Electrographic tachyphylaxis to etomidate and ketamine used for refractory status epilepticus controlled with isoflurane.
Etomidate and ketamine controlled seizures but acute tachyphylaxis occurred. Isoflurane was then used to control seizures.
Biomedical subjects
Publications and source records attributed to M J Bloom.
Etomidate and ketamine controlled seizures but acute tachyphylaxis occurred. Isoflurane was then used to control seizures.
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The purpose of this study was to determine the extent to which localized hypothermia of a monitored extremity alters the assessment of recovery from vecuronium-induced neuromuscular blockade. Bilateral integrated evoked electromyographic (IEMG) responses were measured in the ulner distribution of 14 anaesthetized patients who had differing upper extremity temperatures as measured at the adductor pollicis to determine whether localized hypothermia alters the clinical assessment of spontaneous recovery from vecuronium-induced neuromuscular blockade. All patients received general anaesthesia with thiopentone, N2O/O2 and opioid; 11/14 patients received isoflurane for blood pressure control. Bilateral adductor pollicis, oesophageal and ambient temperatures, and IEMG evoked response (t1) expressed as percent unparalyzed control were recorded during the anaesthetic. The difference in evoked response between the warmer and the colder upper extremity was calculated at 25%, 50% and 75% spontaneous recovery from neuromuscular blockade in the warm extremity. Differences in temperature between extremities ranged from 0.2-11 degrees C. The difference in IEMG-evoked response between extremities was proportional to the difference in temperature, and there was a direct correlation (r = 0.78) between IEMG response and extremity temperature; IEMG response was absent when extremity temperature was less than 25 degrees C. We concluded that localized hypothermia in the monitored extremity decreases the IEMG-evoked response to vecuronium neuromuscular blockade; the greater the temperature decrease, the less the evoked response.(ABSTRACT TRUNCATED AT 250 WORDS)
The interpretation of automatically collected data to produce intelligent alarms and identify particular conditions is nearly impossible without identifying the specific context in which the data are obtained. Shifts in clinical context occur because of changes in the patient's physiologic state, or due to the passage of time, or due to changes imposed by therapeutic intervention such as surgery. Techniques to identify such changes in clinical context are discussed with particular attention to the application of cluster analysis, discriminant analysis, and statistical predictors. An example of these analyses applied to EEG data is presented, showing an unexpected hysteresis of EEG behavior in response to an hypoxic challenge.
Although general purpose computers have been available for more than 40 years, the dramatic plunge in the cost of electronics in the past 10 years has finally made significant computing power affordable to almost anyone. However, a large number of people including professionals have little idea of how a computer really works or what it can and cannot do. Presented here is an introduction to the hardware and software of microcomputers which assumes no working knowledge of electronics or programming. The fundamental pieces of a microcomputer are explained, giving some insight into the reasons why present microcomputers are built the way they are. This is followed by a discussion of the fundamentals of how software is used to make the hardware compute. The various levels of software are discussed, then the most commonly used types of user application software are described, and finally some suggestions are made on how to choose a personal computer.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.