Medical science monitor : international medical journal of experimental and clinical research
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Meta Analysis Comparative Study
Variable designs of clinical trials of neuromuscular blocking agents: an example of studies comparing rocuronium and vecuronium.
Published clinical trials on neuromuscular blocking (NMB) agents are being reported with large variations in their protocols and conflictiing results may emerge from these differences. Because they have been compared in several clinical trials, the study was focused on rocuronium and vecuronium in order to evaluate whether these NMB agents were compared under homogeneous conditions. MATERIAL/ METHOD: A search was made in PubMed, Embase Drugs and Pharmacology, Cochrane Controlled Trials Register, and Cochrane Database of Systematic Reviews. Studies on the neuromuscular response at the adductor pollicis to an i.v. bolus dose of rocuronium or vecuronium in humans were included. Quality of all reports was assessed by means of the 3-item Jadad et al. scale. Twenty-five studies met our inclusion criteria and all were retrieved. ⋯ Clinical trials on neuromuscular blocking agents, e.g. vecuronium versus rocuronium, are being performed with large variability and without following established guidelines.
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Comparative Study Clinical Trial
Is non-invasive monitoring of intracranial pressure waveform analysis possible? Preliminary results of a comparative study of non-invasive vs. invasive intracranial slow-wave waveform analysis monitoring in patients with traumatic brain injury.
An increasing body of evidence supports the concept that intracranial pressure (ICP) slow B waves represent the auto-regulatory response of spontaneous fluctuations of cerebral perfusion pressure. A relationship between cerebral auto-regulation and clinical outcome in patients with traumatic brain injury has also been established. The objective of our prospective clinical study was to compare the B slow ICP waves obtained invasively by standard ICP monitoring to those obtained noninvasively using a new ultrasound technology. ⋯ Ultrasonographic technology (Vittamed) may have significant application in non-invasive continuous cerebrovascular auto-regulation monitoring in patients with severe head injuries.
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Clinical Trial
Early cerebral monitoring using the transcranial Doppler pulsatility index in patients with severe brain trauma.
The early posttraumatic period is critical in patients with traumatic brain injury (TBI) because of the increased risk of secondary ischemic injuries to the injured brain. For these patients, cerebral perfusion pressure (CPP) monitoring is recommended. This, however, requires an invasive device to measure intracranial pressure (ICP). Transcranial Doppler (TCD) ultrasonography is an effective, noninvasive method for the detection of cerebral hemodynamic changes. Use of the dimensionless TCD-pulsatility index (PI) has the advantage of eliminating errors in measurements due to insonation angle variations. ⋯ Pulsatility index measurements permit the early identification of patients with low CPP and high risk of cerebral ischemia. In emergency situations it can be used alone when ICP monitoring is contraindicated or not readily available.