Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 1998
Stabilization and stability of twitch force during mechanomyography of the adductor pollicis muscle.
In order to study the stabilization time, the increase in twitch force during stabilization and the maintenance of stability during mechanomyography of the adductor pollicis muscle, neuromuscular function was monitored in 20 patients anaesthetized without the use of a neuromuscular blocking agent. The effect of the type of stimulation (single twitch [ST; 0.1 Hz], or train-of-four [TOF; 4 stimuli at 2 Hz, repeated every 12 s]) on these variables was studied. When applying TOF stimulation, the variables were also investigated for the TOF percentage [quotient of fourth and first twitch of a TOF stimulus x 100%]. ⋯ Stabilization of twitch force takes too long for many studies of neuromuscular function in the clinical research setting. Therefore, we do not recommend its routine use when performing mechanomyography of the adductor pollicis muscle.
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J Clin Monit Comput · Dec 1998
A method for assessment of standards of care of anesthesia services in departments with different levels of resources.
In developing countries the standards of anesthesia care vary greatly between hospitals. In order to identify the urgent needs of disadvantaged hospitals, we compared three index hospitals in the greater Cairo area, one of which has excellent (category I), on intermediate (category II), and one with severely restricted resources (category III). Standards of care published by the American Society of Anesthesiologists (ASA) were used to develop a spreadsheet for documenting features of pre-, intra- and post-anesthetic care in patients undergoing tonsillectomies, a procedure commonly performed in all three hospitals. ⋯ Urgent help does not mean the need for sophisticated monitors or equipment only, but the establishment of practice standards first. Applying the priciples of modern management, we need to evaluate the structure, processes and outcome of anesthetic practice in developing countries in order to reengineer the way we provide help to anesthetic departments in developing nations. In this modest study we are presenting a means to evaluate the features and processes of the anesthesia services in developing countries.
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J Clin Monit Comput · Dec 1998
The fast flush test--is the clinical comparison equivalent to its in vitro simulation?
An in vitro simulation of the fast flush (FL) test has previously been used to prove that the FL test-measures the dynamic response of entire the blood pressure monitoring system. This simulation has also been used to confirm that the FL test is equivalent to the "gold standard" test for determining dynamic response, namely the square wave (SW) test. The conditions of the in vitro simulation can be reproduced in vivo during cardiopulmonary bypass (CPB) and circulatory arrest. Therefore the present objective was to verify that the previous conclusions about the validity of the FL test, obtained from an in vitro model, are equally valid when applied to in vivo clinical conditions. A secondary objective was to determine whether the patient's arterial tree has any affect on the dynamic characteristics of fluid-filled manometers. ⋯ The clinical conditions during CPB and particularly during circulatory arrest duplicate the in vitro FL test simulation model. These results confirm the validity of the FL test in vivo as well as proving that the dynamic characteristics of a fluid-filled manometer are independent of the patient's vasculature.