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Biomedical subjects

Robert D Warters

Publications and source records attributed to Robert D Warters.

7 recordsLinked to original sources
PubMed2007

The accuracy of electrocardiogram-controlled central line placement.

BACKGROUND: Electrocardiogram (ECG) guidance to confirm accurate positioning of central venous catheters (CVC), placed before surgery in the operating room, is rarely used in the United States. We designed this randomized, controlled trial to investigate whether the use of this technique impacts the accuracy of CVC placement. METHODS: Patients in group ECG (n = 147) had a CVC placed using right-atrial ECG to guide catheter tip positioning. CVCs in group NO-ECG (n = 143) were positioned without this technique. RESULTS: Overall, guidewire-ECG control resulted in more correctly positioned CVCs (96% vs 76%, P < or = 0.001) without increasing placement time. Significantly more CVCs were placed in the middle of the superior vena cava in group ECG (P < or = 0.001), although placement into the right atrium or right ventricle and into other vessels occurred significantly more often in group NO-ECG (P < or = 0.001). Twenty patients in group NO-ECG required repositioning of their CVC after surgery, whereas this maneuver was necessary only in three patients in group ECG (P < or = 0.001). CONCLUSIONS: ECG guidance allows for more accurate CVC placement, and should be considered to increase patient safety and reduce costs associated with repositioning procedures.

Adult↗
PubMed2004

Nasal versus oral fiberoptic intubation via a cuffed oropharyngeal airway (COPA) during spontaneous ventilation.

STUDY OBJECTIVE: To compare the success rate of nasal versus oral fiberoptic intubation in anesthetized patients breathing spontaneously via the cuffed oropharyngeal airway (COPAtrade mark). DESIGN: Prospective, randomized, controlled study. SETTING: Two university-affiliated hospitals. PATIENTS: Patients scheduled for general or plastic surgery of the torso or extremities. INTERVENTIONS: Nasal (n=20) and oral (n=20) fiberoptic intubation were performed in patients while breathing spontaneously via the COPA during standardized anesthesia. MEASUREMENTS: Demographic data, mean arterial pressure, heart rate, end-tidal carbon dioxide (ETCO2), oxygen saturation (SpO2), COPA size, difficult airway predictors, rate of failed ventilation via COPA, and frequency of hypoxemia (SpO2 < 90%) during the procedure, and perioperative untoward events were recorded. MAIN RESULTS: The background, airway difficulty, vital signs and untoward effects were similar in the two groups. Nasal fiberoptic laryngeal view (scale 1-4) was better than the oral grading (3 [median] vs. 2, respectively; p <0.05). Eighty percent of the nasal intubations were successful compared with 40% of the oral intubations (p <0.05). Nasal intubations were accomplished within 153 +/- 15 SD seconds compared with 236 +/- 22 seconds (p <0.05) for the oral intubations, and less propofol was needed in the nasal intubations during the procedures (240 +/- 27 mg [nasal] vs. 277+/- 39 mg [oral]; p <0.05). CONCLUSIONS: Nasal fiberoptic laryngoscopy is more successful and easy than the oral approach in anesthetized patients who are breathing spontaneously through the COPA.

Administration, Inhalation↗
PubMed2003

Anaesthesia for magnetoencephalography in children with intractable seizures.

BACKGROUND: Magnetoencephalography (MEG), a noninvasive technique for evaluation of epileptic patients, records magnetic fields during neuronal electrical activity within the brain. Anaesthesia experience for MEG has not yet been reported. METHODS: We retrospectively reviewed records of 48 paediatric patients undergoing MEG under anaesthesia. Thirty-one patients (nonprotocol group) were managed according to the anaesthesiologist's discretion. Premedication included oral midazolam, chloral hydrate or fentanyl oralet, intravenous midazolam or inhalational anaesthesia with sevoflurane. Anaesthesia was maintained with propofol, midazolam, fentanyl, alone or in combination. A subsequent protocol group (17 patients) received chloral hydrate as premedication and propofol for maintenance of anaesthesia. RESULTS: There was an overall 25% failure of interictal activity and localization on the MEG scan. In the nonprotocol group, 11 scans failed (35.5%). Of these, eight (72.7%) received midazolam orally. Only one failure (5.8%) was recorded in the protocol group in a patient who received chloral hydrate as sedation supplemented by sevoflurane. CONCLUSIONS: In our experience, midazolam premedication resulted in a high MEG failure rate (73%). Chloral hydrate premedication and propofol maintenance resulted in a lower incidence of MEG failure (5.8%). General anaesthesia with a continuous infusion of propofol or sevoflurane appears acceptable, although, lighter levels of anaesthesia might be required to avoid interference with interictal activity of the brain.

Anesthesia, General↗