Hemodynamic and Cardiorespiratory Parameters

Background: The prophylactic use of antimicrobials in patients undergoing surgery is widely performed due to its power to reduce and control infections in the surgical site. Metronidazole, ceftriaxone and enrofloxacin are drugs widely used in veterinary medicine, even during anesthesia, either in healthy patients or under critical conditions. Despite several reports on hemodynamic reactions after intravenous application of antimicrobials in dogs, there are few studies on these effects in dogs undergoing anesthesia. The objective of this study was to evaluate the hemodynamic and cardiorespiratory effects of metronidazole, ceftriaxone and enrofloxacin in dogs anesthetized with isoflurane.Materials, Methods &amp; Results: Forty healthy bitches were used, equally divided into four experimental groups of 10 animals each: placebo group (PG), metronidazole group (MG), ceftriaxone group (CG) and enrofloxacin group (EG). After the experimental phase of data collection, all animals were submitted to ovariohysterectomy using the minimally invasive approach. A catheter was placed in the dorsal metatarsal artery for direct blood pressure monitoring, with systolic (SBP), mean (MBP) and diastolic (DBP) blood pressures were continuously monitored by means of a transducer connected to a multiparametric monitor. The others measured data were heart rate (HR), respiratory rate (RR), body temperature (T°C), carbon dioxide expired fraction (ETCO2), oxygen saturation of hemoglobin (SpO2) in T0 (time immediately before performing the treatment), 5 (T5), 10 (T10), 15 (T15), 20 (T20) and 30 (T30) minutes after administration of the antimicrobial. Anesthetic induction was performed with propofol and anesthetic maintenance was performed with isoflurane. After reaching anesthesia with a surgical plan, all parameters were measured before treatments were performed (T0). Then the sodium chloride solution (0.9% NaCl), 25 mg/kg of metronidazole, 30 mg/kg of ceftriaxone or 5 mg/kg of enrofloxacin was administered in cefalic vein. No complications were observed during anesthesia and surgery in all groups. The animals were monitored for three h after the end of the surgery, and then dispensed without prescription of antimicrobials in the recovery period. The HR showed a significant reduction in T5 and T30 compared to the baseline in EG. The RR had a significant increase in T30 in relation to T0 after the administration of 0.9% NaCl in PG. There were no statistically significant changes in HR for groups PG, MG and CG, and RR for groups EG, MG and CG. SBP and MBP had a significant decrease after 30 min of ceftriaxone application. There was a significant decrease in MBP at T5, T10 and T15 compared to baseline in EG. No changes in blood pressure were detected in PG and MG. The ToC showed a significant reduction from T10 to T30 in the GP, from T5 to T30 in the SG, in the T30 in the GM from T20 to T30 in the GC. For all groups, there were no changes in SpO2, ETCO2 and PAD during the study.Discussion: It was concluded that all studied antimicrobials can be used in prophylactic therapy in dogs, in doses recommended by the literature, as the observed changes are subject to correction and can be easily controlled by a qualified anesthetist. The antimicrobial that did not show cardiorespiratory and hemodynamic changes after intravenous application in bitches anesthetized with isoflurane was metronidazole, so its administration was considered safer when compared to enrofloxacin and ceftriaxone, under the conditions of this study, however its indication is punctual, being restricted to cases of infections by anaerobic agents.

The influence of nursing activities score on clinical alarms service.

to estimate the magnitude of the Nursing Activities Score effect on multiparametric monitor alarm response and staff response time. an observational, cross-sectional study outlined as an open cohort, performed in an Adult General Intensive Care Unit. The time taken for alarms triggered by the multi-parameter monitors was timed and characterized as attended or not. the study obtained a total of 254 alarms triggered from the multiparameter monitors of 63 patients. The mean number of alarms triggered was 4.5 alarms per period/observation and 1.5 alarms/hour. The study showed that the Nursing Activities Score is associated with an additional probability of 4% (p < 0.05) of an alarm being met, for each additional point in the scale, and reduction in team response time. it has been verified that Nursing Activities Score has a direct relationship with the attendance and with the response time to the alarms triggered.

