Use Of Pulse Oximetry Research Articles

Pulp Vitality Testing with a Developed Universal Pulse Oximeter Probe Holder.

Background and Objectives An accurate determination of the pulp status is relevant for a proper endodontic diagnosis. Objectives: The aim was to develop a universal pulse oximeter probe holder for measuring the oxygen saturation and to evaluate the use of pulse oximetry as a test for pulp vitality, by comparing the levels of oxygen saturation in the index finger and in the healthy dental pulp. Materials and Methods The universal holder was designed with software and printed with a 3D printer. The study was carried out on 128 healthy teeth. They were divided into eight groups according to tooth type. Ten root canal treated teeth served as a negative control group. For each patient, a pulse oximeter was first applied on the tooth followed by the index finger. The significance level (α) was set at 0.05. Results: The developed and manufactured universal pulse oximeter probe holder was suitable to measure the pulp vitality of all types of teeth. The handle allowed for holding the pulse oximeter on the tooth in parallel, firmly and securely. Significantly higher oxygen saturation was observed in the index finger (97.22%) compared to the dental pulp (93.17%) (p < 0.001). No correlation was observed between the maxillary teeth and index finger oxygen saturation values (r = 0.05, p = 0.72), whereas, between the mandibular teeth and index finger, a positive correlation was detected (r = 0.29, p = 0.02). There were no significant differences in the pulp oxygen saturation values between different teeth groups. Conclusion: The newly developed universal pulse oximeter probe holder is an effective device for pulp vitality testing.

Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations

BackgroundSedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures.MethodsWe systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded.We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool.ResultsWe identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations.ConclusionsRecommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency.

Respiratory Monitoring During Gamma Knife Radiosurgery: Anesthesiological Aspects.

Gamma Knife surgery (GKS) is a minimally invasive neurosurgical procedure, generally performed under moderate sedation along with local analgesia for fixation of a stereotactic frame to the patient's head, and is managed mostly by nonanesthesiologists. There are some risks for respiratory function during GKS and definite specifics for its management, since the presence of the stereotactic frame may impede access to the patient's airway and interfere with direct visual observation of him or her by medical personnel. Continuous monitoring for early detection of respiratory depression and timely intervention in the event of an emergency seem essential during radiosurgical procedures, but no relevant standards have been established to date. Since hypoventilation appears in advance of desaturation, sole monitoring of peripheral oxygen saturation (SpO2) by pulse oximetry is insufficient for detection of an early respiratory decline. According to the American Society of Anesthesiologists (ASA) practice guidelines for sedation and analgesia by nonanesthesiologists, the adequacy of ventilation during moderate and deep sedation should be evaluated by continuous observation of qualitative clinical signs and monitoring of end-tidal carbon dioxide (EtCO2). Overall, combined use of pulse oximetry and capnography may be recommended during GKS and may enhance its safety, especially in cases of medically fragile, uncooperative, or pediatric patients.

Use of pulse oximetry to screen for infant obstructive sleep apnoea

Introduction: Pulse oximetry is currently used to screen for obstructive sleep apnoea (OSA) in children. However, its use in infant has not yet been well studied. Aim: The aim of this study was to develop a screening criterion using pulse oximetry to identify infant with probable OSA. Materials and Methods: This was a retrospective cross-sectional study including infants <1 year of age with features of upper airway obstruction or requiring home oxygen to find associations between obstructive apnoea hypopnoea index (OAHI) in infant polysomnography (PSG) and parameters in pulse oximetry by Spearman Rho’s correlation. The factor with the strongest correlation is further analysed by receiver-operating characteristic (ROC) curve to identify a cutoff with highest Youden index to screen for probable OSA (OAHI >2 per hour). Results: A total of 27 infants were studied. The index of oxygen desaturation with SpO2 <90% per sampled hour (ODI<90%) had the best correlation with OAHI (r = 0.52, P = 0.005). Using the cutoff of ODI<90% more than 1.3 per hour, the sensitivity and specificity for identifying OAHI >2 per hour was 77% and 71%, respectively. Conclusion: Infant pulse oximetry can be a useful tool to screen for probable infant OSA especially for paediatric units not offering infant PSG service.

