Changes In SpO2 Research Articles

Abstract PR461

Background & Objectives: Pancuronium was marketed in 1964. Use of pancuronium is limited in patients with impaired liver and renal function. Atracurium was introduced in 1982. Atracurium besylate slowly loses potency with time at the rate of approximately 6% per year under refrigeration. Rate of loss in potency increases to approximately 5% per month at 25°C. This study was designed to compare the effect of atracurium versus pancuronium on endotracheal intubation after administration of intubating doses on intubating conditions and cardiovascular parameters in Myanmar population. Materials & Methods: Randomized, prospective, comparative, clinical study of sixty patients (30 for Atracurium & 30 for Pancuronium), age between 20-50 years with ASA I and II who underwent elective surgery requiring GA/ IPPV. After induction with propofol 2.5mg kg-1, 30 patients in group A were given atracurium 0.5mg kg-1 intravenously and 30 patients in group B were received pancuronium 0.1mg kg -1. The first intubation attempt was made 3 minutes after administration of the neuromuscular blocking agent. The heart rate and SpO2 changes were recorded every minute from just before injection of neuromuscular blocking agent till 12 minutes. The changes in arterial blood pressure were also recorded every 3 minutes till 12 minutes after injection of NMBA. Intubation conditions were assessed as excellent, good, fair and poor based on jaw relaxation, position of vocal cords, response of the diaphragm to intubation and the grading at the view of laryngoscopy. The times taken for intubation were also recorded. Results: There were no statistically significant differences in pre-operative haemodynamic data. Atracurium provided more jaw relaxations (p=0.026), better laryngoscopic view (p = 0.028), better vocal cord paralysis & better diaphragmatic relaxation (p = 0.038) and better intubating grading (p = 0.028) than pancuronium. Total time taken for intubation was more prolong with pancuronium (p < 0.01). It was concluded that atracurium provided better intubating conditions than pancuronium. Atracurium caused a slight fall in arterial blood pressure from the baseline but it was not statistically significant. Atracurium had lacked hypertensive response to intubation and provided better haemodynamic stability than pancuronium. Pancuronium caused rapid increase and decrease in blood pressure and had hypertensive stress response to intubation at 6 minutes, which was statistically significant (p < 0.05). Pancuronium caused significant increase in heart rate than atracurium, which was statistically significant at every minute. Conclusion: Atracurium provided that better intubating condition and haemodynamic stability than pancuronium. Presented at ANZCA 2016 as ePoster.

Feasibility, tolerability and safety of pediatric hyperpolarized 129Xe magnetic resonance imaging in healthy volunteers and children with cystic fibrosis.

Hyperpolarized 129Xe is a promising contrast agent for MRI of pediatric lung function, but its safety and tolerability in children have not been rigorously assessed. To assess the feasibility, safety and tolerability of hyperpolarized 129Xe gas as an inhaled contrast agent for pediatric pulmonary MRI in healthy control subjects and in children with cystic fibrosis. Seventeen healthy control subjects (ages 6-15years, 11 boys) and 11 children with cystic fibrosis (ages 8-16years, 4 boys) underwent 129Xe MRI, receiving up to three doses of 129Xe gas prepared by either a commercially available or a homebuilt 129Xe polarizer. Subject heart rate and SpO2 were monitored for 2min post inhalation and compared to resting baseline values. Adverse events were reported via follow-up phone call at days 1 and 30 (range ±7days) post-MRI. All children tolerated multiple doses of 129Xe, and no children withdrew from the study. Relative to baseline, most children who received a full dose of gas for imaging (10 of 12 controls and 8 of 11 children with cystic fibrosis) experienced a nadir in SpO2 (mean -6.0 ± standard deviation 7.2%, P≤0.001); however within 2min post inhalation SpO2 values showed no significant difference from baseline (P=0.11). There was a slight elevation in heart rate (mean +6.6 ± 13.9 beats per minute [bpm], P=0.021), which returned from baseline within 2min post inhalation (P=0.35). Brief side effects related to the anesthetic properties of xenon were mild and quickly resolved without intervention. No serious or severe adverse events were observed; in total, four minor adverse events (14.3%) were reported following 129Xe MRI, but all were deemed unrelated to the study. The feasibility, safety and tolerability of 129Xe MRI has been assessed in a small group of children as young as 6years. SpO2 changes were consistent with the expected physiological effects of a short anoxic breath-hold, and other mild side effects were consistent with the known anesthetic properties of xenon and with previous safety assessments of 129Xe MRI in adults. Hyperpolarized 129Xe is a safe and well-tolerated inhaled contrast agent for pulmonary MR imaging in healthy children and in children with cystic fibrosis who have mild to moderate lung disease.

