British journal of anaesthesia
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The use of a ventilation strategy with high positive end-expiratory pressure (PEEP) that is intended to recruit collapsed alveoli and to prevent recurrent collapse can reduce alveolar protein influx in experimental acute lung injury (ALI). This could affect the pulmonary response to treatment with surfactant, since plasma proteins inhibit surfactant function. We studied the effect of exogenous surfactant on lung mechanics after 4 h of mechanical ventilation with high or low PEEP. ⋯ After surfactant treatment, PaO2 increased to > 53 kPa in both groups. In the ventilated control group alveolar protein influx was greater and TLC35 and Cmax were lower than in the high-PEEP group. We conclude that the pulmonary response to exogenous surfactant after mechanical ventilation in experimental ALI is improved when a ventilation strategy with high PEEP is used.
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The excretion of rocuronium and its potential metabolites was studied in 38 anaesthetized patients, ASA I-III and 21-69 yr old. Rocuronium bromide was administered as an i.v. bolus dose of 0.3 or 0.9 mg kg-1. In Part A of the study, the excretion into urine and bile, and the liver content were studied. ⋯ In most samples, irrespective of the type of biological material, only small amounts of the metabolite 17-desacetyl-rocuronium was found. The results demonstrate that rocuronium is taken up by the liver and excreted into bile in high concentrations. The faecal and urinary excretion of unchanged rocuronium are the major routes of rocuronium elimination.
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A survey into the attitudes of anaesthetists to features in monitoring instruments, particularly the design of alarms, visual warnings, alarm limits and the general instrument interface is reported. Questions in the survey had short introductions outlining a clinical scenario followed by items that proposed alternative design features that an instrument might have. Participants were asked to grade their responses to these alternatives on a scale of 1 (strongly disagree) to 5 (strongly agree). ⋯ They prefer context-specific messages and alarms. They reject overt control systems for delivering anaesthesia, except for use in exceptional circumstances. Generally, the preferences of anaesthetists are consistent with known principles of safe, ergonomic design.
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Editorial Comment
Postoperative nausea and vomiting--time for balanced antiemesis?