Anaesthesia
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Unrecognised postoperative residual neuromuscular block remains a frequent occurrence in recovery rooms. Evidence indicates that current practice continues to perpetuate the status quo, in which 10-40% of patients experience postoperative residual weakness. A departure from the current practice requires small efforts on the clinicians' part. This review addresses several selected core questions regarding neuromuscular blockade monitoring and provides a framework to rationally discuss and develop basic guidelines for the use of neuromuscular blocking agents in patient care.
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Measurement allows us to quantify various parameters and variables in natural systems. In addition, by measuring the effect by which a perturbation of one part of the system influences the system as a whole, insights into the functional mechanisms of the system can be inferred. ⋯ What is often more important is the description of trends in measured variables. In this article, we give some examples - focussed around oxygen sensors - of how new sensors can make important measurements and might in the future contribute to improved clinical management.
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The ability to gently ventilate a patient's lungs using a self-inflating bag requires a properly working adjustable pressure-limiting (APL) valve. We compared the performance of the APL valves of the GE Aisys CS(2) and the Draeger Fabius anaesthetic machines during closure and opening from 1-20 and from 20-1 cmH2 O, using standardised experimental baby and adolescent patient lung models. Airway pressures and inspiratory tidal volumes were measured using an ASL-5000 test lung and a GE Aisys CS(2) near-patient spirometry sensors. ⋯ Airway pressures in the Draeger Fabius APL valves demonstrated a near linear increase and decrease. Airway pressure values measured in the Draeger Fabius were never higher than those set by the APL valves, whereas in the GE Aisys CS(2) , they considerably exceeded set pressures (by up to 27 cmH2 O). We conclude that the performance of the GE Aisys CS(2) APL valve does not allow safe bag-assisted ventilation of a patient's lungs.
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Previous studies of critical care admissions have largely compared patients that have been granted or declined admission. To better understand the decision process itself, our ethnographic approach combined observation of and interviews with critical care physicians in a large English hospital. We observed 30 critical care doctors managing 71 referrals and conducted ten interviews with senior decision-makers to explore the themes raised by our observations. ⋯ When patients were declined admission, they were not simply forgotten or left behind; they nevertheless underwent careful assessment and follow-up. Thus, depicting admission or refusal as a binary event is misleading. We suggest that prescriptive admission algorithms are problematic for clinicians, in that they may not take into account the complexity of clinical practice.