Articles from Anesthesiology

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Patel, Santosh I. ; Souter, Michael J.
Equipment-related Electrocardiographic Artifacts: Causes, Characteristics, Consequences, and Correction [Review]
Anesthesiology. 108(1):138-148, January 2008.
Abstract
Interference of the monitored or recorded electrocardiogram is common within operating room and intensive care unit environments. Artifactual signals, which corrupt the normal cardiac signal, may arise from internal or external sources. Electrical devices used in the clinical setting can induce artifacts by various different mechanisms. Newer diagnostic and therapeutic modalities may generate artifactual changes. These artifacts may be nonspecific or may resemble serious arrhythmia. Clinical signs, along with monitored waveforms from other simultaneously monitored parameters, may provide the clues to differentiate artifacts from true changes on the electrocardiogram. Simple measures, such as proper attention to basic principles of electrocardiographic measurement, can eliminate some artifacts. However, in persistent cases, expert help may be required to identify the precise source and minimize interference on the electrocardiogram. Technological advancements in processing the electrocardiographic signal may be useful to detect and eliminate artifacts. Ultimately, an improved understanding of the artifacts generated by equipment, and their identifying characteristics, is important to avoid misinterpretation, misdiagnosis, and iatrogenic complication.

Kroner, Anke ; Binnekade, Jan M. ; Graat, Marleen E. ; Vroom, Margreeth B. ; Stoker, Jaap
On-demand Rather than Daily-routine Chest Radiography Prescription May Change Neither the Number Nor the Impact of Chest Computed Tomography and Ultrasound Studies in a Multidisciplinary Intensive Care Unit
Anesthesiology. 108(1):40-45, January 2008.
Abstract
Background: Elimination of daily-routine chest radiographs (CXRs) may influence chest computed tomography (CT) and ultrasound practice in critically ill patients.Methods: This was a retrospective cohort study including all patients admitted to a university-affiliated intensive care unit during two consecutive periods of 5 months, one before and one after elimination of daily-routine CXR. Chest CT and ultrasound studies were identified retrospectively by using the radiology department information system. Indications for and the diagnostic/therapeutic yield of chest CT and ultrasound studies were collected.Results: Elimination of daily-routine CXR resulted in a decrease of CXRs per patient day from 1.1 +/- 0.3 to 0.6 +/- 0.4 (P <>

Plain Radiography Versus CT Scans

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Dai, Li-Yang; Wang, Xiang-Yang; Jiang, Lei-Sheng et al
Plain Radiography Versus Computed Tomography Scans in the Diagnosis and Management of Thoracolumbar Burst Fractures
Spine. 33(16):E548-E552, July 15, 2008.
Abstract
Study Design. The role of plain radiography in the diagnosis and management of thoracolumbar burst fractures was evaluated when compared with computed tomography (CT) scans.Objective. To determine the accuracy of plain radiography in detecting thoracolumbar burst fractures when CT scans were used as the gold standard, and to assess the impact of disagreement of the results between plain radiographs and CT scans on treatment plan.Summary of Background Data. There have been few studies comparing the value of plain radiography with that of CT scans in the diagnosis and management of thoracolumbar burst fractures.Methods. Radiographs of 73 patients with a compression or burst fracture were reviewed independently by 3 residents and 3 spine surgeons. The results of CT scans were used as the gold standard to determine the accuracy of plain radiography for the diagnosis. More quantitative results of 57 patients with a burst fracture based on plain radiographs alone were compared with those after addition of CT scans. The disagreement between the results was analyzed, and the impact of disagreement on treatment plan was defined as the changes of load sharing score between <=6 and >=7.Results. The accuracy of plain radiography improved with the experience of observers. The results on the load sharing score agreed between plain radiographs alone and radiographs with CT scans only for 56%, indicating moderate agreement. The impact of disagreement on treatment plan was significant (P <>