The Impact of Routine Pulse Oximetry Use on Outcomes in COVID-19-Infected Patients at Increased Risk of Severe Disease: A Retrospective Cohort Analysis

Background: A phenomenon of silent hypoxaemia has been described in patients with COVID-19 pneumonia, which is characterised by low oxygen saturation levels of Methods: We performed a retrospective cohort analysis using data from a large South African insurance administrator. Patients were categorised as high risk, based on age or if they had specific underlying clinical conditions, or if they were classified as high risk from predictive models based on medical scheme administrative claims data. The impact of pulse oximetry home monitoring on COVID-19 clinical outcomes were investigated by use of Cox proportional hazard models.Findings: Between 2 March 2020 and 31 October 2020, of 38 645 patients analysed, 8 113 were in the intervention group. The 60-day mortality rate for the evaluated high-risk population was 1·35%. After adjusting for the age and co-morbidity differences, the intervention group was found to have an adjusted hazard ratio (HR) of 0·52 (pInterpretation: High-risk COVID19 patients who used a pulse oximeter to monitor oxygen saturation levels had significantly lower mortality rates, compared to other high-risk patients. The mortality benefit was explained by earlier presentation to hospital, as suggested by lower initial CRP levels.Funding Statement: None.Declaration of Interests: None.Ethics Approval Statement: Ethics clearance was obtained from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand.

Use of home pulse oximetry with daily short message service messages for monitoring outpatients with COVID-19: The patient's experience.

Studies have shown COVID-19 patients may have a low oxygen saturation (SpO2) independent of visible respiratory distress, a phenomenon termed “silent hypoxia.” Silent hypoxia creates uncertainty in the outpatient setting for clinicians and patients alike. In this study, we examined the potential for pulse oximeters in identifying early signs of clinical deterioration. We report descriptive results on COVID-positive patients’ experiences with a comprehensive home monitoring tool comprised of home SpO2 measurements with a novel symptom-tracking short message service/text messaging application. Of patients who required hospitalization, 83% sought care as a result of low pulse oximeter readings. Nearly all patients who did not require hospitalization reported that having a pulse oximeter provided them with the confidence to stay at home. Essentially all patients found a home pulse oximeter useful. Keeping COVID-19-positive patients at home reduces the potential for disease spread and prevents unnecessary costs and strain on the healthcare system.

Barriers and Facilitators to Guideline-Adherent Pulse Oximetry Use in Bronchiolitis.

Continuous pulse oximetry monitoring (cSpO2) in children with bronchiolitis does not improve clinical outcomes and has been associated with increased resource use and alarm fatigue. It is critical to understand the factors that contribute to cSpO2 overuse in order to reduce overuse and its associated harms. This multicenter qualitative study took place in the context of the Eliminating Monitor Overuse (EMO) SpO2 study, a cross-sectional study to establish rates of cSpO2 in bronchiolitis. We conducted semistructured interviews, informed by the Consolidated Framework for Implementation Research, with a purposive sample of stakeholders at sites with high and low cSpO2 use rates to identify barriers and facilitators to addressing cSpO2 overuse. Interviews were audio recorded and transcribed. Analyses were conducted using an integrated approach. Participants (n = 56) included EMO study site principal investigators (n = 12), hospital administrators (n = 8), physicians (n = 15), nurses (n = 12), and respiratory therapists (n = 9) from 12 hospitals. Results suggest that leadership buy-in, clear authoritative guidelines for SpO2 use incorporated into electronic order sets, regular education about cSpO2 in bronchiolitis, and visual reminders may be needed to reduce cSpO2 utilization. Parental perceptions and individual clinician comfort affect cSpO2 practice. We identified barriers and facilitators to deimplementation of cSpO2 for stable patients with bronchiolitis across children's hospitals with high- and low-cSpO2 use. Based on these data, future deimplementation efforts should focus on clear protocols for cSpO2, EHR changes, and education for hospital staff on bronchiolitis features and rationale for reducing cSpO2.

