Acta anaesthesiologica Scandinavica. Supplementum
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The new nondepolarizing muscle relaxant rocuronium belongs to the chemical group of aminosteroidal muscle relaxants and is similar to vecuronium in its chemical structure and pharmacologic action. The principal clinical advantage of rocuronium over vecuronium is the short time to onset of the neuromuscular block. The two other new muscle relaxants, mivacurium and cis-atracurium, belong to the group of benzylisoquinoline muscle relaxants. ⋯ While its action is similar to that of atracurium, it does not release histamine and its administration is not accompanied by marked changes in blood pressure or heart rate. Even the simple tactile monitoring of the neuromuscular transmission enables the clinician to adjust the doses of these and other muscle relaxants to the needs of individual patients. Precise adjustment of the doses of muscle relaxants contributes to their safer clinical use by avoiding an excessively deep and unnecessarily prolonged neuromuscular block.
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Acta Anaesthesiol Scand Suppl · Jan 1996
The importance of patient/ventilator interactions during non-invasive mechanical ventilation.
A number of inferences about diagnostic and therapeutic implications of PVA during non-invasive ventilation may be drawn from these observations. 1. Augmentation of ventilation above spontaneous breathing requires coordination between patient effort and machine output. 2. During sleep, hypocapnia limits the amount that ventilation can be augmented when the ventilator is set in the spontaneous (patient triggered) mode. 3. ⋯ The diagnostic and therapeutic implications of PVA and wasted triggering efforts differ depending on the level of inspiratory drive; in the presence of a low drive, PVA is a manifestation of relative hypocapnia and inspiratory unloading; changes in ventilator settings may not be required. In the presence of a high drive, PVA reflects machine sensing failure or abnormal lung mechanics. In this case, sedation or changes in ventilator settings may be required.