Cerebral and Muscle Oxygenation During Intermittent Hypoxia Exposure in Healthy Humans.

To evaluate changes in muscle and cerebral oxygenation during intermittent hypoxia (IH). Fifteen healthy subjects were exposed to 45-min IH (2-min cycles). Arterial blood oxygen saturation (SpO2), prefrontal cortex and brachial biceps muscle oxygenation (assessed by near-infrared spectroscopy), heart rate, and ventilation were continuously recorded. During 2-min IH cycles, changes in SpO2 (9.2% ± 3.3%) were associated with significant changes in cortex oxygenation (3.2% ± 1.8%), minute ventilation, and heart rate, but no change in muscle oxygenation (0.2% ± 1.0%). Fluctuations of blood oxygen levels comparable to severe obstructive sleep apnea translate into distinct pattern of oxygenation changes in the muscle and cortex.

Effects of Early Bedside Cycle Exercise on Intracranial Pressure and Systemic Hemodynamics in Critically Ill Patients in a Neurointensive Care Unit.

Physiotherapy is an important part of treatment after severe brain injuries and stroke, but its effect on intracranial and systemic hemodynamics is minimally investigated. Therefore, the aim of this study was to assess the effects of an early bedside cycle exercise on intracranial and systemic hemodynamics in critically ill patients when admitted to a neurointensive care unit (NICU). Twenty critically ill patients suffering from brain injuries or stroke were included in this study performed in the NICU at Sahlgrenska University Hospital. One early implemented exercise session was performed using a bedside cycle ergometer for 20min. Intracranial and hemodynamic variables were measured two times before, three times during, and two times after the bedside cycling exercise. Analyzed variables were intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial blood pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2), cardiac output (CO), stroke volume (SV), and stroke volume variation (SVV). The cycling intervention was conducted within 7±5days after admission to the NICU. Cycle exercise increased MAP (p=0.029) and SV (p=0.003) significantly. After exercise CO, SV, MAP, and CPP decreased significantly, while no changes in HR, SVV, SpO2, or ICP were noted when compared to values obtained during exercise. There were no differences in data obtained before versus after exercise. Early implemented exercise with a bedside cycle ergometer, for patients with severe brain injuries or stroke when admitted to a NICU, is considered to be a clinically safe procedure.

Reduction In Oxygen Delivery Under Severe Hypoxia Affects Cognitive Function During Moderate Exercise

Reduction in oxygen delivery during hypoxia might impair cognitive function at rest. In contrast, acute moderate exercise can improve cognitive function. A recent study suggested that cognitive function improves during moderate exercise even under moderate hypoxia. However, it is unclear how moderate exercise affects cognitive function under severe hypoxia. PURPOSE:To clarify the effects of moderate exercise on cognitive function under severe hypoxia. METHODS:Thirteen subjects completed cognitive tasks under either normoxia or severe normobaric hypoxia (FIO2; 0.12~0.13) in a randomized crossover design. For each condition, participants underwent preliminary testing to assess peak oxygen uptake (peak VO2) while pedaling an ergometer. After a 5-min warm-up (30% peak VO2), they cycled at moderate intensity (50% peak VO2) for 15 min. Cognitive tasks were performed at rest and 5 min after the start of exercise at moderate intensity. Cognitive tasks were a spatial delayed-response task and a Go/NoGo task, which required working memory and executive function. Pulse oximetric saturation (SpO2) and cerebral oxygenation were monitored throughout the experiment. Cerebral oxygenation was recorded by near infrared spectroscopy and was expressed as changes from baseline. RESULTS:Severe hypoxia significantly decreased SpO2 and cerebral oxygenation at rest relative to normoxia (SpO2: 97.9 ± 0.7 vs. 87.8 ± 1.5 %, p < 0.01; cerebral oxygenation: 0.2 ± 1.3 vs -8.9 ± 1.7 %, p < 0.01). Moreover, relative to rest, exercise significantly decreased SpO2 and cerebral oxygenation under hypoxia (SpO2: 87.8 ± 1.5 vs. 77.5 ± 3.0 %, p < 0.01, cerebral oxygenation: -8.9 ± 1.7 vs. -17.0 ± 2.4 %, p < 0.01). Compared with rest, reaction time (RT) on the Go/NoGo task improved during exercise in both conditions (Normoxia: 1015 ± 315 vs. 862 ± 208 ms, p < 0.01, Hypoxia: 1023 ± 228 vs. 896 ± 236 ms, p < 0.01). Neither exercise nor hypoxia altered the accuracy on the cognitive tasks. In the hypoxic condition, ΔRT was negatively correlated with changes in SpO2 (r = -0.56; p < 0.05). CONCLUSIONS:Acute moderate exercise improves cognitive function even under severe hypoxia. However, the improvements under hypoxia appear to lessen as SpO2 decreases during exercise.

