Journal of clinical monitoring
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We studied the accuracy and repeatability of train-of-four (TOF) ratio measurements made from a dynamic piezoelectric sensor that records movement of the thumb in response to ulnar nerve stimulation compared with an isometric mechanomyogram that measures force of contraction of the adductor pollicis. ⋯ Both sensors showed diminished repeatability in TOF measurement with decreasing stimulation current. The data indicate that neither sensor is reliable for general monitoring of neuromuscular block at submaximal current levels. However, the individual patient results showed that some patients could be monitored accurately with both sensors, even at the lowest stimulation current levels.
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Comparative Study
Brief wakeful response to command indicates wakefulness with suppression of memory formation during surgical anesthesia.
In a previous study of patients emerging from anesthesia following surgery, we found that a brief wakeful response to command of an eye opening or single hand squeeze or count was not associated with memory formation, while the response of four hand squeezes or counts was associated with memory. We wanted to determine the anesthetic requirements for obtaining this brief wakeful response endpoint during surgery and to determine if memory occurred at this endpoint during surgical anesthesia. ⋯ A brief wakeful response to a command of opening the eyes or squeezing the hand was not associated with increased memory formation during surgery. A brief wakeful response to command was found during surgery when patients received fentanyl 4 micrograms/kg; but it was rarely found at fentanyl dosages of 2 micrograms/kg or less.
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The goal of this study was to determine whether the intraoperative vigilance of anesthesia residents is different when they keep a manual record than when an assistant performs the charting. ⋯ The results demonstrate that anesthesia residents are equally attentive to an experimental signal displayed on an electronic monitor while manually charting as they are when an assistant keeps the record. This brings into question the contention that eliminating the record-keeping task will result in a reduced level of vigilance.