Product development in technology based firms in innovation environments

Abstract: Technology based firms (TBFs) require innovative products to survive and compete in the market. The creation of products that sustain the competitiveness of companies depends directly on their product development process (PDP). The objective of this research was to investigate how PDP is carried out in TBFs in innovation environments. The research is qualitative, based on multiple case studies. Three companies in technology parks in the South and Southeast of Brazil were studied. The companies produced the following products: multiparametric monitor, an ondaleta and a microfiltration system. The key findings of the research were a lack of formal PDP planning and unstructured development processes. As a contribution, the study proposes that TBFs use a milestone strategy in the PDP microphases, guaranteeing greater efficiency in product development without the need to create rigid processes in project development. The study also highlights the importance of cooperation with clients and suppliers during the revision phases of PDP. The products resulting from PDP of the companies studied were identified as incremental innovation, novel for the national market, but with established technology on the international market. Future studies should assess the evolution and learning curve in the product development phase of TBFs.

Perfil de termorregulaçãoe desfecho clínico em pacientes críticos com sepse

Objetivo: descrever o perfil da temperatura corporal (TC) e o desfecho em pacientes com sepse atendidos em uma Unidade de Terapia Intensiva (UTI).Métodos: estudo retrospectivo, descritivo e exploratório. Incluíram-se pacientes maiores de 18 anos, diagnosticados com sepse grave ou choque séptico no período de janeiro a dezembro 2012, atendidos em uma UTI de um hospital púbico. Foram levantadas variáveis sociodemográficas, clínicas e o desfecho. Para a avaliação da TC, consideraram-se todas as medidas registradas durante a internação, aferidas na região axilar por termômetro digital acoplado ao monitor multiparamétrico. Adicionalmente, propuseram-se cenários comparativos entre o número de episódios de febre ou hipotermia nas 24 horas após a internação e nas 24 horas prévias ao desfecho. Os dados foram coletados nos prontuários físicos e eletrônicos.Resultados: foram incluídos 105 pacientes, com predominância de maiores de 60 anos, sexo masculino e cor branca. O desfecho clínico para 26 (24,8 %) foi a alta e para 79 (75,2 %), o óbito. Foram observadas 8778 verificações da TC, sendo a hipotermia mais frequente no grupo óbito (p = 0,00). No grupo alta, as medidas dentro da normalidade foram mais frequentes (p = 0,00). Entre os cenários propostos, houve diferenças estatisticamente significantes entre os grupos quando ocorreram dois ou mais episódios de febre nas 24 horas prévias ao desfecho.Conclusão: a descrição do perfil de termorregulação em pacientes sépticos mostrou que a TC é um indicador complementar capaz de auxiliar a equipe na prática clínica com intuito de propiciar melhores desfechos.

Do the Manual or Computer-Controlled Flowmeters Generate Similar Isoflurane Concentrations in Tafonius?

Introduction: Tafonius is an anesthesia machine with computer-controlled monitor and ventilator. We compared the isoflurane fluctuations in the circuit with manual (MF) or computer-driven (CF) flowmeters, investigated the origin of the differences and assessed whether isoflurane concentration time course followed a one-compartment model.Material and Methods: A calibrated TEC-3 isoflurane vaporizer was used. Gas composition and flows were measured using a multiparametric monitor and a digital flowmeter. Measurements included: (1) Effects of various FiO2 with MF/CF on the isoflurane fraction changes in the breathing system during mechanical ventilation of a lung model; wash-in kinetic was fitted to a compartmental model; (2) Gas outflow at the common gas outlet (CGO) with MF/CF at different FiO2; (3) Isoflurane output of the vaporizer at various dial settings with MF/CF set at different flows without and with reduction of the CGO diameter.Results: (1) The 3% targeted isoflurane concentration was not reached; additional time was required to reach specific concentrations with CF (lowest FiO2, longer time). The exponential course fitted a two-compartment model; (2) Set and measured flows were identical with MF. With CF at 0.21 FiO2, flow was intermittently 7.6 L min−1 or zero (mean total: 38% of the set flow); with CF at 1.00 FiO2, flow was 10.6 L min−1 or zero (mean: 4–5.3 L min−1); with 0.21 < FiO2 < 1.00, combined flow was intermittent (maximum output: 15.6 L min−1); (3) With MF, isoflurane output was matching dial setting at 5 L min−1 but was lower at higher flows; with CF generating intermittent flows, isoflurane output was fluctuating. With the 4 mm diameter CGO, isoflurane concentration was close to dial setting with both MF and CF. With a 14 G CGO, isoflurane concentration was lower than dial setting with MF, higher with CF.Conclusions and Clinical Relevance: Using MF or CF led to different isoflurane fraction time course in Tafonius. Flows were lower than set with CF; the TEC-3 did not compensate for high/intermittent flows and pressures; the CGO diameter influenced isoflurane output.