Age-related incidence of desaturation events and the cardiac responses on stroke index, cardiac index, and heart rate measured by continuous bioimpedance noninvasive cardiac output monitoring in infants and children undergoing general anesthesia

Study objectiveTo assess the effects of desaturation on stroke index (SI), cardiac index (CI), and heart rate (HR) using the ICON continuous noninvasive cardiac output monitor in children undergoing general anesthesia. DesignRetrospective analysis of a prospectively collected data set. SettingPediatric operating rooms in a tertiary academic medical center. PatientsChildren younger than 20 years who experienced desaturation while undergoing general anesthesia. InterventionAll records were retrospectively searched for desaturation events defined as a recorded Spo2 ≤ 90%. We compared the data from the prior 4 minutes (baseline) with mild, moderate, and severe levels of desaturation. MeasurementsThe relationship between Spo2 and percent change in SI, CI, and HR from baseline was assessed using a generalized linear model with repeated measures and the least-squares method. Main resultsData from 446 patients were reviewed; 38 events were eligible for analysis after exclusions. There were significant decreases in SI at all saturation ranges below 95%: −6.5% (P < .001) for 85%-95%, −8.9% (P = .002) for 71%-84%, and −11% (P < .001) for ≤70%. Based on the result from the regression, Spo2 was associated with change in SI with borderline significance (P = .053) but not that of HR and CI. There was a strong relationship to desaturation events with young age (P < .001), particularly infants younger than 6 months. ConclusionEvents associated with desaturation in children under general anesthesia were significantly associated with decreased SI with a greater effect with lower saturation nadirs. It is unclear if other concurrent events could have also contributed to adverse hemodynamic responses during desaturation. In most children, a compensatory increase in HR generally offsets concurrent decreases in CI. It would appear that bradycardia is a late manifestation of hypoxemia.

Oxygen Reserve Index: A Novel Noninvasive Measure of Oxygen Reserve--A Pilot Study.

Pulse oximetry provides no indication of downward trends in PaO2 until saturation begins to decrease. The Oxygen Reserve Index (ORI) is a novel pulse oximeter-based nondimensional index that ranges from 1 to 0 as PaO2 decreases from about 200 to 80 mmHg and is measured by optically detecting changes in SvO2 after SaO2 saturates to the maximum. The authors tested the hypothesis that the ORI provides a clinically important warning of impending desaturation in pediatric patients during induction of anesthesia. After preoxygenation, anesthesia induction, and tracheal intubation, the anesthesia circuit was disconnected and oxygen saturation was allowed to decrease to 90% before ventilation recommenced. The ORI and SpO2 values were recorded from a Masimo Pulse Co-Oximeter Sensor at the beginning of apnea, beginning and end of intubation, beginning and end of the ORI alarm, and 2 min after reoxygenation. Data from 25 healthy children, aged 7.6 ± 4.6 yr, were included in the analysis. During apnea, the ORI slowly and progressively decreased over a mean of 5.9 ± 3.1 min from 0.73 ± 0.16 at the beginning of apnea to 0.37 ± 0.11. SpO2 remained 100% throughout this initial period. Concurrently with alarm activation, the ORI began to decrease rapidly, and in median of 31.5 s (interquartile range, 19 to 34.3 s), saturation decreased to 98%. In this pilot study, the ORI detected impending desaturation in median of 31.5 s (interquartile range, 19-34.3 s) before noticeable changes in SpO2 occurred. This represents a clinically important warning time, which might give clinicians time for corrective actions.