Prevalence of Continuous Pulse Oximetry Monitoring in Hospitalized Children With Bronchiolitis Not Requiring Supplemental Oxygen

CP Bonafide, R Xiao, PW Brady. JAMA . 2020;323(15):1467–1477 To measure continuous pulse oximetry use in children with bronchiolitis. A multicenter cross-sectional study was performed in pediatric wards in 56 US and Canadian hospitals in the Pediatric Research in Inpatient Settings Network from December 1, 2018, through March 31, 2019. Participants included a convenience sample of patients aged 8 weeks through 23 months with bronchiolitis who were not receiving active supplemental oxygen administration. Patients with extreme prematurity, cyanotic congenital heart disease, pulmonary hypertension, …

Clinical use of pulse oximetry in adults

The article is devoted to the practical aspects of pulse oximetry. Pulse oximetry is a photoplethysmographic method for determining heart rate and the percentage of oxyhemoglobin in arterial blood. The method allows you to objectively evaluate arterial hypoxemia, therefore, it can be used in functional diagnostics and in the daily practice of interns of any specialization. The article briefly presents the history of pulse oximetry and a description of the technique. Particular attention is paid to the accuracy of measurements and reference values of pulse oximetry. The functional significance ofpulse oximetry is also considered here. Several sections are devoted to practical issues: interpretation of the results of pulse oximetry in the diagnosis of arterial hypoxia, in the differential diagnosis of shortness of breath, the diagnostic value of the phenomenon of desaturation. A large section is devoted to the importance of pulse oximetry in viral pneumonia COVID-19

Predictive value of pulse oximetry for mortality in infants and children presenting to primary care with clinical pneumonia in rural Malawi: A data linkage study.

The mortality impact of pulse oximetry use during infant and childhood pneumonia management at the primary healthcare level in low-income countries is unknown. We sought to determine mortality outcomes of infants and children diagnosed and referred using clinical guidelines with or without pulse oximetry in Malawi. We conducted a data linkage study of prospective health facility and community case and mortality data. We matched prospectively collected community health worker (CHW) and health centre (HC) outpatient data to prospectively collected hospital and community-based mortality surveillance outcome data, including episodes followed up to and deaths within 30 days of pneumonia diagnosis amongst children 0-59 months old. All data were collected in Lilongwe and Mchinji districts, Malawi, from January 2012 to June 2014. We determined differences in mortality rates using <90% and <93% oxygen saturation (SpO2) thresholds and World Health Organization (WHO) and Malawi clinical guidelines for referral. We used unadjusted and adjusted (for age, sex, respiratory rate, and, in analyses of HC data only, Weight for Age Z-score [WAZ]) regression to account for interaction between SpO2 threshold (pulse oximetry) and clinical guidelines, clustering by child, and CHW or HC catchment area. We matched CHW and HC outpatient data to hospital inpatient records to explore roles of pulse oximetry and clinical guidelines on hospital attendance after referral. From 7,358 CHW and 6,546 HC pneumonia episodes, we linked 417 CHW and 695 HC pneumonia episodes to 30-day mortality outcomes: 16 (3.8%) CHW and 13 (1.9%) HC patients died. SpO2 thresholds of <90% and <93% identified 1 (6%) of the 16 CHW deaths that were unidentified by integrated community case management (iCCM) WHO referral protocol and 3 (23%) and 4 (31%) of the 13 HC deaths, respectively, that were unidentified by the integrated management of childhood illness (IMCI) WHO protocol. Malawi IMCI referral protocol, which differs from WHO protocol at the HC level and includes chest indrawing, identified all but one of these deaths. SpO2 < 90% predicted death independently of WHO danger signs compared with SpO2 ≥ 90%: HC Risk Ratio (RR), 9.37 (95% CI: 2.17-40.4, p = 0.003); CHW RR, 6.85 (1.15-40.9, p = 0.035). SpO2 < 93% was also predictive versus SpO2 ≥ 93% at HC level: RR, 6.68 (1.52-29.4, p = 0.012). Hospital referrals and outpatient episodes with referral decision indications were associated with mortality. A substantial proportion of those referred were not found admitted in the inpatients within 7 days of referral advice. All 12 deaths in 73 hospitalised children occurred within 24 hours of arrival in the hospital, which highlights delay in appropriate care seeking. The main limitation of our study was our ability to only match 6% of CHW episodes and 11% of HC episodes to mortality outcome data. Pulse oximetry identified fatal pneumonia episodes at HCs in Malawi that would otherwise have been missed by WHO referral guidelines alone. Our findings suggest that pulse oximetry could be beneficial in supplementing clinical signs to identify children with pneumonia at high risk of mortality in the outpatient setting in health centres for referral to a hospital for appropriate management.

