Explore the vast range of titles available.

The nozzle of the pMDI canister can then be fitted into the conical hole, and the pMDI can be actuated synchronized with inspiration for direct drug delivery to the tracheobronchial tree [Figure 5].In vitro studies have shown that aerosol drug delivery to the lower respiratory tract ranges from 0.3% to 97.5% with pMDIs. [5] This wide variation in drug delivery can be attributed to various factors such as ventilator mode and settings, heat and humidification of the inspired gas, density of inhaled gas, size of endotracheal tube, and method of connecting pMDI in the ventilator circuit. The optimal technique for drug delivery by pMDI in ventilated patients is as follows:[1],[3]{Figure 4}{Figure 5} Assure tidal volume> 500 ml (in adults) during assisted ventilationRemove excess secretionsShake pMDI vigorouslyPlace pMDI in adaptor in ventilatory circuitCoordinate pMDI actuation with beginning of inspirationAllow a breath hold at end inspiration for 3–5 sAllow passive exhalationWait at least 15s between actuations; administer total dose.

[...]we sent the drug for drug analysis by the government approved lab [Table 1], but we also decided to do an in vitro baricity test to compare the supplied drug with other brands available in the market. After the collection of CSF in each ampoule, 0.2 ml of dye labelled test drug was put on the surface of CSF in the test tubes marked 'isobaric'(I), heavy brand X (HX), heavy brand Y (HY) and fentanyl (F).

Physicians, health care workers, members of the clergy, and laypeople throughout the world have accepted fully that a person is dead when his or her brain is dead. Although the widespread use of mechanical ventilators and other advanced critical care services have transformed the course of terminal neurologic disorders. Vital functions can now be maintained artificially for a long period of time after the brain has ceased to function. There is a need to diagnose brain death with utmost accuracy and urgency because of an increased awareness amongst the masses for an early diagnosis of brain death and the requirements of organ retrieval for transplantation. Physicians need not be, or consult with, a neurologist or neurosurgeon in order to determine brain death. The purpose of this review article is to provide health care providers in India with requirements for determining brain death, increase knowledge amongst health care practitioners about the clinical evaluation of brain death, and reduce the potential for variations in brain death determination policies and practices amongst facilities and practitioners. Process for brain death certification has been discussed under the following: 1. Identification of history or physical examination findings that provide a clear etiology of brain dysfunction. 2. Exclusion of any condition that might confound the subsequent examination of cortical or brain stem function. 3. Performance of a complete neurological examination including the standard apnea test and 10 minute apnea test. 4. Assessment of brainstem reflexes. 5. Clinical observations compatible with the diagnosis of brain death. 6. Responsibilities of physicians. 7. Notify next of kin. 8. Interval observation period. 9. Repeat clinical assessment of brain stem reflexes. 10. Confirmatory testing as indicated. 11. Certification and brain death documentation. DOI: 10.4103/0972-5229.53108