Association between hypoxemia and anemia following arthroplasty: A pilot clinical study.

Hypoxia and anemia are common complications following joint arthroplasty. Whether hypoxia indicates that a patient is anemic and whether anemia causes a decline in arterial oxygen pressure accompanied by hypoxemia are not completely understood. The aim of the present study was to determine the association between hypoxemia and anemia following arthroplasty. A total of 135 patients who underwent arthroplasty at the China-Japan Friendship Hospital between January and May 2013 were retrospectively analyzed. The patients were divided into five groups depending on the type of arthroplasty they had experienced: Unilateral total knee arthroplasty (TKA), bilateral TKA, unilateral total hip arthroplasty (THA), bilateral THA or unilateral unicompartmental knee arthroplasty. Perioperative peripheral oxygen saturation (SpO2) and hemoglobin (Hb) levels were assessed, and the associations between the changes in SpO2 (ΔSpO2) and hemoglobin (ΔHb) levels on the first and third postoperative days (PODs) were analyzed using Pearson's correlation test for each group. The perioperative SpO2 curves for the various groups were typically at their lowest on the day of surgery. Significant hypoxemia was observed on POD 0-2, although a stable recovery curve was observed on POD 3-5. Trends in ΔHb were observed among the 5 groups, with the lowest Hb value observed predominantly on POD 2 and 3. By POD 4 and 5 Hb levels had recovered, with a steadily and consistently increasing curve. There was no statistically significant correlation between ΔSpO2 and decrease in Hb levels (P>0.05). SpO2 levels should not serve as a clinical indicator of the incidence and severity of anemia in patients who have undergone primary arthroplasty. To a point, the degree of postoperative anemic status does not affect SpO2 levels.

Comparison of jaw thrust and trapezius squeezing test as indicators for laryngeal mask airway insertion in infants and young children

To compare the effectiveness of the jaw thrust and the trapezius squeezing test(TST) for laryngeal mask airway (LMA) insertion in infants and children under sevoflurane anesthesia. A total of 100 children aged from 6 month to 3 years, American Society of Anesthesiologists(ASA) Ⅰ-Ⅱ and undergoing minor operation were enrolled from January to June 2015 in Tianjin Children's Hospital. The patients were randomly divided into jaw thrusting group (Group J, n=50)and trapezius squeezing group(Group T, n=50). Anesthesia was induced with sevoflurane. When children's eyelash reflex lose, jaw thrust/trapezius squeeze was applied every 15 seconds.It's considered that the depth of anesthesia was not enough, and test reaction was positive if any movements of body, limbs or toes were found at the point of test. Sevoflurane should be keep on inhalation until negative test reaction was appeared. Then LMA was inserted immediately.The time required for the negative test, end-tidal sevoflurane concentrations (ETsev), the index of Narcotrend anesthesia monitor(NT), the occurrence of gross purposeful movements, coughing, gagging, breath-holding, laryngospasm or an SpO2 < 90% during LMA insertion in two groups of patients were observed and recorded. The condition of LMA insertion and the rate of successful insertion were evaluated. The blood pressure(BP), heart rate(HR) and SpO2 were also recorded before and after LMA insertion. In group J and group T, the time required for the negative test was (2.31±1.03) vs (2.85±0.97)min(t=-2.462, P<0.05), ETsev was(3.25±1.02)% vs (3.81±0.87) %(t=-2.361, P<0.05), the depth of anesthesia NT index was(50.41±5.38) vs (41.32±4.92)(t=3.021, all P<0.05). All of above results were significantly different. The successful rate of the first attempt LMA insertion was 78% vs 100%(χ(2)=12.36 , P<0.01), respectively. The differences had statistical significance. The conditions of LMA insertion in group T were superior to those in group J. The incidences of gross purposeful movements, coughing, gagging, breath-holding and SpO2<90% during LMA insertion in group J were 20%, 16%, 10%, 14% and 8%, which were higher than those in group T (2%, 2%, 0, 2%, 0), the differences were significant(χ(2)=8.27, 5.98, 5.26, 4.89, 4.17, all P<0.05). No significant change in blood pressure, heart rate and SpO2 were found before and after inserting LMA in two groups. The trapezius squeezing test is a superior indicator of adequate condition for LMA insertion compared to the jaw thrust in infants and young children under sevoflurane anesthesia.

