Capnography during deep sedation with propofol by nonanesthesiologists: a randomized controlled trial.

Background: Propofol, a short-acting hypnotic drug, is increasingly administered by a diverse group of specialists (e.g., cardiologists, gastroenterologists) during diagnostic and therapeutic procedures.

Splenic artery rupture during pregnancy concealed by a pancreatic lymphangioma: a rare co-occurrence.

A pregnant woman presented to a local hospital with abdominal pain and hemorrhagic shock. Emergency caesarean section ruled out an obstetric cause and revealed a large mass, interpreted as a hematoma, with active bleeding of unknown origin. Because of her poor clinical condition, the patient was admitted to our hospital.

[Fire and explosion hazard during oxygen use in operating rooms].

In both 2006 and 2007 a large operating room fire occurred in the Netherlands. One patient died as a result of a sudden intense flash fire caused by a leaking oxygen connection. Smaller operating room fires can cause severe burn injuries and inhalation trauma in patients.

Validation of a clinical prediction rule to reduce preoperative type and screen procedures.

Background: We have developed a prediction rule for the occurrence of perioperative red blood cell transfusion to help to reduce the number of unnecessary preoperative type and screen procedures. We evaluated the robustness of this prediction rule in patients from another hospital.

Methods: The rule was retrospectively applied to 1282 consecutive patients ('validation set') who underwent similar surgical procedures to the patients in the derivation study.

Advanced pulse oximeter signal processing technology compared to simple averaging. II. Effect on frequency of alarms in the postanesthesia care unit.

Study Objective: To determine the effect of a new pulse oximeter (Nellcor Symphony N-3000, Pleasanton, CA) with signal processing technique (Oxismart) on the incidence of false alarms in the postanesthesia care unit (PACU).

Design: Prospective study.

Setting: Nonuniversity hospital.

Advanced pulse oximeter signal processing technology compared to simple averaging. I. Effect on frequency of alarms in the operating room.

Study Objective: To determine the effect of a new signal processing technique (Oxismart, Nellcor, Inc., Pleasanton, CA) on the incidence of false pulse oximeter alarms in the operating room (OR).

Design: Prospective observational study.

Influence of pulse oximeter settings on the frequency of alarms and detection of hypoxemia: Theoretical effects of artifact rejection, alarm delay, averaging, median filtering or a lower setting of the alarm limit.

Objective: The potential benefit of a reduced frequency of false pulse oximeter low oxyhemoglobin saturation (SpO2) alarms is that the attention of personnel is only directed to patients who experience hypoxemia. The present study was undertaken to better understand the effects of different settings of the pulse oximeter on false (artifact) and true (hypoxemia) alarms.

Methods: Using the original SpO2 data of 200 postoperative patients, we calculated off-line the effects of five methods (artifact rejection, alarm delay (2-44 s, 2 s increments), averaging (10-90 s), median filtering (10-90 s) and decreasing the alarm limit from 90% to 85%) on the number of (true- and false) alarms.

Influence of pulse oximeter lower alarm limit on the incidence of hypoxaemia in the recovery room.

In a prospective, randomized study, we have investigated the effects of two arbitrary pulse oximeter lower alarm limit (LAL) settings (90% = group 90, n = 320 and 85% = group 85, n = 327) on the incidence of hypoxaemia in the recovery room. In group 90, we calculated the theoretical effect of elimination of transient episodes of low pulse oximeter oxyhaemoglobin saturation (SpO2) by introducing a time delay between the onset of the alarm condition and triggering of the alarm. When only hypoxaemic episodes lasting more than 1 min were included, SpO2 < or = 90% occurred in 11% of patients in group 90 and in 20% in group 85 (relative risk (RR) 1.

Influence of motivation of care providers on the incidence of postoperative hypoxaemia in the recovery room.

We have studied the influence of motivation of care providers on the incidence and duration of postoperative hypoxaemia in the recovery room. In a prospective, switch-back designed cohort study, we have compared the incidence of low pulse oximeter saturation values (SpO2) during pre-intervention, intervention and post-intervention phases. Low SpO2 values were classified as either hypoxaemia (SpO2 < or = 90%, minimum duration 1 min) or artefact.

Influence of moderate hypothermia on posterior tibial nerve somatosensory evoked potentials.

Posterior tibial nerve somatosensory evoked potentials (PTN-SSEP) were recorded in eight patients during cardiac surgery with cardiopulmonary bypass and moderate hypothermia (25-28 degrees C). There was no correlation between changes in amplitude and temperature; however, latencies of potentials recorded over the tibial nerve in the popliteal fossa, the lumbar spinal cord, and the cortex increased linearly as temperature decreased. Latency changes correlated well with nasopharyngeal temperature, but only poorly with rectal and lower limb muscle temperatures.