Association Between Bronchiolitis Patient Volume and Continuous Pulse Oximetry Monitoring in 25 Hospitals.

Continuous pulse oximetry monitoring in stable patients with bronchiolitis is discouraged by national guidelines in order to reduce overuse, yet wide practice variation exists among hospitals. Understanding the association between monitoring overuse and hospital unit-level factors may identify areas for improvement. Conducted at 25 sites from the Pediatric Research in Inpatient Settings (PRIS) Network's Eliminating Monitoring Overuse (EMO) study, this substudy used data from 2,366 in-person observations of pulse oximetry use in patients with bronchiolitis to determine whether hospital unit-level factors were associated with variation in pulse oximetry use for patients in whom continuous monitoring is not indicated. Hospital units were classified by bronchiolitis admission burden. Monitoring rates were analyzed in a mixed-effects model that accounted for variation in baseline monitoring rates among hospitals and adjusted for covariates significantly associated with continuous pulse oximetry monitoring use in the primary study's analysis. Low burden units (<10% of total admissions) had a 2.16-fold increased odds of pulse oximetry overuse compared to high burden units (≥40% of total admissions) (95% CI, 1.27-3.69; P = .01). These results suggest that units caring for a lower percentage of patients with bronchiolitis are more likely to overuse pulse oximetry despite national guidelines.

Validity of Continuous Pulse Oximetry Orders for Identification of Actual Monitoring Status in Bronchiolitis.

The accuracy of pulse oximetry monitor orders for identifying infants with bronchiolitis who are being continuously monitored is unknown. In this 56-hospital repeated cross-sectional study, investigators used direct bedside observation to determine continuous pulse oximetry monitor use and then assessed if an active continuous monitoring order was present in the electronic health record. Investigators completed 3,612 observations of infants aged 8 weeks to 23 months hospitalized with bronchiolitis and on room air. Most monitored infants did not have an active monitoring order (sensitivity 49% [95% CI, 41-57]). The positive predictive value of a monitoring order was 77% (95% CI, 72-82), and the negative predictive value was 69% (95% CI, 61-77). Teams intending to measure continuous pulse oximetry use should understand the limitations of using electronic health record orders as a stand-alone measure.

Improving Hospital Oxygen Systems for COVID-19 in Low-Resource Settings: Lessons From the Field.

Oxygen therapy is an essential medicine and core component of effective hospital systems. However, many hospitals in low- and middle-income countries lack reliable oxygen access-a deficiency highlighted and exacerbated by the coronavirus disease (COVID-19) pandemic. Oxygen access can be challenged by equipment that is low quality and poorly maintained, lack of clinical and technical training and protocols, and deficiencies in local infrastructure and policy environment. We share learnings from 2 decades of oxygen systems work with hospitals in Africa and the Asia-Pacific regions, highlighting practical actions that hospitals can take to immediately expand oxygen access. These include strategies to: (1) improve pulse oximetry and oxygen use, (2) support biomedical engineers to optimize existing oxygen supplies, and (3) expand on existing oxygen systems with robust equipment and smart design. We make all our resources freely available for use and local adaptation.

Acute Viral Bronchiolitis: A Narrative Review.

