RESUMO
The monitoring of the neuromuscular blockade is critical for patient's safety during and after surgery. The monitoring of neuromuscular blockade often requires the use of Train of Four (TOF) technique. During a TOF test two electrodes are attached to the ulnar nerve, and a series of four electric pulses are applied. The electrical stimulation causes the thumb to twitch, and the amount of twitch varies depending on the amount of neuromuscular blockade in patient's system. Current medical devices used to assist anesthesiologists to perform TOF monitoring often require free hand movement and do not provide accurate or reliable results. The goal of this work is to design, prototype and test a new medical device that provides reliable TOF results when thumb movement is restricted. A medical device that uses a pressurized catheter balloon to detect the response thumb twitch of the TOF test is created. An analytical model, numerical study, and mechanical finger testing were employed to create an optimum design. The design is tested through a pilot human subjects study. No significant correlation is reported with subjects' properties, including hand size.
Assuntos
Bloqueio Neuromuscular , Fármacos Neuromusculares não Despolarizantes , Humanos , Monitoração Neuromuscular/métodos , Nervo Ulnar/fisiologia , Estimulação ElétricaRESUMO
Availability of powerful intravenous hypnotics and opioids with specific pharmacokinetic profiles, including rapid onset and short duration of action has allowed the development and popularization of total intravenous anesthesia (TIVA). Due to its safety, rapid titrability, quick recovery with better operating room efficiency, and a low incidence of nausea and vomiting, TIVA has become a valid alternative to inhaled general anesthesia. There are several modes of TIVA administration that range from the simple intermittent injection of small boluses of hypnotics with or without opioids to the infusion of anesthetics using complex computerized infusion pumps. Target-controlled infusion (TCI) TIVA consists of the administration of intravenous anesthetics according to their pharmacokinetic profiles in order to maintain desired concentration of the drugs in the central compartment (effect-site concentration).