Improved neuromuscular blockade using a novel neuromuscular blockade advisory system: a randomized, controlled, clinical trial.

BACKGROUND: Conventional incremental bolus administration of neuromuscular blocking (NMB) drugs is associated with limitations in intraoperative control, potential delays in recovery, and residual blockade in the postanesthetic period. To overcome such limitations, we developed a novel adaptive control computer program, the Neuromuscular Blockade Advisory System (NMBAS). The NMBAS advises the anesthesiologist on the timing and dose of NMB drugs based on a sixth-order Laguerre model and the history of the patient's electromyographic responses. Here, we tested the hypothesis that the use of the NMBAS improves NMB compared to standard care. METHODS: We conducted a prospective, randomized, controlled, blinded, parallel-group, clinical trial with n = 73 patients (ASA physical status I-III) undergoing abdominal surgery under general anesthesia > or =1.5 h with NMB using rocuronium. Patients were allocated to standard care or NMBAS-guided rocuronium administration. The primary outcome variable was the incidence of intraoperative events reflecting inadequate NMB. Secondary outcome variables included train-of-four (TOF) ratios at the end of surgery before reversal, the total doses of rocuronium, reversal agents, anesthetics and other drugs, the incidence of postoperative adverse events, and the incidence of anesthesiologist noncompliance with NMBAS recommendations. RESULTS: Of 73 enrolled patients, n = 30 per group were eligible for analysis. Patient demographics were comparable between the groups. The incidence in total intraoperative events associated with inadequate NMB was significantly lower in the NMBAS group compared to standard care (8/30 vs 19/30; P = 0.004). Mean TOF ratios at the end of surgery before reversal were higher in the NMBAS group (0.59 [95% CI, 0.48-0.69] vs 0.14 [95% CI, 0.04-0.24]; P < 0.0001). Total administered doses of rocuronium, reversal drugs, and other drugs, and the incidence of postoperative adverse events were not different. CONCLUSIONS: Compared to standard practice, NMBAS-guided care was associated with improved NMB quality and higher TOF ratios at the end of surgery, potentially reducing the risk of residual NMB and improving perioperative patient safety.

Summary consensus statement of the Review Board of the Swiss Complementary Medicine Evaluation Programme, (Programme Evaluation Komplementärmedizin, PEK) regarding the PEK process and products.

The international review board was set up as the scientific advisory body of the Swiss Complementary Medicine Evaluation Programme (PEK) in 2002. It has met several times and has given advice with respect to the most important aspects of the programme. It would have been the normal procedure for the review board to have had the opportunity to comment on the drafts of the final scientific products as well as the draft of the summary report, in order to advise on them, before the documents became publicly available and formed the basis for political decision making. But the responsible authorities changed this process. In the following, the review board comments both on this process and on the products.

Carta aberta ás Federadas sobre a Biblioteca Virtual em Saúde Homeopatia Dr Matheus Marim (BVS-Homeopatia) / Open letter to the Federations about the Virtual Health Library Homeopathy Dr Matheus Marim (VHL-Homeopathy)

A BVS Homeopatia existe há mais de 20 anos, sendo mantida pela BIREME, que é um órgão da OPAS e OMS. Esta BVS é o portal de divulgação e de reconhecimento da Homeopatia dentro do universo médico, odontológico, veterinário e farmacêutico de toda a América Latina. A BVS é de acesso gratuito, oferecendo informações validadas e confiáveis sobre a Homeopatia, disponibilizando para consulta a maior base de dados da área, a base Homeoindex, exclusiva da Homeopatia, com mais de 13.000 registros indexados. A base Homeoindex é também responsável por compartilhar parte de seus registros de Homeopatia com várias outras bases de dados internacionais.

Cómo construir una recomendación de tratamiento / How to recommend a treatment

La decisión terapéutica conlleva un proceso de análisis complejo, en el que intervienen por una parte el beneficio de la intervención, y por otro, el riesgo, los costos y las molestias para el paciente. El American College of Chest Physicians (ACCP) junto con el grupo internacional de trabajo GRADE desarrolló una serie de criterios como guía para la confección de recomendaciones, que consisten en evaluar la fuerza de la recomendación y la calidad de la evidencia. Para tomar una decisión el médico debe, independientemente del grado de recomendación, aplicar su juicio crítico considerado las circunstancias locales e individuales de su paciente y sus preferencias.