Acute viral bronchiolitis (AVB) is the leading cause of hospital admissions among infants in developed and developing countries and associated with increased morbidity and cost of treatment. This review was performed to guide the clinicians managing AVB in light of evidence accumulated in the last decade. We searched published English literature in last decade regarding etiology, diagnosis, treatment, and prevention of AVB using PubMed and Cochrane Database of Systematic Reviews. Respiratory syncytial virus is the most common causative agent. The diagnosis is mainly clinical with limited role of diagnostic investigations and chest radiographs are not routinely indicated. The management of AVB remains a challenge, as the role of various interventions is not clear. Supportive care in form of provision of heated and humidified oxygen and maintaining hydration are main interventions. The use of pulse oximetry helps to guide the administration of oxygen. Trials and systematic reviews evaluated various interventions like nebulized adrenaline, bronchodilators and hypertonic saline, corticosteroids, different modes of noninvasive ventilation (high-flow nasal cannula [HFNC], continuous positive airway pressure [CPAP], and noninvasive positive pressure ventilation [NPPV]), surfactant, heliox, chest physiotherapy, and antiviral drugs. The interventions which showed some benefits in infants and children with AVB are adrenaline and hypertonic saline nebulization, HFNC, CPAP, NIV, and surfactant. The routine administration of antibiotics, bronchodilators, corticosteroids, steam inhalation, chest physiotherapy, heliox, and antiviral drugs are not recommended.

Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance.

During the ongoing coronavirus disease (COVID-19) pandemic, reports in social media and the lay press indicate that a subset of patients are presenting with severe hypoxemia in the absence of dyspnea, a problem unofficially referred to as “silent hypoxemia.” To decrease the risk of complications in such patients, one proposed solution has been to have those diagnosed with COVID-19 but not sick enough to warrant admission monitor their arterial oxygenation by pulse oximetry at home and present for care when they show evidence of hypoxemia. Though the ease of use and low cost of pulse oximetry makes this an attractive option for identifying problems at an early stage, there are important considerations with pulse oximetry about which patients and providers may not be aware that can interfere with successful implementation of such monitoring programs. Only a few independent studies have examined the performance of pocket oximeters and smart phone–based systems, but the limited available data raise questions about their accuracy, particularly as saturation falls below 90%. There are also multiple sources of error in pulse oximetry that must be accounted for, including rapid fluctuations in measurements when the arterial oxygen pressure/tension falls on the steep portion of the dissociation curve, data acquisition problems when pulsatile blood flow is diminished, accuracy in the setting of severe hypoxemia, dyshemoglobinemias, and other problems. Recognition of these issues and careful counseling of patients about the proper means for measuring their oxygen saturation and when to seek assistance can help ensure successful implementation of needed monitoring programs.

Double standards: why is pulse oximetry standard care, whereas tissue oximetry is not?

Why is pulse oximetry a standard monitor, whereas tissue oximeter is not? Is this a double-standard treatment? There appears to be a lack of enthusiasm for a continual investigation into whether the use of pulse oximetry leads to reduced morbidity and mortality in acute care although there is no robust evidence attesting to its outcome benefits. In contrast, research investigating the outcome effectiveness of tissue oximetry-guided care is consistently ongoing. A recent randomized controlled trial involving 800 patients who underwent laparoscopic hysterectomy found that, although muscular tissue oxygen saturation-guided care did not reduce the overall occurrence of postoperative nausea and vomiting for all patients, it did reduce the occurrence of these symptoms in patients who had a body mass index ≥25. It was also observed that muscular tissue oxygen saturation increases when blood pressure falls following the administration of nicardipine. These studies highlight the persistence of interest in understanding the value of tissue oximetry in patient care. Pulse oximetry and tissue oximetry are treated differently although neither monitor has robust evidence attesting to its outcome benefits. This difference may root in the difference in the physiology they monitor, the cost, the ease of use/interpretation/intervention and the relevance to patient safety and care quality. Pulse oxygen saturation represents a vital sign, whereas tissue oxygen saturation is likely a quality sign; however, further research endeavors are required to fully understand how to best use tissue oximetry.