Evaluation effects of nebulized gentamicin in exacerbation of chronic obstructive lung disease.

Background:Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. Exacerbation of COPD has negative effect on quality of life. Therapeutic effect of nebulized antibiotics in pulmonary infections has been reported previously. Hence, we evaluated the effect of nebulized gentamicin in acute exacerbation of COPD (AECOPD).Materials and Methods:In this clinical trial study, 86 hospitalized patients with AECOPD were divided into two groups for using nebulized gentamicin twice daily (case group) and placebo (control group) for 5 days in addition to standard treatment. On admission and on the 6th day, respiratory rate (RR), white blood cell (WBC), spirometry, and SPO2 (arterial O2 saturation by pulse oxymetry) were measured in groups. The severity of dyspnea was evaluated by the Medical Research Council scale.Results:In both groups, changes of SpO2, RR, forced an expiratory volume of first second (FEV1), and forced vital capacity (FVC) were significant during the times of intervention (P < 0.05). However, changes of FEV1 and FVC were significantly different between two groups (P < 0.05). So that increments of FEV1 and FVC were higher in the case group than control group. WBC decreased significantly in the case group (P < 0.05) compared to control group. There was no significant difference between groups in severity of dyspnea after intervention (P > 0.05).Conclusion:Treatment with Nebulized Gentamicin in AECOPD exacerbation resulted in further improvement of FVC and FEV1 on the 6th day.

The Impact of Catheter Size on SpO2 Changes in Endotracheal Suctioning

The Impact of Catheter Size on SpO2 Changes in Endotracheal Suctioning

Effects of intravenous laser irradiation on respiratory physiology parameters of amyotrophic lateral sclerosis patients: An uncontrolled observational study

IntroductionRespiratory dysfunction and complications are the most common causes of death in amyotrophic lateral sclerosis (ALS) patients. This study observed the changes of respiratory physiology parameters during intravenous laser irradiation (ILI) treatment on ALS patients. MethodsEighteen ALS patients received ILI treatment four times a week for 2 weeks. The end tidal carbon dioxide (EtCO2), respiratory rate (RR), saturation of peripheral oxygen (SpO2) and pulse rate were measured for 15min before and during treatment by using capnography and oxymetry. For estimating the mechnism of ILI on respiratory function, we evaluated the LF (low frequency)/HF (high frequency) ratio of heart rate variability (HRV). ResultsThe results showed that RR, SpO2 and pulse were significantly reduced during ILI (p<.001). But the change of SpO2 and pulse value during ILI were significantly increased (p=.014<.05, p=.003<.01). LF (low frequency)/HF(high frequency) ratio value was significantly increased during ILI (p=.045<.05). ConclusionILI led to a statistically significant difference in SpO2 and pulse changes in ALS patients despite the supine position. These results seem to be caused by an ILI’s action to stimulate the sympathetic nervous system and modulate hyperkinetic hemodynamics. But, in order to clarify these results, a well designed study is now required.

Influence of pulmonary factors on pulse oximeter saturation in preterm infants

AimTo describe how the stability of oxygen saturation measured by pulse oximetry (SpO2%) varies within and between infants with bronchopulmonary dysplasia (BPD).MethodsClinically stable infants with BPD had SpO2 measured at...

Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% < 90% for >10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression.

Hypoxemia during aeromedical evacuation of the walking wounded.

