J Clin Monit Comput - Intraoperative MRI electrical noise and monitor ECG filters affect arrhythmia detection and identification.

Tópicos

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Resumo

Most electrical equipment in the modern operating room (OR) radiates electrical noise (EN) that can interfere with patient monitors. We have described the EN that an intraoperative magnetic resonance imaging (iMRI) system emits and have shown that this high-energy EN diminishes the quality of the ECG waveform during iMRI scans in our neurosurgical OR. We have also shown that the ECG signal filters in our iMRI-compatible patient monitor reduce this interference but, in the process, disturb the true morphology of the displayed waveform. This simulation study evaluates how iMRI-generated EN affects the ability of the anesthetist to detect and identify ECG arrhythmias and whether the patient monitor's ECG signal filters can improve arrhythmia recognition. Using an ECG simulator, we generated Lead II and V5 ECG signal segments that contained either no arrhythmia or one of four common cardiac arrhythmias. We filtered the ECG segments with four filters available on our iMRI-compatible monitor (Veris MR, MEDRAD Inc., Indianola, PA USA). We then digitized the segments and mixed simulated iMRI EN into the resultant tracings. With institutional approval and written informed consent, board-certified anesthesiologists reviewed the tracings, determined if an arrhythmia was present and identified the arrhythmia. We conducted the study anonymously. We reported the data as percent correct arrhythmia detection and correct arrhythmia identification. Thirty-one anesthesiologists completed the study. Overall, the participants correctly detected 79.5% (95% CI: 77.2, 81.7%) of the arrhythmias and correctly identified 62.5% (95% CI: 59.8, 65.3%) of the arrhythmias, regardless of EN presence. Although the proportions among monitor noise filters studied were not significant, the manufacturer-designated MR5 Veris MR filter optimized arrhythmia detection and arrhythmia identification for our participants, regardless if EN was present in the ECG tracings. In the neurosurgical OR, the anesthetist must be able to effectively monitor a patient in the presence of iMRI-generated EN. Depending on the OR design, the patient may be out of the anesthetist's direct view during a scan procedure. The anesthetist must rely on monitored physiologic parameters to assess patient status during this time. He/she should be familiar with his/her monitor's filtering capabilities and routinely adjust the ECG filters to achieve the best compromise between minimized EN effects and maximized displayed ECG signal quality.

Resumo Limpo

electr equip modern oper room radiat electr nois en can interfer patient monitor describ en intraop magnet reson imag imri system emit shown highenergi en diminish qualiti ecg waveform imri scan neurosurg also shown ecg signal filter imricompat patient monitor reduc interfer process disturb true morpholog display waveform simul studi evalu imrigener en affect abil anesthetist detect identifi ecg arrhythmia whether patient monitor ecg signal filter can improv arrhythmia recognit use ecg simul generat lead ii v ecg signal segment contain either arrhythmia one four common cardiac arrhythmia filter ecg segment four filter avail imricompat monitor veri mr medrad inc indianola pa usa digit segment mix simul imri en result trace institut approv written inform consent boardcertifi anesthesiologist review trace determin arrhythmia present identifi arrhythmia conduct studi anonym report data percent correct arrhythmia detect correct arrhythmia identif thirtyon anesthesiologist complet studi overal particip correct detect ci arrhythmia correct identifi ci arrhythmia regardless en presenc although proport among monitor nois filter studi signific manufacturerdesign mr veri mr filter optim arrhythmia detect arrhythmia identif particip regardless en present ecg trace neurosurg anesthetist must abl effect monitor patient presenc imrigener en depend design patient may anesthetist direct view scan procedur anesthetist must reli monitor physiolog paramet assess patient status time hesh familiar hisher monitor filter capabl routin adjust ecg filter achiev best compromis minim en effect maxim display ecg signal qualiti

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