BACKGROUND: Morbidly obese patients undergoing general anesthesia are at risk of hypoxemia during anesthesia induction. High-flow nasal oxygenation use during anesthesia induction prolongs safe apnea time in nonobese surgical patients. The primary objective of our study was to compare safe apnea time, between patients given high-flow nasal oxygenation or conventional facemask oxygenation during anesthesia induction, in morbidly obese surgical patients. METHODS: Research ethics board approval was obtained. Elective surgical patients ≥18 years with body mass index ≥40 kg·m−2 were included. Patients with severe comorbidity, gastric reflux disease, known difficult airway, or nasal obstruction were excluded. After obtaining informed consent patients were randomized. In the intervention (high-flow nasal oxygenation) group, preoxygenation was provided by 100% nasal oxygen for 3 minutes at 40 L·minute−1; in the control group, preoxygenation was delivered using a facemask with 100% oxygen, targeting end-tidal O2 >85%. Anesthesia was induced with propofol, remifentanil, and rocuronium. Bag-mask ventilation was not performed. At 2 minutes after rocuronium, videolaryngoscopy was performed. If the laryngoscopy grade was I or II, laryngoscope was left in place and the study was continued; if grade III or IV was observed, the patient was excluded from the study. During the apnea period, high-flow nasal oxygenation patients received nasal oxygen at 60 L·minute−1; control group patients received no supplemental oxygen. The primary outcome, safe apnea time, was reached when oxygen saturation measured by pulse oximetry (Spo 2) fell to 95% or maximum 6 minutes of apnea. The patient was then intubated. T tests and χ2 analyses were used to compare groups. P < .05 was considered significant. RESULTS: Forty patients completed the study. Baseline parameters were comparable between groups. Safe apnea time was significantly longer (261.4 ± 77.7 vs 185.5 ± 52.9 seconds; mean difference [95% CI], 75.9 [33.3–118.5]; P = .001) and the minimum peri-intubation Spo 2 was higher (91.0 ± 3.5 vs 88.0 ± 4.8; mean difference [95% CI], 3.1 [0.4–5.7]; P = .026) in the high-flow nasal oxygenation group compared to the control group. CONCLUSIONS: High-flow nasal oxygenation, compared to conventional oxygenation, provided a longer safe apnea time by 76 seconds (40%) and higher minimum Spo 2 in morbidly obese patients during anesthesia induction. High-flow oxygenation use should be considered in morbidly obese surgical patients.
www.clinicaltrials.gov (NCT02816463). Registered 28 June 2016.
Currently, the quality of guidelines for the perioperative management of patients with obstructive sleep apnea (OSA) is unknown, leaving anesthesiologists to make perioperative management decisions with some degree of uncertainty. This study evaluated the quality of clinical practice guidelines regarding the perioperative management of patients with OSA. This study was reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of the MedlineALL (Ovid) database was conducted from inception to February 26, 2021, for clinical practice guidelines in the English language. Quality appraisal of guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. Descriptive statistical analysis of each of the 6 domains was expressed as a percentage using the formula: (obtained score – minimum possible score)/(maximum possible score – minimum possible score). Of 192 articles identified in the search, 41 full texts were assessed for eligibility, and 10 articles were included in this review. Intraclass correlation coefficients of the AGREE II scores across the 7 evaluators for each guideline were each >0.9, suggesting that the consistency of the scores among evaluators was high. Sixty percent of recommendations were based on evidence using validated methods to grade medical literature, while the remainder were consensus based. The median and range scores of each domain were: (1) scope and purpose, 88% (60%–95%); (2) stakeholder involvement, 52% (30%–82%); (3) rigor of development, 67% (40%–90%); (4) clarity of presentation, 74% (57%–88%); (5) applicability, 46% (20%–73%); and (6) editorial independence, 67% (19%–83%). Only 4 guidelines achieved an overall score of >70%. This critical appraisal showed that many clinical practice guidelines for perioperative management of patients with OSA used validated methods to grade medical literature, such as Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and Oxford classification, with lower scores for stakeholder involvement due to lack of engagement of patient partners and applicability domain due to lack of focus on the complete perioperative period such as postdischarge counseling. Future efforts should be directed toward establishing higher focus on the quality of evidence, stakeholder involvement, and applicability to the wider perioperative patient experience.
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Power Quality is major issue that has led to large amount of research by the industry and academic experts. The increased uses of the electronics in electrical utilities have created a need of monitoring the power quality and provide the mitigation to enhance the performance of the electrical equipment. With advancement in technologies and availability of various online monitoring tools, it is very important to assess and review these technologies. The increased rate of research in this field is proven to be beneficial to the consumers. Customers are now able to request for better quality of service and making the Power Quality issue more important. This paper provide an inclusive review of various application of signal processing on power quality events, analysis of artificial intelligent techniques to classify the signals and optimization techniques for decision making. The paper also explores the upcoming opportunities for power quality classification and further improvement in terms of higher performance of the electrical equipment.
An ambulance tracking system (ATS) is the need of the hour due to the recent pandemic situation going on around us. It is necessary that patients carrying vehicles such as ambulances must be equipped with the ATS technology. The ATS technology helps the hospital administration to carry out the necessary steps before the patient arrives at the hospital premises. In this technology, Global systems for Mobile communication (GSM) and Global Positioning System (GPS) are used for the efficient working of this device. In this system, a low-cost microcontroller-based electronic device Arduino is used to control the GPS and GSM modules. In this system, modem and display device such as liquid crystal display (LCD) is used at the user end which is also called as Base Station. Information regarding the location of the ambulance is provided by the GPS module. GSM module is used for communicating with the base station. The hospital administration can get the information of the arrival of the ambulance well in time and can increase the chance of survival of the patient as the time required for setting up basic components is done well in advance. This system can also be used for various other vehicles used in emergency situations.
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