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Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults: Conclusion

In an attempt to determine the factors that would be most predictive of arterial oxygen desaturation, we examined factors related to minimum Sa02. Three factors were found to be independent predictors: (1) low baseline Sa02; (2) the duration of the procedure; and (3) indices of left ventricular failure such as increased pulmonary arterial diastolic pressure, pulmonary capillary wedge pressure, end-diastolic volume, and decreased cardiac index. Five (63 percent) of the eight patients with symptoms or signs of heart failure before catheterization had episodes of arterial hypoxemia (Sa02 <90 percent) during the procedure. Thus, patients with congestive heart failure before catheterization or ventricular dysfunction found at catheterization are at increased risk of hypoxemia. buy antidepressants online Continue reading this post…

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults: Discussion

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults: DiscussionArterial hypoxemia may be associated with arrhythmias, myocardial ischemia, myocardial infarction, or congestive heart failure in the patient with coronary artery or valvular heart disease. It is difficult to predict, in any particular patient, the oxygen tension necessary to prevent morbidity; however, an arterial oxygen tension (Pa02) less than 60 mm Hg is considered by most authorities to be hypoxemic. A value for Sa02 of 90 percent corresponds approximately to a Pa02 of 60 mm Hg. In addition, Sa02 of 90 percent is at the steep portion of the oxygen-hemoglobin dissociation curve, where a small decrease in Pa02 will cause a large decrease in the amount of oxygen carried by hemoglobin. Therefore, we considered Sa02 less than 90 percent to represent arterial hypoxemia in our population. diabetes medications Continue reading this post…

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults: Angiography

When the effect of coronary cineangiography, left ventriculography, and balloon inflation during percutaneous transluminal coronary artery angioplasty on Sa02 were measured, two patients were excluded, one because he was having multiple episodes of desaturation with such frequency that we were unable to establish accurate readings for Sa02 before angiography or baseline values before angioplasty, and another because his peripheral pulses were not adequate to register accurate pulse oximeter readings during contrast injection. This population of 27 patients had 10 ±1 (range, 4 to 20) single coronary artery contrast injections per patient, with 5 to 7 ml of contrast per injection. After combining contrast injections occurring within one minute of each other into one effective injection, these 27 patients had 7 ± 1 (range, 1 to 18) effective contrast injections per patient, for a total of 182. The largest decrease in Sa02 observed within the one minute following an injection was 5 percent in one patient, and another nine injections (in eight patients) were followed by a decrease in Sa02 of 3 percent or more. Of these ten injections, in four the Sa02 decreased below 90 percent, but for no more than 12 seconds (Table 3). Continue reading this post…

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults: Results

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults: ResultsThe patient population had a mean age of 53 ±3 years (range, 21 to 83 years) and mean weight of 83 ± 3 kg. Nineteen patients were men, and ten were women. Eighteen patients (62 percent) had a history of smoking. Nineteen patients received sedation before or during catheterization (14 with diazepam [2 to 15 mg], two with morphine [3 to 9 mg], and three with combinations of diazepam and morphine). The mean duration of the procedure was 96 ±5 minutes. The baseline Sa02 was 96 ±0.4 percent (range, 93 to 100 percent). All patients had a decrease in Sa02 from baseline at some time during catheterization. The lowest Sa02 for the population was 90 ± 1 percent (range, 82 to 96 percent; p<0.01 compared to baseline). Decrease from baseline to lowest Sa02 was 6 ±0.5 percent (range, 2 to 11 percent). The time at which the lowest Sa02 occurred did not relate to any event during catheterization. Continue reading this post…

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults: Materials and Methods

From the continuous recording of SaOa, the following data were derived for each patient: (1) lowest Sa02 persisting for at least eight seconds during the entire procedure; (2) number and duration of episodes during which Sa02 decreased below 90 percent; (3) the Sa02 immediately before and the lowest Sa02 in the one minute following ventriculography, coronary cineangiography, or balloon inflation during percutaneous transluminal coronary artery angioplasty. The patients age, sex, weight, hematocrit reading, smoking history, extent of coronary artery disease, location and extent of valvular disease, and signs of congestive heart failure before catheterization were recorded. Sedation before and during the procedure was administered at the discretion of the attending cardiologist and was recorded. actos tablets Continue reading this post…

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in Adults

Continuous Oxygen Saturation Monitoring during Cardiac Catheterization in AdultsCardiac catheterization has been associated with a variety of complications, including arrhythmias, myocardial infarction, hypotension, and acute pulmonary edema. Hypoxemia may occur during cardiac catheterization and could contribute to morbidity, as well as potentially alter physiologic parameters measured at catheterization. We know of only two published studies in which arterial hemoglobin oxygen saturation (SaOJ was continuously monitored during cardiac catheterization.* Both of those investigations were conducted on pediatric patients and were performed to determine the reliability of noninvasive Sa02 monitors. Using pulse oximetry, we examined the continuous beat-to-beat changes in Sa02 in an adult population during cardiac catheterization. Measurements of Sa02 by noninvasive pulse oximetry have been shown to be accurate over a wide range of saturations when compared to in vitro blood measurements of Sa02 using a spectrophotometric oximeter (CO-Oximeter). Continue reading this post…