Παρασκευή 28 Σεπτεμβρίου 2018

Impact of non-invasive continuous blood pressure monitoring on maternal hypotension during cesarean delivery: a randomized-controlled study

Abstract

Purpose

This study aimed to investigate the efficacy of the ClearSight™ system (Edwards Lifesciences, Irvine, CA) for reducing the incidence of hypotension compared with the traditional oscillometric blood pressure monitoring in cesarean delivery under spinal anesthesia.

Methods

Forty patients undergoing cesarean delivery under spinal anesthesia were enrolled. The patients were randomly divided into two groups (Control and ClearSight groups). All patients received spinal anesthesia using 0.5% hyperbaric bupivacaine (11.5 mg) and fentanyl (10 µg). Blood pressure was managed with the same protocol using the ClearSight™ system (ClearSight group) and oscillometric blood pressure monitoring (Control group). Furthermore, we compared the accuracy of the ClearSight™ system with the traditional oscillometric monitoring for blood pressure measurement using Bland–Altman, four-quadrant plot, and polar plot analyses.

Results

The incidence of hypotension was significantly lower in the ClearSight group from induction to delivery (45% vs. 0%, p < 0.001) and to the end of surgery (50% vs. 20%, p = 0.049). Intraoperative nausea occurred more frequently in the Control group (45% vs. 10%, p = 0.012). The ClearSight™ system demonstrated acceptable accuracy with a bias of − 4.3 ± 11.7 mmHg throughout the procedure. Four-quadrant analysis revealed an excellent trending ability of the ClearSight™ system with a concordance rate of approximately 95%. In the polar plot analysis, the angular bias and concordance rate were − 13.5° ± 19.0° and 76.9%, respectively.

Conclusions

The accuracy and trending ability of the ClearSight™ system for blood pressure measurement was clinically acceptable in cesarean delivery under spinal anesthesia, leading to reductions in maternal hypotension and nausea.



https://ift.tt/2Qi5PYg

Total parenteral nutrition in the pleural space

Description  

A male infant was delivered spontaneously at 29+3 weeks and transferred to the local neonatal unit for uplift in care. This included 24 hours of ventilation, 12 hours of dobutamine and placement of a peripherally inserted central catheter (PICC) for total parenteral nutrition (TPN). By 24 hours he was extubated onto Optiflow at 6 L/min and Fraction of Inspired Oxygen (FiO2) of 0.21. Expressed breastmilk was commenced whilst awaiting PICC placement.

A 22G 80 mm Leaderflex PICC was aseptically inserted on day 2 into the right antecubital fossa. The line did not bleed but flushed easily. A 0.9% sodium chloride infusion was commenced whilst awaiting confirmation of line position. Chest X-ray showed the PICC projected over the subclavian vein with mild residual airspace shadowing in both lungs (figure 1). The PICC position was felt to be acceptable when the X-ray was reviewed prospectively and retrospectively.

Figure 1

Chest X-ray showing peripherally inserted central catheter...



https://ift.tt/2OpFR81

Extracranial meningiomas concurrently found in the lung and vertebral bone: a case report

Primary pulmonary meningiomas are very rare, and primary intraosseous meningiomas outside the head and neck region have not yet been reported. We report an extremely unusual case of concurrent meningiomas aris...

https://ift.tt/2Qc7i2b