But how long did you keep the patient in this position after the spinal insertion? If it was less than1 5-20 minutes, the bupivacaine will still shift as per my previous post, and a high spinal will result.
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Show posts MenuQuote from: Matthew Parsons on January 25, 2005, 08:00:48 PM
Having said that, I must admit I see little harm in using it on almsot everybody.
Quote from: naveen laiker on January 15, 2005, 09:03:33 AM
Just because u like and use LMA a lot.u cant cross the limit.BE sure to be concerned as soon as ETCO2 enters in 50s.If not satisfied INTUBATE and hyperventilate.GET BLOOD GASES FOR SAFETY OF PATIENT
QuoteThe Utility of Cerebral Oximetry in Critically Ill Patients
Susan Marlow, Ken Parsons, Violet Miller and Brian J O'Neil
Saint John Hospital: Detroit, MI
ABSTRACT
Objective:
Jugular bulb oxygen saturation has been correlated to the adequacy of resuscitation and neurologic outcomes in critically ill patients. Regional cerebral oximetry (rSO2) provides a continuous, non-invasive method to monitor cerebral oxygen saturation in the frontal lobes, which is highly correlated with jugular bulb oxygenation. Our aim is to study the utility of rSO2 in the resuscitation of critically ill patients in the emergency department (ED).
Hypothesis:
Cerebral oximetry predicts the adequacy of resuscitation and neurologic outcomes.
Methods:
A prospective observational study was performed on a convenience sample of critically ill patients with altered mental status at a community hospital ED. The INVOS cerebral oximeter was used to detect rSO2. Cerebral oximetry, vital signs, acid—base status, lactates interventions, creatine kinase—BB (CK-BB), and neurologic status at hospital discharge were recorded. Outcome measures were neurologic outcome, defined by the Glasgow Outcome Scale, and adequacy of resuscitation (AOR), defined by base deficit and lactate levels. Data were analyzed utilizing descriptive statistics and Pearson correlation.
Results:
Twelve subjects were enrolled. Five patients either maintained or were quickly resuscitated to rSO2 levels between 50% and 80% and all displayed both adequate resuscitation and returned to normal activity. Five patients had rSO2 outside the above range, 4 below (all with inadequate resuscitation), and 1 above, (large frontal bleed), all 5 of whom died. Two patients had rSO2 within normal ranges; both had intracranial bleeding in the posterior circulation and poor neurologic outcomes. The rSO2 had positive predictive values (PPVs) of 100% and 57% and negative predictive values (NPVs) of 40% and 100% for neurologic outcome and AOR, respectively.
Conclusion:
In critically ill patients, cerebral oximetry has excellent positive and negative predictive values for neurologic outcome and adequacy of resuscitation, respectively. This study is limited by the small sample size.
Quote
Sudden Severe Hypotension During Induction Of Anesthesia For Carotid Endarterctomy (CEA):
The Utility Of NIRS. A Case Report.
QuoteObjectives:
The timing of bifrontal decompressive craniectomy (BDC) in patients with intractable intracranial hypertension (IH) is crucial, and the decision to do surgery is based primarily on invasive neuromonitoring. In this report the authors show the efficacy of a non-invasive, near infrared transcranial cerebral oximeter (TCCO) in the management of a patient with post-traumatic IH.
Clinical Presentation:
A 14-year-old male patient who had severe head injury following road traffic accident (RTA). His Glasgow Come Score (GCS) was 6/15. Brain computerized tomography (CT) scan showed multiple brain contusions and diffuse brain edema. He developed a state of IH that did not respond to standard medical treatment. We have used TCCO for neuromonitoring, its readings showed marked difference between the two cerebral hemispheres and this correlated well with the clinical and radiological findings.
Intervention:
Because of the decreasing trend of cerebral oxygen saturation and pupillary changes (anisocoria) BDC was performed. The timing of surgery was appropriate as no brain infarction occurred. Following surgery, TCCO readings were normal and the patient recovery was dramatic and relatively quick.
Conclusion:
TCCO may be an efficient Neuromonitoring tool in determining the time for surgical interference in patients with IH following RTA.
Citation:
Sherif El-Watidy, Abdelazeem El-Dawlatly, Zain A. Jamjoom, Essam El-Gamal: Use of Transcranial Cerebral Oximeter as Indicator for Bifrontal Decompressive Craniectomy. The Internet Journal of Anesthesiology. 2004. Volume 8 Number 2.
QuoteCrit Care Med. 1997 Jul;25(7):1252-4.
Failure of the INVOS 3100 cerebral oximeter to detect complete absence of cerebral blood flow.
Gomersall CD, Joynt GM, Gin T, Freebairn RC, Stewart IE.
Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT.