Accuracy and trending ability of the fourth-generation FloTrac/Vigileo System™ in patients undergoing abdominal aortic aneurysm surgery

Abstract

Purpose

The fourth-generation FloTrac/Vigileo™ improved its algorithm to follow changes in systemic vascular resistance index (SVRI). This revision may improve the accuracy and trending ability of CI even in patients who undergo abdominal aortic aneurysm (AAA) surgery which cause drastic change of SVRI by aortic clamping. The purpose of this study is to elucidate the accuracy and trending ability of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery by comparing the FloTrac/Vigileo™-derived CI (CI_FT) with that measured by three-dimensional echocardiography (CI_3D).

Methods

Twenty-six patients undergoing elective AAA surgery were included in this study. CI_FT and CI3_D were determined simultaneously in eight points including before and after aortic clamp. We used CI_3D as the reference method.

Results

In the Bland–Altman analysis, CI_FT had a wide limit of agreement with CI_3D showing a percentage error of 46.7%. Subgroup analysis showed that the percentage error between CO_3D and CO_FT was 56.3% in patients with cardiac index < 2.5 L/min/m² and 28.4% in patients with cardiac index ≥ 2.5 L/min/m². SVRI was significantly higher in patients with cardiac index < 2.5 L/min/m² (1703 ± 330 vs. 2757 ± 798; p < 0.001). The tracking ability of fourth generation of FloTrac/Vigileo™ after aortic clamp was not clinically acceptable (26.9%).

Conclusions

The degree of accuracy of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery was not acceptable. The tracking ability of the fourth-generation FloTrac/Vigileo™ after aortic clamp was below the acceptable limit.

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Trends in the Implementation of Active Surveillance for Low-Risk Papillary Thyroid Microcarcinomas at Kuma Hospital: Gradual Increase and Heterogeneity in the Acceptance of This New Management Option

Thyroid, Ahead of Print.


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Quantitative Analysis of the Benefits and Risk of Thyroid Nodule Evaluation in Patients ≥70 Years Old

Thyroid, Ahead of Print.


https://ift.tt/2pZVV2J

Seasonal Changes in Serum TSH Concentrations Observed from Big Data Obtained During Six Consecutive Years from 2010 to 2015 at a Single Hospital in Japan

Thyroid, Ahead of Print.


https://ift.tt/2GwcTMu

Application of wavelet analysis to detect dysfunction in cerebral blood flow autoregulation during experimental hyperhomocysteinaemia

Abstract

The purpose of the present study was to investigate the use of laser Doppler flowmetry (LDF) signals coupled with spectral wavelet analysis to detect endothelial link dysfunction in the autoregulation of cerebral blood flow in the setting of hyperhomocysteinaemia (HHcy). Fifty-one rats were assigned to three groups (intact, control, and HHcy) according to the results of biochemical assays of homocysteine level in blood plasma. LDF signals on the rat brain were recorded by LAKK-02 device to measure the microcirculatory blood flow. The laser operating wavelength and output power density were1064 nm and 0.051 W/mm², respectively. A Morlet mother wavelet transform was applied to the measured 8-min LDF signals, and periodic oscillations with five frequency intervals were identified (0.01–0.04 Hz, 0.04–0.15 Hz, 0.15–0.4 Hz, 0.4–2 Hz, and 2–5 Hz) corresponding to endothelial, neurogenic, myogenic, respiratory, and cardiac origins, respectively. In initial state, the amplitude of the oscillations decreased by 38% (P < 0.05) in the endothelial range in HHcy rats than in control rats. Cerebral autoregulation was challenged by hemorrhagic hypotension. The lower limit of autoregulation raised in a rat model of chronic HHcy (71.5 ± 0.7 mmHg in HHcy vs. 62.3 ± 0.5 mmHg in control). The data obtained indicate that the laser Doppler method and wavelet analysis may be successfully applied to detect the dysfunction of the endothelial link in cerebral vessel tone and to reveal the pathological shift of lower limit of autoregulation.

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“Hanger” in Intubation and Laryngoscopy

Abstract

Achieving an adequate exposure in laryngoscopy is an extremely tedious task for the operating surgeon, especially for the anterior commissure lesions. Various maneuvers have been described to overcome this difficulty, but failed in providing an adequate exposure leading to a poor outcome. To create a device that can deliver uniform pressure over the laryngeal cartilage and succeed in providing an adequate exposure of the glottic lesion. A total of 44 patients were included in the study, divided into two groups containing 22 patients each. The distance at the level of anterior commissure from the superior border of the distal end of the laryngoscope was noted and compared. Group A subjected to digital cricoid pressure showed a mean distance of 9.09 of exposure with variance of 1.22 and Group B subjected to cricoid pressure with the cricoid catapult showed a mean distance of 11.76 with variance of 1.59. The groups were statistically analyzed using Anova Test and the test was found to be very significant (p < 0.0001). The catapult is made of a hanger defining its economics, which has a vital role in difficult intubations especially in anterior placed larynx, short neck and obese patients, also succeeds in providing an adequate exposure of the glottic lesion, (especially the anterior commissure) by delivering uniform pressure over the laryngeal cartilage, leading to a superior operative outcome.

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Stapes Surgery Teaching Tool: A Simple and Stable Technique

Abstract

Stapedotomy followed by placement of a piston prosthesis is the mainstay for surgical management of otosclerosis primarily undertaken to improve hearing in patients. Although a simple and elegant procedure, prosthesis placement in stapes surgery is difficult to master. Improper surgical technique or improper placement of prosthesis may result in complications which may require revision surgery. We here describe a training technique that is simple, inexpensive, improves the skills and can be done using easily available materials such as a disposable syringe, stapler pin and micro-forceps. Regular practice with this training module minimizes surgical time and can even be done just prior to the surgery, however, this is not a substitute for temporal bone dissections.

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