Hypobaric hypoxemia is a well-known risk of aeromedical evacuation (AE). Validating patients as safe to fly includes assessment of oxygenation status as well as oxygen-carrying capability (hemoglobin). The incidence and severity of hypoxemia during AE of noncritically injured casualties have not been studied. Subjects deemed safe to fly by the validating flight surgeon were monitored with pulse oximetry from the flight line until arrival at definitive care. All subjects were US military personnel or contractors following traumatic injuries. Noninvasive oxygen saturation (SpO2), pulse rate, and noninvasive hemoglobin were measured every 5 seconds and recorded to electronic memory. Patient demographics and physiologic data were collected by chart abstraction from the Air Force Form 3899, patient movement record. The incidence and duration of hypoxemic events (SpO2 < 90%) and critical hypoxemic events were determined (SpO2 < 85%). Sixty-one casualties were evaluated during AE from Bagram Air Base to Landstuhl Regional Medical Center. The mean (SD) age was 26.2 (6) years, Injury Severity Score (ISS) was 8 (11), and mean SpO2 before AE was 96% (2%). The mean (SD) transport time was 9.3 (1.3) hours. Patients were monitored before AE for a brief period, yielding a total recording time of 10.28 hours. The mean (SD) hemoglobin at the time of enrollment was 13.2 (3.5) g/dL (9.4-18.0 g/dL). Hypoxemia (SpO2 < 90%) was seen in 55 (90%) of 61 subjects. The mean duration of SpO2 less than 90% was 44 minutes. The mean (SD) change in SpO2 from baseline to mean in-flight SpO2 was 4% (1.2%). Thirty-four patients (56%) exhibited an SpO2 less than 85% for 11.7 (15) minutes. Hypoxemia is a common event during AE of casualties. In patients with infection and concussion or mild traumatic brain injury, this could have long-term consequences. Epidemiologic/prognostic study, level V.

Relationship of Oxygen Saturation with Neonatal and Maternal factors in Vaginal and Cesarean Deliveries

Hypoxemia is the major cause of neonatal morbidity and mortality. The study aims to determine the influence of birth weight, Apgar score, gestation age, body mass index and hemoglobin of mother on levels of SpO2 in healthy newborns born vaginally and through cesarean section. A hospital Based, observational study conducted in Department of Pediatrics, Universal College of Medical Sciences-Teaching Hospital, Bhairahawa, Lumbini, Nepal; on 49 vaginal and 49 cesarean deliveries with Apgar Score ≥ 6. SpO2 was estimated by pulse oximeter post-ductally between 1 to 30 minutes of birth. The observed SpO2 values were correlated with neonatal and maternal factors. Vaginal and Cesarean deliveries SpO2 were comparable for birth weight, gestational age, Apgar score of neonates, body mass index and hemoglobin of the mother. Birth weight in vaginally delivered babies and Apgar score in cesarean births showed significant change in SpO2 (P<0.05). At all points of time the SpO2 values were higher in neonates, born by cesarean than those born out of spontaneous vaginal deliveries (P<0.001). SpO2 levels in neonates born through cesarean section were higher in comparison to thoseborn by vaginal route. Birth weight and Apgar score had correlation with SpO2 in vaginal and cesarean births, respectively.

Lost without trace: oximetry signal dropout in preterm infants

Oxygen saturation (SpO2) signal dropout leaves caregivers without a reliable measure to guide oxygen therapy. We studied SpO2 dropout in preterm infants on continuous positive airway pressure, noting the SpO2...

Influence of Gadoxetate Disodium on Oxygen Saturation and Heart Rate during Dynamic Contrast-enhanced MR Imaging.

