Elemer K. Zsigmond

Intra-arterial Blood Pressure Measurements

To the Editor.— Often there is a great reliance placed on the monitoring of intra-arterial blood pressure (BP) by sophisticated transducers and recorders without the awareness of potential pitfalls in methodology. Since 1960 when I started using intraarterial BP measurements in the management of critically ill patients, I encountered scores of cases in which blind reliance on the directly monitored arterial pressure led to catastrophic iatrogenic complications or death. Proper selection of the arterial catheterization site, the type of the catheter, the method of the anticoagulation, the type of connecting lines and transducers, the adequacy of the recording equipment, and the frequency and accuracy of recalibration can substantially alter the systolic or peak pressures, mean pressures, and diastolic or minimum BPs. Comparison of direct intra-arterial BP with noninvasive computerized oscillometric measurements on the contralateral extremities of patients without vascular diseases showed greater reliability and dependability of the oscillometric than the

Routine Temperature Monitoring During Anesthesia

To the Editor.— Malignant hyperthermia, or more accurately, acute familial peranesthetic rhabdomyolysis, still causes death and disability because of its delayed recognition. In 1969 we recommended routine temperature monitoring in all patients undergoing anesthesia with triggering agents, namely, all potent inhalational anesthetics and succinylcholine. A survey that I recently conducted showed that only 60% of anesthesiologists use routine temperature monitoring in adults. Frequently the high cost of continuous temperature monitoring is quoted as an excuse for neglecting temperature monitoring. The introduction of liquid crystal thermography has brought down the cost to a negligible level,

Screening of Blood Donors

1.50 per patient, if a temperature sensor tape is used during anesthesia. In view of the facts that (1) there is a high mortality (35%) despite the recently introduced intravenous dantrolene therapy, that (2) there is an incidence of 1:7,000 to 1:15,000 in the anesthetized population that is not negligible, and that (3) there is a

Direct Arterial Blood Pressure Measurements-Reply

To the Editor.— Malignant hyperthermia, or more accurately, acute familial peranesthetic rhabdomyolysis, still causes death and disability because of its delayed recognition. In 1969 we recommended routine temperature monitoring in all patients undergoing anesthesia with triggering agents, namely, all potent inhalational anesthetics and succinylcholine. A survey that I recently conducted showed that only 60% of anesthesiologists use routine temperature monitoring in adults. Frequently the high cost of continuous temperature monitoring is quoted as an excuse for neglecting temperature monitoring. The introduction of liquid crystal thermography has brought down the cost to a negligible level,

Causes of Ventricular Arrhythmias

1.50 per patient, if a temperature sensor tape is used during anesthesia. In view of the facts that (1) there is a high mortality (35% ) despite the recently introduced intravenous dantrolene therapy, that (2) there is an incidence of 1:7,000 to 1:15,000 in the anesthetized population that is not negligible, and that (3) there is a

Pancuronium Bromide (Continued)

In Reply.— I well recognize the advantages of the direct arterial BP measurements, since I was among the first who routinely used it in clinical anesthesia and intensive care. In combination with ECG and phonocardiography, I have used the arterial tracings in the calculation of systolic time intervals (PEP/LVET). 1 Furthermore, I agree with Dr Goyette on the relative safety of arterial catheterization, since I have experienced only two transient arterial spasms, but no permanent sequelae, in more than 5,000 patients with radial artery catheterization and 300 sophisticated health professional volunteers with brachial arterial catheterization. I hope to summarize my experience with arterial catheterization gained in the past 20 years in a review article soon.