Efeitos da associação de propofol - Cetamina versus propofol isolado em cães submetidos à orquiectomias

O propofol é um anestésico intravenoso utilizado para indução anestésica que pode ser usado também na manutenção, associado ou não. O objetivo deste estudo foi investigar se o propofol associado à cetamina na indução e manutenção anestésica em orquiectomia de cães causa alterações cardiorrespiratórias, comparado a seu uso isolado. Dentre as avaliações verificou-se tempo de indução e recuperação anestésica, perfil hemodinâmico, e quantificação do percentual de redução de dose obtido com a associação proposta. Foram utilizados 20 cães machos entre um e seis anos de idade, sem distinção de raça e peso. Os animais foram distribuídos aleatoriamente em quatro grupos cada um com cinco animais, sendo os grupos: PC (propofol + cetamina), P (propofol), C (cetamina) e o grupo CTRL (controle). Os parâmetros foram avaliados por um monitor multiparamétrico, imediatamente após a medicação pré-anestésica e a cada 15 minutos até o final do procedimento. Os resultados demonstraram que nenhum dos grupos supracitados mostraram alterações estatisticamente significativas na frequência cardíaca, porém para a frequência respiratória houve diferença estatística do grupo CTRL versus o grupo P e o grupo C no qual p foi menor que 0,001 e do grupo CTRL versus PC no qual o valor de p foi menor que 0,05. A saturação periférica de oxigênio foi estatisticamente significativa entre o grupo CTRL e grupo P (p menor que 0,001) e entre o grupo CTRL e PC (p foi menor que 0,01). Para temperatura corporal houve diferença estatística significativa em relação o grupo CTRL versus P (p foi menor que 0,001), entre o grupo CTRL versus PC e entre o grupo CTRL versus C o valor de p também foi menor que 0,001. Pode-se concluir que o protocolo anestésico com maior vantagem de utilização em orquiectomia de cães foi a associação de propofol com cetamina, propiciando melhor frequência respiratória e saturação de oxigênio, diminui pela metade a dose dos anestésicos e propiciou melhor indução e recuperação anestésica.

A pilot study exploring the effects of musical genres on the depth of general anaesthesia assessed by haemodynamic responses.

This pilot study aimed to investigate whether and how music and musical genres may influence the depth of anaesthesia, as measured using changes in arterial blood pressure (ABP), including systolic blood pressure (SBP), and heart rate (HR) across three different surgical time points. This work focused on a sample of 12 female cats (Felis catus) that were subjected to an elective ovariohysterectomy (OVH), and three different surgical time points were considered (T1, coeliotomy; T2, ligature placement and transection of the ovarian pedicle; and T3, ligature placement and transection of the uterine body). All of the cats were subjected to stimulation with 2 min segments of three music tracks from different genres (pop [PM], classical [CM] and heavy metal [HM]). At the same time, ABP and HR measurements were obtained using a multi-parametric monitor. For statistical analysis, P values <0.05 were considered significant. For all cats, music exposure induced statistically significant changes in the parameters under study; the same finding was observed for the genre of music. The majority of cats experienced the same variation pattern, with lower values when exposed to CM, intermediate values when exposed to PM and higher values when exposed to HM. Our results indicate that the development of sensory processing of acoustic stimuli is maintained by cats under general anaesthesia and reveal the influence of music on the autonomous nervous system, as measured using HR and SBP.

Influence of music and its genres on respiratory rate and pupil diameter variations in cats under general anaesthesia: contribution to promoting patient safety.

The aims of the study were to recognise if there is any auditory sensory stimuli processing in cats under general anaesthesia, and to evaluate changes in respiratory rate (RR) and pupillary diameter (PD) in anaesthetised patients exposed to different music genres, while relating this to the depth of anaesthesia. A sample of 12 cats submitted for elective ovariohysterectomy was exposed to 2 min excerpts of three different music genres (classical [CM], pop [PM] and heavy metal [HM]) at three points during surgery (T1 = coeliotomy; T2 = ligature placement and transection of the ovarian pedicle; T3 = ligature placement and transection of the uterine body). A multiparametric medical monitor was used to measure the RR, and a digital calliper was used for PD measurement. Music was delivered through headphones, which fully covered the patient's ears. P values <0.05 were considered to be statistically significant. Statistically significant differences between stimuli conditions for all surgical points were obtained for RR (T1, P = 0.03; T2, P = 0.00; T3, P = 0.00) and for PD (T1, P = 0.03; T2, P = 0.04; T3, P = 0.00). Most individuals exhibited lower values for RR and PD when exposed to CM, intermediate values to PM and higher values to HM. The results suggest that cats under general anaesthesia are likely to perform auditory sensory stimuli processing. The exposure to music induces RR and PD variations modulated by the genre of music and is associated with autonomic nervous system activity. The use of music in the surgical theatre may contribute to allowing a reduced anaesthetic dose, minimising undesirable side effects and thus promoting patient safety.

