Continuous noninvasive cardiac output in children: is this the next generation of operating room monitors? Initial experience in 402 pediatric patients.

BACKGROUND: Electrical Cardiometry(™) (EC) estimates cardiac parameters by measuring changes in thoracic electrical bioimpedance during the cardiac cycle. The ICON(®), using four electrocardiogram electrodes (EKG), estimates the maximum rate of change of impedance to peak aortic blood acceleration (based on the premise that red blood cells change from random orientation during diastole (high impedance) to an aligned state during systole (low impedance)). OBJECTIVE: To determine whether continuous cardiac output (CO) data provide additional information to current anesthesia monitors that is useful to practitioners. METHODS: After IRB approval and verbal consent, 402 children were enrolled. Data were uploaded to our anesthesia record at one-minute intervals. Ten-second measurements (averaged over the previous 20 heart beats) were downloaded to separate files for later comparison with routine OR monitors. RESULTS: Data from 374 were in the final cohort (loss of signal or improper lead placement); 292,012 measurements during 58,049 min of anesthesia were made in these children (1 day to 19 years and 1 to 107 kg). Four events had a ≥25% reduction in cardiac index at least 1 min before a clinically important change in other monitored parameters; 18 events in 14 children confirmed manifestations of other hemodynamic measures; eight events may have represented artifacts because the observed measurements did not seem to fit the clinical parameters of the other monitors; three other events documented decreased stroke index with extreme tachycardia. CONCLUSIONS: Electrical cardiometry provides real-time cardiovascular information regarding developing hemodynamic events and successfully tracked the rapid response to interventions in children of all sizes. Intervention decisions must be based on the combined data from all monitors and the clinical situation. Our experience suggests that this type of monitor may be an important addition to real-time hemodynamic monitoring.

Effect of propofol on anal sphincter pressure during anorectal manometry.

We evaluated the effect of propofol on resting anal sphincter pressure (RP) during anorectal manometry performed under general anesthesia in 20 children with chronic constipation. After propofol bolus administration, there was a significant decrease in the RP in 95% of children from a mean of 51.5 ± 15.3 to a mean nadir of 21.7 ± 10.5 mmHg (P < 0.001). The new postpropofol RP of 47.0 ± 12.4 mmHg was significantly lower compared with prepropofol RP (P < 0.0001). Propofol should be used with caution as an anesthetic agent for anorectal manometry, given the potential for confounding RP measurements.

Cardiac index as a surrogate marker for anxiety in pediatric patients undergoing ambulatory endoscopy: a prospective cohort study.

Objective.Pediatric patients undergoing medical procedures often grapple with preoperative anxiety, which can impact postoperative outcomes. While healthcare providers subjectively assess anxiety, objective quantification tools remain limited. This study aimed to evaluate two objective measures-cardiac index (CI) and heart rate (HR) in comparison with validated subjective assessments, the modified Yale Preoperative Anxiety Scale (mYPAS) and the numeric rating scale (NRS).Approach.In this prospective, observational cohort study, children ages 5-17 undergoing ambulatory endoscopy under general anesthesia underwent simultaneous measurement of objective and subjective measures at various time points: baseline, intravenous placement, two-minutes post-IV placement, when departing the preoperative bay, and one-minute prior to anesthesia induction.Main Results.Of the 86 enrolled patients, 77 had analyzable CI data and were included in the analysis. The median age was 15 years (interquartile range 13, 16), 55% were female, and most were American Society of Anesthesiologists (ASA) Physical Status 2 (64%), and had previous endoscopies (53%). HR and CI correlated overall (r= 0.65, 95% CI: 0.62, 0.69;p< 0.001), as did NRS and mYPAS (r= 0.39, 95% CI: 0.34, 0.44;p< 0.001). The correlation between HR and CI was stronger with NRS (r= 0.24, 95% CI: 0.19, 0.29;p< 0.001; andr= 0.13, 95% CI: 0.07, 0.19;p< 0.001, respectively) than with mYPAS (r= 0.06, 95% CI: 0.00, 0.11;p= 0.046; andr= 0.08, 95% CI: 0.02, 0.14;p= 0.006, respectively). The correlation with mYPAS for both HR and CI varied significantly in both direction and magnitude across the different time points.Significance.A modest yet discernable correlation exists between objective measures (HR and CI) and established subjective anxiety assessments.