Audible pulse tones, based on a variable-pitch frequency scale, allow the anesthesiologist to determine the patient's oxygen saturation without constant visual examination of the monitor display. The ability to reliably detect oxygen saturation levels based on audible pulse tones may be compromised when multiple pulse oximeter systems are used. The goal of this observational study was to examine the pitch frequency scales from several different pulse oximeter manufacturers. Using simulator technology, incremental oxygen saturations between 80% and 100% were created. The frequencies of various pulse tones in this range were measured with an oscilloscope. From this data, the relationship between oxygen saturation and corresponding pulse tone frequency was examined. Diagrammed results showed wide variation in the pulse frequency scales used by the pulse oximeters tested. At any oxygen saturation level between 80% and 100%, none of the monitors had the same pulse tone frequency. With such variation among systems, the ability to accurately determine oxygen saturation from a pulse tone may be hindered. In locations where different pulse oximeter systems are encountered, the potential for confusion exists. Anesthesiologists need to be aware of these differences, and should familiarize themselves with the audible frequency scale of a particular pulse oximeter model before its use.
Since the early 1 990s, endovascular surgery has provided another treatment option for the management of abdominal aortic aneurysms. Its shorter postoperative recovery time, absence of an abdominal incision, and avoidance of aortic cross-clamping gives endovascular abdominal aortic aneurysm repair its appeal. New vascular grafts are being developed that may expand the number of eligible candidates. This less-invasive form of abdominal aortic aneurysm repair still provides the anesthesiologist with several challenges. The procedure has been performed under general anesthesia, regional anesthesia, and local anesthesia with monitored anesthesia care. The potential benefits of one anesthetic type over another for endovascular abdominal aortic aneurysm repair have not yet been fully explored. Several intraoperative complications, including acute aortic rupture and misdeployment of the stent graft, can necessitate conversion to an open laparotomy. Endovascular repair in the short term compares favorably to open surgical repair with a reduction in morbidity, blood loss, and hospital stay. Still, endovascular abdominal aortic aneurysm repair is a relatively new corrective modality, and long-term controlled trials comparing it with open repair have not yet been reported. As more research into the technique is performed, new strategies for endovascular abdominal aortic aneurysm repair may further increase the options available to patients. Endovascular surgery is rapidly becoming a common treatment modality for vascular disease. Abdominal aortic aneurysms (AAA), once repaired only by an open surgical procedure, can now be treated via this new minimally invasive technique.' Its shorter postoperative recovery time, the absence of an abdominal incision, and the avoidance of aortic cross-clamping gives endovascular AAA repair its appeal.2'3 Newly designed grafts and wider eligibility criteria allow the technique to be applied to an increasing number of patients.4
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