Lack of validation of the Dixtal (DX 2020) upper arm blood pressure monitor, in oscillometric mode, for clinical use in an intensive care unit, according to the European Society of Hypertension-International Protocol revision 2010

The aim of the study was to evaluate the accuracy of the oscillometric blood pressure section in the DX 2020 Dixtal multiparametric monitor in adults according to the European Society of Hypertension-International Protocol as revised in 2010 (ESH-IP 2010). The blood pressure was sequentially verified in 33 individuals admitted to an adult ICU (18 men, mean age 44 years) with a mercury column sphygmomanometer (two observers) and the DX 2020 test device (one supervisor). Ninety-nine pairs of differences were obtained. Data analysis followed the ESH-IP 2010 requirements. In the first requirement, the DX 2020 device failed in the validation study in the 5, 10, and 15 mmHg ranges. From the 99 pairs of differences, only 43/73, 69/87, and 81/96 were obtained for systolic blood pressure and 29/65, 56/81, and 71/93 were obtained for diastolic blood pressure. In the second requirement, at least 24 individuals should have, from their comparisons, two under 0-5 mmHg ranges, which was observed only with 16 individuals in the systolic and nine in the diastolic range. Moreover, at maximum, only three readings could have differences of more than 5 mmHg, and this was observed in 10 individuals in the systolic range and 17 individuals in the diastolic range. The DX 2020 automatic multiparametric monitor for blood pressure measurement has not been recommended for clinical use according to the ESH-IP 2010. It is important to highlight that this work refers only to a blood pressure measurement module and that the same conclusion cannot be drawn for its other functions.

On-line measurement of systolic pressure variation and pulse pressure variation on a multiparametric monitor

On-line measurement of systolic pressure variation and pulse pressure variation on a multiparametric monitor

Syncope in old people. The importance of multiparametric monitor in OBI evaluation

Syncope is a common clinical entity, and it causes up to 3% of admission in the Emergency Department. The evaluation of syncope begins with a careful history, physical examination, and electrocardiography, with a correct identification of etiology at the presentation in up to 50% of cases. Moreover, the underlying cause of syncope remains unidentified in a elevated percentage of patients. The application of Standard Guidelines and the institution of the Observation Unit (OBI) with continuous monitoring improves patients management, chiefly in the geriatric population (> 65 years old). In older patients the clinical features of syncope are less defined, and the medical history has a limited value. The management in the OBI of this group of patient with continuous monitoring could become the best approach. The ECG monitoring can detect life-threatening arrhythmias in older patients with apparent non cardiac syncope. In the firs six months of 2005 the Emergency Department of the Ospedale San Paolo (Savona) evaluated 164 patients > 65 years old with diagnosis of syncope/pre-syncope. During monitoring we detected events of arrhythmia in 12 patients (7,3%), including ventricular tachycardia in 2, atrial fibrillation in 4, paroxysmal atrial flutter in 2, paroxysmal supraventricular tachycardia in 1, asystole in 1 and third-degree atrioventricular block in 2 patients. We briefly describe 2 of this case: in both cases the first suggestion indicates a possible non cardiac etiology, but the subsequent monitoring shows episodes of potentially fatal arrhythmia. Both an early discharge and an in non-monitorized bed admission wouldn’t have preserved the two patient by a sudden cardiac death.

A novel system for simultaneous monitoring of locomotor and sound activities in animals

This paper describes a PC-based system for simultaneous monitoring of locomotor and sound activities on small rodents. The displacement and location signals of the animal were first determined across consecutive video-frames, followed by marked data reduction to cater for long-term studies. At the same time, sounds generated by the animal were detected and the sound level was recorded as root-mean-square values at 1 s intervals. Preliminary data showed that such a multi-parametric monitor system could provide comprehensive information on the animal's activity.