To investigate whether gadoxetate disodium affects peripheral capillary oxygen saturation (SpO2) and/or heart rate (HR) during dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging in patients with liver diseases. This retrospective study was approved by the institutional review board, who waived the requirement for informed consent. Four hundred fifty-eight patients (171 women [mean age, 66.5 years; range, 23-87 years] and 287 men [mean age, 61.1 years; range, 25-89 years]) who underwent liver DCE MR imaging with gadoxetate disodium (0.025 mmol per kilogram of body weight) from October 28, 2013, to June 24, 2014, were included in this study. They were monitored for SpO2 and HR during DCE MR imaging. Motion artifact severity was graded by using a five-point scale, and transient severe motion (TSM) was defined by a score of at least 4. The association between TSM and baseline predictors was assessed, and HR and SpO2 at each postcontrast phase were compared with those at the precontrast phase in the TSM and non-TSM groups. Four hundred thirty-six patients were included in the non-TSM group, and 22 were included in the TSM group. Although the motion score was the worst at the arterial phase, the observed mean differences in SpO2 and HR between the precontrast phase and the arterial phase were less than 1% and 5 beats per minute, respectively (mean SpO2 ± standard deviation for the non-TSM group, 96.7% ± 1.8 vs 96.9% ± 1.8 [P = .11]; SpO2 for the TSM group, 96.4% ± 1.6 vs 96.1% ± 1.6 [P > .99]) (HR for the non-TSM group, 68.9 beats per minute ± 12.4 vs 70.9 beats per minute ± 12.1 [P < .0001]; HR for the TSM group, 75.0 beats per minute ± 11.8 vs 79.9 beats per minute ± 10.2 [P < .0001]). Intravenous gadoxetate disodium (a weight-based dose) does not cause changes in SpO2 and HR that lead to image quality degradation.

A comparative study of total intravenous anesthesia with propofol/ketamine and propofol/tramadol combinations in orthopedic outpatient procedures

Background: Propofol opioid/nonopioid combinations provide adequate analgesia during and after surgery. The aim of this study was to compare the effect of anesthesia with propofol/ketamine versus propofol/tramadol on the haemodynamic parameters and pain in patients undergoing orthopaedic outpatient surgical procedures.Methods: Fifty patients with ASA status I-II between the age group of 20-50 years undergoing orthopaedic outpatient surgical procedures under general anesthesia were randomly assigned to propofol/ ketamine (n=25, group I) and propofol/ tramadol (n=25, group II) groups. Patients in group I were induced with propofol 150 μg/kg/min IV and ketamine 50 μg/kg/min IV and in group II induction was performed with propofol 150 μg/kg/min IV and tramadol 1 mg/kg/min. IV. The hemodynamic parameters, oxygen saturation (SpO2), respiration rate, sedation and pain were measured before and after induction at predefined time points and were compared between groups.Results: There was significant difference between groups in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR). SBP, DBP and HR were stable in patients induced with propofol/ketamine. The SBP, DBP and HR decreased significantly after induction with propofol/tramadol compared to premedication, but tends to return to normal after 25 minutes. No significant changes in SpO2 found in both the groups at all-time points. Both groups are sedated and showed no difference in pain score with few episodes of unpleasant dreams or hallucinations or adverse complications.Conclusions: Propofol/tramadol anesthesia in patients undergoing orthopaedic procedures provided stable hemodynamic and respiratory stability, sedation and pain reduction as effective as propofol/ketamine anesthesia.

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children.

This study explored the sedative and analgesic effects of fentanyl combined with propofol via an intrathecal chemotherapy injection for acute leukemia (acute lymphocytic leukemia or acute myelocytic leukemia) among children, to relieve pain and difficulty during intrathecal injection, improve treatment compliance, increase the success rate of single puncture, and reduce procedure failure, with the aim of developing a painless procedure for children with acute leukemia. Fifty person-times received fentanyl combined with propofol via an intrathecal chemotherapy injection among the hospitalized children with leukemia. The patients' cooperation with the procedure, response to the medication, dosages of fentanyl and propofol, reaction to the procedures, wake-up time, and changes in oxygen saturation (SpO2), heart rate (HR), respiration, and blood pressure (BP) before, during, and after the procedures were observed. The doctors who performed the procedures assessed the quality of sedation and analgesia. In the treatment group, the patients were quiet during the lumbar puncture and intrathecal injection, showing good sedation and analgesia. HR and respiration decreased slightly. There were no changes in SpO2 and BP. No obvious respiratory depression occurred with proper dosages. Only a few patients showed stertorous respiration, which stopped soon after the procedures. In the control group, the patients were agitated, crying, and not cooperative before and during the procedures, which made the procedures very difficult. During intrathecal injection, pain obviously reduced and the success rate of single lumbar puncture increased. It is safe and effective to apply fentanyl combined with propofol for sedation and analgesia.