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LETTERS TO THE EDITOR

Improving Pulse Oximetry Signal Quality

Professor, Clinical Anesthesia, Univ. Calif. Med. Center, San Francisco

To the Editor:

Kober, et al. (1) describe active warming as a means of improving pulse oximetry signal quality in pre-hospital trauma patients.

Another technique I have used extensively on hospitalized trauma patients with poor pulse oximetry signals is to perform a digital block on the digit occupied by the oximeter. It is a simple and relatively noninvasive procedure. Using a 1 in. 25 GA. needle, with 1–2 cc. of 1% lidocaine, (make sure no epinephrine is in the lidocaine) inject circumferentially around the base of the digit.

This single digit sympathectomy instantly enhances the pulse oximetry signal, and lasts 30–45 minutes. During that interval, volume replacement, warming and other resuscitative measures have usually resolved the issue.

The procedure is so simple, effective and safe, (only 10–20 mg. lidocaine involved) that perhaps paramedics should be taught and authorized to perform it under radio call direction of an ER MD when indicated.

Reference

1. Kober A., Scheck T., Lieba F. et. al. The influence of active Warming on Signal Quality of Pulse Oximetry in Prehospital Trauma Care, Anesth. Analg. 2002; 95: 961–6.

Response

Department of Anesthesiology and General Intensive Care, Vienna General Hospital, University of Vienna, Vienna, Austria

In Response:

We appreciate the interest in our recent article (1). Of course, when planning the study, we kept the sympatholytic effects of small doses of vasoconstrictor-free local anesthetics in mind, which should also improve signal quality of pulse oximetry. Unfortunately, in our paramedic based rescue system, invasive procedures are not allowed to be performed by paramedics. Therefore, in this study we were limited to non-invasive procedures, only.

Reference

1. Kober A, Scheck T, Lieba F, et al. The influence of active warming on signal quality of pulse oximetry in prehospital trauma care. Anesth Analg 2002; 95: 961—6.[Abstract/Free Full Text]

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