J Clin Monit Comput - Analysis of plethysmographic waveform changes induced by beach chair positioning under general anesthesia.

Tópicos

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Resumo

During shoulder surgery, patients typically are placed in the beach chair position. In rare cases, this positioning has resulted in devastating outcomes of postoperative cerebral ischemia (Cullen and Kirby in APSF Newsl 22(2):25-27, 2007; Munis in APSF Newsl 22(4):82-83, 2008). This study presents a method to noninvasively and continuously hemodynamically monitor patients during beach chair positioning by using the photoplethysmograph signal recorded from a commercial pulse oximeter. Twenty-nine adults undergoing shoulder surgery were monitored before and after beach chair positioning with electrocardiogram, intermittent blood pressure, end tidal carbon dioxide, and photoplethysmograph via Nellcor finger pulse oximeter. Fast Fourier transform (FFT) was used to perform frequency-domain analysis on the photoplethysmograph (PPG) signal for data segments taken 80-120?s before and after beach chair positioning. The amplitude density of respiration-associated PPG oscillations was quantified measuring the height of the FFT peak at respiratory frequency. Results were reported as (median, interquartile range) and statistical analysis was performed using Wilcoxon sign rank test. Data were also collected when vasoactive drugs phenylephrine and ephedrine were used to maintain acceptable mean arterial pressure during a case. With beach chair positioning, all subjects who did not receive vasoactive drugs showed an increase in the FFT amplitude density of respiration-associated PPG oscillations (p?<?0.0001) without change in pulse-associated PPG oscillations. The PPG was more accurate at monitoring the change to beach chair position than blood pressure or heart rate. With vasoactive drugs, pulse-associated PPG oscillations decreased only with phenylephrine while respiration-associated oscillations did not change. Frequency domain analysis of the PPG signal may be a better tool than traditional noninvasive hemodynamic parameters at monitoring patients during beach chair position surgery.

Resumo Limpo

shoulder surgeri patient typic place beach chair posit rare case posit result devast outcom postop cerebr ischemia cullen kirbi apsf newsl muni apsf newsl studi present method noninvas continu hemodynam monitor patient beach chair posit use photoplethysmograph signal record commerci puls oximet twentynin adult undergo shoulder surgeri monitor beach chair posit electrocardiogram intermitt blood pressur end tidal carbon dioxid photoplethysmograph via nellcor finger puls oximet fast fourier transform fft use perform frequencydomain analysi photoplethysmograph ppg signal data segment taken s beach chair posit amplitud densiti respirationassoci ppg oscil quantifi measur height fft peak respiratori frequenc result report median interquartil rang statist analysi perform use wilcoxon sign rank test data also collect vasoact drug phenylephrin ephedrin use maintain accept mean arteri pressur case beach chair posit subject receiv vasoact drug show increas fft amplitud densiti respirationassoci ppg oscil p without chang pulseassoci ppg oscil ppg accur monitor chang beach chair posit blood pressur heart rate vasoact drug pulseassoci ppg oscil decreas phenylephrin respirationassoci oscil chang frequenc domain analysi ppg signal may better tool tradit noninvas hemodynam paramet monitor patient beach chair posit surgeri

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