Document Detail

Normal fluctuation of physiologic cardiovascular variables during anesthesia and the phenomenon of "smoothing".
MedLine Citation:
PMID:  2072127     Owner:  NLM     Status:  MEDLINE    
With the advent of automated anesthesia record keeping devices, concern has arisen that "abnormal" values will appear in the record and possibly lead to medicolegal compromise. A retrospective review of automated records from a series of anesthesia cases was undertaken to determine if abnormal values do occur, how frequent they are, and whether they cause problems. A total of 14,826 (4,942 each) noninvasive heart rate, systolic, and diastolic blood pressure readings from 118 case printouts generated by a Diatek Arkive Patient Information Management System (63 cases) or a Datascope Datatrac record keeper (55 cases) were recorded. The study sample covered a broad range of surgical operations, anesthetic procedures, and patient ages and medical histories. During these 118 anesthetics, the majority of readings of all three variables fell within normal ranges (defined for this study as 80 to 180 and 50 to 110 mm Hg for systolic and diastolic blood pressures, respectively, and 60 to 140 beats/min for heart rate). During the anesthetics, 3.6% of the systolic pressure readings, 13.25% of the diastolic readings, and 4.25% of the heart rate readings were recorded outside these ranges. No serious intraoperative or postoperative anesthesia complications were associated with these out-of-range readings, nor would they be expected in a sample of this size, since serious anesthetic complications are rare. This preliminary observation of one person's experience may help address the concern associated with allowing high and low blood pressure and heart rate readings to be automatically recorded "unsmoothed." In medicolegal situations, it should also begin to demonstrate that such fluctuations are neither uncommon nor abnormal, and that a true record of these readings should be neither a cause for concern nor an opportunity for medicolegal exploitation.
F E Block
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of clinical monitoring     Volume:  7     ISSN:  0748-1977     ISO Abbreviation:  J Clin Monit     Publication Date:  1991 Apr 
Date Detail:
Created Date:  1991-08-22     Completed Date:  1991-08-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8506707     Medline TA:  J Clin Monit     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  141-5     Citation Subset:  IM    
Department of Anesthesiology, College of Medicine, Ohio State University, Columbus 43210.
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MeSH Terms
Anesthesia, Conduction
Anesthesia, General
Blood Pressure / physiology*
Computer Systems
Forms and Records Control
Heart Rate / physiology*
Medical Records*
Monitoring, Physiologic* / instrumentation
Retrospective Studies

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