The usefulness of continuous monitoring of central venous oxygen saturation (ScvO2) in comparison with the capnogram during cardiopulmonary resuscitation (CPR) was demonstrated in a cardiac arrest patient. ScvO2 and end-tidal carbon dioxide (ETCO2) decreased following cessation of chest compression or increased during recovery of systemic circulation. During the complete stasis of systemic circulation, when defibrillation was done, ScvO2 did not change, while ETCO2 gradually decreased. However the larger decrease in ScvO2 temporally occurred when chest compression was resumed. And also the ScvO2 monitoring had great advantage to detecting peripheral tissue oxygenation. ScvO2 seems to be no less accurate and reliable monitoring than the capnogram during CPR procedures. Since the capnogram is non-invasively and easily used in cardiac arrest patients, ScvO2 monitoring combined with the capnogram is a more preferable method for assessing the efficacy of ongoing CPR.
Several investigators have proposed criteria to predict the need for postoperative mechanical ventilation in patients with myasthenia gravis. Kimura et al. recently described the Shinshu University scoring system which is applied to Japanese patients. They identified eight risk factors-myasthenia and/or cholinergic crisis, respiratory disease, bulbar palsy, thymoma, operability, other complications, pyridostigmine dosage, and% vital capacity. We tested the value of this scoring system retrospectively in 74 patients with myasthenia gravis who recieved thymectomy. Sixty-four patients out of 74 (86.5%) were predicted accurately by the scoring system. However, six patients, predicted not to need controlled ventilation, needed prolonged postoperative ventilatory support. Of these 6 patients, two had seriously reduced % vital capacity of less than 59%, one had a progressive exacerbation of myasthenic symptoms before surgery, and one encountered bulbar weakness with menstruation. This study aimed to propose new criteria and a modified scoring system. We applied the statistical technique of multivariate discriminant analysis to select the most useful preoperative variables for identifying with myasthenia gravis patients who need mechanical ventilation. Using this new scoring system, a prediction of the postoperative need for ventilatory support was accurately achieved in 94.6%, and false negative could be reduced in only two cases .
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