- The use of end-tidal argon to detect venous air embolism: foiled by "fake oxygen!" JOURNAL OF CLINICAL MONITORING AND COMPUTING 2019; 33 (5): 925?26
- Cerebral Oximetry Fails as a Monitor of Brain Perfusion in Cardiac Surgery: A Case Report A & A PRACTICE 2019; 12 (12): 441?43
Cerebral Oximetry Fails as a Monitor of Brain Perfusion in Cardiac Surgery: A Case Report.
Cerebral oximetry is commonly being advocated as a monitor for regional cerebral tissue oxygenation during cardiac surgery. We have increasing concern about the accuracy of this monitor, including the current systems entering the market, with new probes and algorithms. We present 2 cases where cerebral oximetry failed to accurately portray cerebral oxygenation. In the current form, cerebral oximetry may at best be an expensive tool without any benefit on outcomes. In addition, it may contribute to misleading and confusing clinical data.
View details for PubMedID 30663993
The use of end-tidal argon to detect venous air embolism: foiled by "fake oxygen!"
Journal of clinical monitoring and computing
Venous air-embolism (VAE) potentially catastrophic complication surgery. Based on previous data using changes in end-tidal nitrogen as an indicator of VAE, we surmised that changes in end-tidal argon (EtAr) may be an indicator of VAE. We sought to determine if a commercial mass-spectrometer (PCT Proline Analyzer 61700-8 Class 85, Ametek, Pittsburgh, PA 15238) could be used to detect changes in EtAr in an invitro model. A Drager Apollo? (Drager, Lubeck, Germany) anesthesia machine was used to ventilate a dummy lung (2 L bag) with a minute ventilation of 6 L/min in 100% oxygen. The quadrupole mass-spectrometer (sampling at 0.0004 atm-cc/sec) was attached to the end-tidal inlet of the machine. Room air (1-60 mL) was injected into the dummy lung to simulate VAE. A strong baseline ion-current (1.2?×?10-12 amps) of argon was noted. Due to this contamination we were unable to detect "VAE" events of injected air. Argon represents approximately 0.93% of room air, or about 9300 parts per million (ppm). We detected about 2000 ppm argon in medical-grade oxygen (or 0.2%), limiting our ability to detect changes in EtAr. This is a USP-accepted contaminant, rendering this technology is insensitive for early, rapid detection of VAE. We assumed medical grade oxygen was pure and were surprised to learn otherwise. We want to share this likely largely unknown finding with the medical community.
View details for PubMedID 30467672
- Held down by the anchoring bias: recurrent laryngeal papillomatosis masquerading as status asthmaticus Journal of Head and Neck Anesthesia 2018
Cancellation of Elective Cases in a Recently Opened, Tertiary/Quaternary-Level Hospital in the Middle East.
Anesthesia and analgesia
Case cancellations have a negative financial impact due to revenue loss and the potential costs of underutilized time. The goals of this study at a recently opened hospital in the Middle East were to measure the cancellation rates for elective surgical or endoscopic cases and to identify the reasons for cancellation. During the 1-month study period, 170 (22.4%) of the 760 scheduled cases were cancelled. Cultural norms and patient no-shows on the day of surgery accounted for the majority of case cancellations. Understanding local factors on hospital functions may be vital for organizations expanding into new geographic areas.
View details for DOI 10.1213/ANE.0000000000002104
View details for PubMedID 28514326
- Getting Burned by Lactic Acid. Hospital pediatrics 2016; 6 (9): 558-559
Is blood donation an opportunity for hypertension awareness?
2016; 26 (2): 89-98
To assess the blood pressure (BP) of donors, the rate of hypertensive range readings amongst donors not previously identified as hypertensive and determine the value of an informational sheet about hypertension given at the time of donation.To determine the value of screening for high BP during blood donation as a public health activity.Blood donation centres measure donor BPs before accepting donations and thus provide a unique opportunity for hypertension screening and education.An anonymous survey was completed by blood donors over 2 weeks. The survey contained 22 questions regarding demographics, BP knowledge and monitoring. Participants then received a hypertension information sheet and assessed its utility with three additional questions.Out of 839 survey responses received, 688 respondents reported their BP in the following categories, normotensive range: 46ˇ9%, pre-hypertensive range: 41ˇ7% and hypertensive range: 11ˇ3%. Notably, of donors with hypertensive range readings, 45% reported no known history of hypertension. After reading the hypertension pamphlet, 63ˇ9% of donors found it valuable, while 38ˇ9% did not. Furthermore, 67% of donors said they were likely to use the information they learned, while 23% of donors said they were unlikely to do so.An opportunity exists for increasing hypertension awareness during blood donation. Additionally, our findings indicate that an educational pamphlet at the time of donation is valuable to donors. Overall, these findings suggest that increasing hypertension awareness as part of a blood donation screening is not only needed but also useful as a public health measure.
View details for DOI 10.1111/tme.12286
View details for Web of Science ID 000378141800002
View details for PubMedID 26996380