Availability of records in an outpatient preanesthetic evaluation clinic.

Objective: Despite efforts to develop electronic access to medical records, there are few data on availability of past evaluations. Typical analyses assess only availability of paper charts. We studied the availability of prior internal and external medical documentation in the preanesthetic clinic of our tertiary teaching institution, which has had access to hospital-wide electronic records for five years.

Aortic stenosis with end-stage liver disease: prioritizing surgical and anesthetic therapies.

A 48-year-old man with end-stage liver disease and aortic stenosis (AS), was being evaluated for liver transplantation. This report focuses on the question of which medical problem to correct first, the end-stage liver disease or the AS. Risk factors for surgical correction of AS and liver transplantation are reviewed and discussed, and the surgical and anesthetic management strategies for this patient are outlined.

Evaluation of electrosurgical interference to low-power spread-spectrum local area net transceivers.

Objective: To study whether an electrosurgery device interferes with the operation of a low-power spread-spectrum wireless network adapter.

Methods: Nonrandomized, unblinded trials with controls, conducted in the corridor of our institution's operating suite using two portable computers equipped with RoamAbout omnidirectional 250 mW spread-spectrum 928 MHz wireless network adapters. To simulate high power electrosurgery interference, a 100-watt continuous electrocoagulation arc was maintained five feet from the receiving adapter, while device reported signal to noise values were measured at 150 feet and 400 feet distance between the wireless-networked computers.

The Internet and electronic transmission of medical records.

Objective: To review, from a legal perspective the potential for using the Internet for inter-institutional transfer of patient medical records.

Methods: Basic issues and recent legislation that relate to protection of both medical data, and those transferring that data over public network systems is reviewed.

Results: Many laws already in existence can be applied to Internet transmission, but questions of jurisdiction remain.

Anesthesia information-management systems: their role in risk-versus cost assessment and outcomes research.

Computerized clinical information systems clearly have a role in this era of managed care when outcomes research and cost/benefit analyses are becoming crucial. Despite anesthesiologists' leadership in developing physician-entry systems, automated recordkeeping systems have been underused. This report reviews the problems and possible solutions associated with establishing more effective and user-friendly systems in the anesthesia specialty.

Computerized pre-anesthetic evaluation results in additional abstracted comorbidity diagnoses.

Objective: To study the impact of information from a physician-entry computerized preanesthetic evaluation system on the coding of International Classification of Diseases (ICD-9-CM) diagnoses and on hospital reimbursement due to alterations in diagnosis-related group (DRG) codes.

Methods: Nonrandomized, unblinded trial conducted at a 570-bed university tertiary care hospital. First without and then with reference to information contained on computer-based preanesthetic evaluation reports, medical charts were coded by the study institution's usual professional codes for ICD-9-CM discharge diagnoses and DRG assignment.

Use of data from a hospital online medical records system by physicians during preanesthetic evaluation.

Objective: There is no data on the use of hospital-wide online medical record (OLMR) systems by anesthesiologists. We measured how often anesthesiologists accessed the OLMR database maintained by the hospital, how often data was copied from this database into the clinic's computer system, and how much data was copied.

Methods: In a preanesthetic evaluation clinic that has a computerized evaluation system designed for physician-entered data, a graphical user-interface prototype link provided access to the hospital OLMR database for users and was studied over a 37-day period.

Magnetron-based inline microwave fluid warmer.

Objective: To develop an in-line microwave fluid warming system that eliminates the difficulties of uneven heating that are characteristic of batch-mode microwave fluid warmers.

Methods: Using a commercial microwave oven, we developed a method for warming fluid as it flowed through tubing along a defined path in the oven's cavity. Algorithms utilizing either proportional or adaptive control were used to control microwave heating cycles by varying the heating pulse-width during 3-second epochs.

The efficiency of preoperative evaluation: a comparison of computerized and paper recording systems.

Objective: We designed and implemented a preoperative evaluation record system with seven networked computers for use by physicians and other medical staff. This study compared the efficiency of the new computerized system with that of the paper system.

Methods: We reviewed data from preoperative evaluations completed from November 1990 through December 1992.

Real-time automated computerized detection of venous air emboli in dogs.

Objective: My objective was to develop a real-time pattern recognition system to monitor the precordial Doppler and end-tidal CO2 for characteristic changes of venous air emboli. The system also must check the adequacy of the input signals, to allow for unattended operation. The sensitivity of the precordial Doppler monitoring of the resulting system was the focus of this study.

A method for evaluation of enhancement operations in two-dimensional echocardiographic images.

A means of estimating the degree of enhancement of structure and suppression of background noise in filtered two-dimensional echocardiographic images is described. The method is termed the peak-to-background ratio. To test the method, two-dimensional short-axis echocardiographic images were enhanced with Laplacian operations of increasing mask size.

Applications of cross-correlation techniques to the quantitation of wall motion in short-axis two-dimensional echocardiographic images.

Echocardiography is now a mainstay in the diagnosis of cardiovascular disease. Rapid methods for quantitation of the images would provide an effective tool for the diagnosis of change in left ventricular function. The purpose of this article is to show the feasibility of using the cross-correlation technique to quantify change in left ventricular function over time in two-dimensional short-axis echocardiographic images.

Computer-assisted Doppler monitoring to enhance detection of air emboli.

Currently, two of the most sensitive clinical approaches commonly used to monitor for venous air embolism, i.e., precordial Doppler audio and capnography, require the attention of the anesthesiologist's eye or ear, which is a distraction from other aspects of care.

Augmentation of cerebral blood flow induced by hemodilution in stroke patients after superficial temporal-middle cerebral arterial bypass operation.

Experimental hemodilutional therapy has been shown to raise collateral perfusion to acutely ischemic brain regions distal to occluded internal carotid (ICA) and middle cerebral (MCA) arteries and to reduce infarct size. Superficial temporal (STA)-MCA anastomosis surgically establishes additional regional collateralization, and this bypass angiographically enlarges over time. Despite bypass patency verification by Doppler recording made at the edge of the craniectomy, the microsurgical STA-MCA anastomosis in 11 stroke patients did not produce early changes in cerebral perfusion parameters in the MCA territory of either hemisphere as determined by 133xenon inhalation.

Quantitative EEG alterations after isovolemic-hemodilutional augmentation of cerebral perfusion in stroke patients.

Eleven patients with ischemic neurologic deficits in the middle cerebral arterial (MCA) territory and ipsilateral slowing on initial EEG underwent venesection and equal volume replacement with intravenous 5% human serum albumin. As the mean hematocrit was reduced by 19%, the mean cerebral blood flow (CBF) in the MCA territory of the affected and contralateral hemisphere determined by the 133Xenon inhalation technique increased 18 and 21%, respectively. Similarly, CBF in the contralateral occipital region increased 17%.