THIS ARTICLE HAS BEEN RETRACTED: Relationship between stimulating current and accelographic train‐of‐four response at the great toe

Abstract

SummaryThe incidence and origin of contamination of the vocal cords in 53 trauma patients was studied when tracheal intubation was performed before hospital admission. Eighteen patients (34%) had gross contamination which was blood in 15 patients and gastric contents in three patients. This has implications for prehospital airway management and particularly for use of the laryngeal mask airway. Since victims of major trauma may have full stomachs and impaired airway reflexes they are assumed to be at high risk of large airway and pulmonary aspiration [1]. Both gastric contents and debris from the upper airway, particularly blood, may be aspirated. The actual incidence of aspiration in trauma patients is unknown. It is also unclear whether the risk of aspiration comes primarily from blood and debris from the upper airway or from gastric contents. Where the major risk lies has implications for airway management. We examined the incidence and nature of aspiration in a group of trauma patients. MethodsOver a 10-week period, we studied 53 consecutive adult patients with major trauma who required tracheal intubation before admission to hospital by members of the London Helicopter Emergency Medical Service (London HEMS). Four doctors and five paramedics were involved in the study. After each intubation was performed, the presence and nature of gross contamination of the vocal cords visible at direct larangoscopy was recorded. Patient age, sex, mortality, mechanism of injury, nature of injuries and Glasgow coma score (GCS) before intubation were recorded. The status of the person intubating (doctor or paramedic) was also recorded. Pathologists performing post-mortem examinations on patients who died within 4 h of injury were asked to look specifically for evidence and nature of pulmonary aspiration. ResultsThere were 42 males and 11 females. The mean age of the patients was 41 years (range 16-80 years). Twenty-one patients survived and 32 died. Of the nonsurvivors, 17 died within 4 h of injury. Forty-four patients (83%) had head injuries of which 32 were isolated, six head and chest and six head and multiple injuries. Twenty-nine patients had a GCS of 3 and 39 scored 8 or below. Twenty-nine patients sustained their injuries in road-traffic accidents (20 as pedestrians). Eleven were injured in falls from a height.Twenty patients (38%) were intubated by paramedics and 33 (62%) by doctors.Eighteen (34%) patients had evidence of gross contamination of the vocal cords at direct laryngoscopy. All 18 had head injuries and a GCS below 8. In 15 of these patients, the airway was contaminated with blood and, in three, by gastric contents. The results of post-mortem examinations on 10 of the 17 patients who died within the first 4 h were available to us. One confirmed aspiration of gastric contents seen at laryngoscopy, one confirmed aspiration of blood, seven confirmed that no aspiration had occurred and one showed no evidence of aspiration 1097ᮊ 1999 Blackwell Science Ltd where a moderate amount of blood had been seen at intubat...

RETRACTED ARTICLE: Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone

“…It has been reported that the value of T1 recorded at the supramaximal current is generally > 90% of the T1 value elicited at 60 mA. [2][3][4] Thus, the lowest current able to produce a value of T1 of more than 90% of the value of T1 recorded at 60 mA was regarded as the supramaximal current. This method of determining the supramaximal current is in accordance with previous reports.…”

“…This method of determining the supramaximal current is in accordance with previous reports. [2][3][4] Once the supramaximal current had been determined in each patient in the four groups, the TOF stimuli were delivered every 20 sec at the supramaximal current for approximately five minutes until the accelerographic and mechanical responses stabilized. Thereafter, the accelerographic value of T1 and the mechanical twitch height in response to T1 were regarded as controls.…”

Reversal of Vecuronium With Neostigmine: A Comparison Between Male and Female Patients

“…As the skin thickness increases, the supramaximal stimulating current for the monitoring of neuromuscular blockade becomes high 26 ). It was noted that skin thickness was greater in men than in women27).…”