Journal of clinical monitoring and computing
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The increasing focus on health care costs requires that all physicians evaluate practice behaviors. The primary emphasis in anesthesia has been limiting the use of expensive medications and interventions. Reducing waste is another approach, and volatile anesthetics are an appropriate target in that simple reduction of fresh gas-flow (FGF) rates is effective. A monitor that measures and displays the cost of wasted volatile anesthetic was developed and used to determine if real-time display of the cost would result in decreased FGF rates, which, in turn, would decrease wasted anesthetic. ⋯ Nine residents were initially enrolled, but due to scheduling difficulties only five residents completed the protocol. Data from cases using the WGM demonstrated a 50% decrease (3.58 +/- 1.34 l/min vs. 1.78 +/- 0.51 l/min (p = 0.009)) in the scavenger flow rates, which resulted in a 48% ($5.28 +/- 0.68 vs. $2.72 +/- 0.80 (p = 0.002)) decrease in hourly cost of wasted volatile anesthetic. There was no difference between the Baseline and Visible phases with regard to use of nitrous oxide or intravenous anesthetic agents. CONCLUSIONS. The WGM decreased wasted volatile anesthetic by encouraging decreased FGF rates.
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J Clin Monit Comput · Jul 1999
Increase in twitch force of the adductor pollicis muscle with stabilized preload at constant thumb abduction before and after administration of muscle relaxant.
To determine whether the twitch force of the adductor pollicis remains stable when 0.1 Hz single twitch stimulation is started after stabilization of the thumb preload at a constant degree of thumb abduction; also to study any possible increase in twitch force before the onset of and after the recovery from neuromuscular block. ⋯ Twitch forces may increase when stimulation is started after stabilization of thumb preload at a constant degree of thumb abduction. In some patients twitch forces may increase before the onset of neuromuscular block with vecuronium or d-tubocurarine; twitch forces increase after recovery from suxamethonium.
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Inhaled nitric oxide (NO) was found to cause selective pulmonary vasodilation in the late 1980's and since then there has been a huge interest in studying its clinical benefits. The equipment used to deliver and monitor inhaled NO has gone through a dramatic evolution from simple flow meters and industrial monitors to to-days purpose built, fully integrated, NO delivery and monitoring systems that were designed specifically for the demanding area of the intensive care unit. This paper explores the evolution of inhaled NO delivery systems and identifies the design challenges, the safety and regulatory requirements and the ease of use issues that had to be solved to bring this new exciting new class of medical device in to clinical use.