Parental Perspectives on Continuous Pulse Oximetry Use in Bronchiolitis Hospitalizations.

Because of the impact of continuous pulse oximetry (CPOX) on the overdiagnosis of hypoxemia in bronchiolitis, the American Academy of Pediatrics and the Choosing Wisely campaign have issued recommendations for intermittent monitoring. Parental preferences for monitoring may impact adoption of these recommendations, but these perspectives are poorly understood. Using this cross-sectional survey, we explored parental perspectives on CPOX monitoring before discharge and 1 week after bronchiolitis hospitalizations. During the 1-week call, half of the participants were randomly assigned to receive a verbal statement on the potential harms of CPOX to determine if conveying the concept of overdiagnosis can change parental preferences on monitoring frequency. An aggregate variable measuring favorable perceptions of CPOX was created to determine CPOX affinity predictors. In-hospital interviews were completed on 357 patients, of which 306 (86%) completed the 1-week follow-up. Although 25% of parents agreed or strongly agreed that hospital monitors made them feel anxious, 98% agreed that the monitors were helpful. Compared to other vital signs, respiratory rate (87%) and oxygen saturation (84%) were commonly rated as "extremely important." Providing an educational statement on CPOX comparatively decreased parental desire for continuous monitoring (40% vs 20%; P < .001). Although there were no significant predictors of CPOX affinity, the effect size of the educational intervention was higher in college-educated parents. Parents find security in CPOX. A brief statement on the potential harms of CPOX use had an impact on stated monitoring preferences. Parental perspectives are important to consider because they may influence the adoption of intermittent monitoring.

Making the Case for Limited Physiologic Monitoring in a Data-Hungry World.

Megan* paced the small hospital room, pausing to peer anxiously at the sleeping infant in a white plastic crib. As I introduced myself, Megan laughed nervously and explained her unease: “For the first time in her life, Riley is sleeping unmonitored,” she said, glancing again at her 5-month-old infant. Before today’s admission for bronchiolitis, Riley’s sleep routine included strapping on her Owlet, a pulse oximetry–based home infant monitor. “It’s ironic,” Megan pointed out. Now, hospitalized for a respiratory illness, Riley would ostensibly have less monitoring than at home. “Seeing her numbers makes me feel safer. What’s the harm?” Megan asked. Megan’s question gets to the heart of pediatric hospital medicine’s struggle to transition away from continuous pulse oximetry monitoring of stable patients with bronchiolitis and at the sentiments explored by Chi et al1 in “Parental Perspectives on Continuous Pulse Oximetry Use in Bronchiolitis Hospitalizations.” The clinical downsides to continuous monitoring of such patients, including overdiagnosis of hypoxemia, increased length of stay, alarm fatigue and delayed alarm response time among nurses, are well characterized.2–4 Given that bronchiolitis is responsible for over 100 000 hospitalizations a year,5 … Address correspondence to Irit R. Rasooly, MD, MSCE, Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, 3500 Civic Center Blvd, Buerger Center for Advanced Pediatric Care, 12th Floor, Philadelphia, PA 19104. E-mail: rasoolyi{at}email.chop.edu

