Health devices
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In this issue, we evaluate three liquid disinfecting flexible endoscope reprocessors that can be used with a user-supplied liquid chemical germicide (LCG), primarily for high-level disinfection (HLD). Applying most of the same criteria and test methods, we also evaluated a fourth unit, presented separately, that is marketed as a liquid sterilizing reprocessor and must be used with manufacturer-supplied, single-use containers of LCG. Although the sterilizing unit can be used for rigid endoscopes, surgical instruments, and endoscopic accessories, we evaluated its application to the reprocessing of only flexible endoscopes. ⋯ Selection of a unit will be based on the needs and preferences of the individual healthcare facility. Our ratings also assume that these units will be used according to the manufacturers' instructions and the endoscope's operator's manual. Note that, although the evaluated liquid disinfecting units provide detergent-flushing, post-detergent water-rinse, and post-detergent water-rinse-removal phases, manual cleaning of endoscopes before automatic reprocessing is essential, regardless of which reprocessor is used.
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Ohmeda PPD is counting on desflurane's decreased solubility, which provides improved control of anesthetic level and allows faster recovery, and its reduced toxicity to the liver and kidney to sufficiently differentiate it from its competitor, isoflurane, to make it the inhalation anesthetic of choice in the future. However, even though initial interest has been high, resistance has arisen for several reasons: Desflurane's high MAC requires reduced fresh-gas flows to keep its rate of consumption down. It may not be suitable for certain applications (e.g., for induction of pediatric patients, for use with patients with tachycardia or hypertension). ⋯ Agent monitors will need to be upgraded or new monitors will need to be purchased if the drug is to be measured. The future prices of the drug and its vaporizer are not certain. All of these factors must be considered before committing to this new technology.
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In this issue, we evaluate seven models of disposable breathing circuits from seven manufacturers; the evaluated circuits are intended to be used for adult patients on critical care ventilators. This study is a follow-up to our earlier Evaluation of disposable breathing circuits for use with portable ventilators, published in Health Devices 22(7), July 1993. We based our ratings on the breathing circuits' ability to function properly with minimal intervention from the healthcare provider. ⋯ We caution readers not to base purchasing decisions on our ratings alone, but on a thorough understanding of the issues surrounding our conclusions, which can be gained by reading this study in its entirety. We offer additional guidance and discuss important selection factors and usage issues in the Selection and Use Guide for Disposable Breathing Circuits included at the end of the Evaluation. Also see "Pre-use Verification of Breathing Circuits" in this issue for step-by-step guidelines to help healthcare providers and caregivers verify proper performance and identify the defective circuits that inevitably reach the clinical setting.