PREVENTION OF OXYTOCIN-INDUCED HYPOTENSION IN CAESAREAN SECTION BY PHENYLEPHRINE: EFFECT OF PRELOAD Dr. Anita Chikara

Introduction: One of the leading causes of maternal mortality with uterine atony is Postpartum haemorrhage (PPH) and can be reduced by proper use of uterotonic agents like oxytocin which is most commonly used. Approximately 80% of the patients suffers Spinal-induced hypotension (SIH) for cesarean delivery (CD) and is a frequently encountered problem. Postpartum haemorrhage (PPH) is one of the leading causes of maternal mortality with uterine atony in about 50% cases. There are many approaches to prevent hypotension but no single approach has been shown as the gold standard, and each prophylactic treatment comes with accompanying risks. Crystalloid preload can prevent hypotension has a poor efficacy in preventing hypotension, due to rapid redistribution into the extracellular space. Phenylephrine is a short-acting alpha agonist, can be administered by bolus as well as by infusion to treat oxytocin induced hypotension. Phenylephrine obtunds oxytocin-induced decrease in systemic vascular resistance (SVR) and increase in heart rate and cardiac output&#x0D; Material and Methods: Patients were randomized to be in the colloid or crystalloid infusion groups. Normal singleton pregnancy, beyond 36 weeks gestation, between 19and 35 years of age, weight between 50 and 100 kg, and height ranging from 150-180 cm. Pre-anaesthetic evaluation of all the patients was done. Intravenous administration of preload was delivered for 30 min, prior to spinal anaesthesia and when the fluid load was complete, IV patency was maintained at a rate of 5 ml/hour and medications were flushed with LR. Standard monitoring for all patients was done through use of non-invasive blood pressure (NIBP) measurement, electrocardiography, and pulse oximetry. Oxygen (2 l/min) was administered via nasal cannula. The average Systolic BP and accompanying heart rate (HR) of these 3 measurements were recorded as mean baseline values. Patients feeling about nausea was recorded from start of anaesthesia at every 5 minutes interval. Results: Mean age in lacteted ringer solution group was 25.27±5.11 years while in hydroxyethyl starch group it was 26.19±4.67. Mean Spinal uterine incision time was 15.88±4.27 and 17.18±3.35 in lacteted ringer solution group and hydroxyethyl starch group respectively. Estimated blood loss in ml(mean±SD) was 443±59.44 and 479±61.32 in lacteted ringer solution group and hydroxyethyl starch group respectively. Systolic blood pressure baseline (mean±SD) 126.45±11.33 and 129.12±9.24 in lacteted ringer solution group and hydroxyethyl starch group respectively. Heart rate (mean±SD) was 88.87±9.45 and 88.21±10.55 in lacteted ringer solution group and hydroxyethyl starch group respectively. Significantly less phenylephrine was used in the colloid group (1058 ± 558 mcg) compared to the crystalloid group (1400 ± 513 mcg) (P = 0.0019) . There was no significant difference in the incidence of maternal nausea and vomiting, as well as APGAR scores at 1 and 5 min.&#x0D; Conclusion: In prevention of SIH and treatment, Phenylephrine with collids are found to be superior than crystelloids because of the sparing effect of phenylephrine associated with preloading colloids.&#x0D; Keywords: crystelloids, collids, lactated, cesarean delivery

Role of pulse oximetry as a screening tool for detection of critical congenital heart diseases in newborns in Southern India

Background: Timely diagnosis of critical congenital heart disease (CrCHD) is challenging but critical. Although echocardiography is the gold standard for diagnosis of CrCHD, it cannot be used as a screening tool. Pulse oximetry is a non-invasive, cost-effective screening tool, which can be used to detect CrCHDs in newborns. Objective: The main objective of the study was to assess the usefulness of pulse oximetry as a screening tool for early detection of CrCHD in otherwise asymptomatic newborns. Materials and Methods: This study was a hospital-based prospective observational study carried out at the Department of Paediatrics at a Tertiary Hospital of Southern India over a period of 12 months from January 2016 to December 2016. A total of 1000 asymptomatic newborns of &gt;35 weeks of gestation born in the hospital were enrolled in the study. The screening was considered positive if pulse oximetry saturation (SpO2) &lt;90% in right hand (RH) or foot (F) or three readings of SpO2 of 90–94% in RH and F or &gt;3% SpO2 difference between RH and F at three readings. Echocardiography was performed in those with clinical suspicion of CHD and/or positive pulse oximetry screening. Results: In the present study, the sensitivity of pulse oximetry for detection of CrCHD was 100% and specificity was 98.5%. Conclusion: Pulse oximetry screening is an effective and reliable test which significantly increases the detection rate of CrCHDs compared to the current practice of clinical examination alone as a screening tool. This study reinforces the importance of pulse oximetry screening in newborns.