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Del Santo T, DI Filippo A, Romagnoli S. Rapid sequence induction of anesthesia: works in progress and steps forward with focus to oxygenation and monitoring techniques. Minerva Anestesiol 2024; 90:181-190. [PMID: 37851418 DOI: 10.23736/s0375-9393.23.17569-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The description of the main scientifically consolidated innovations in recent years on Rapid Sequence Induction have been the subject of this narrative review. Data sources were PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicaTrials.gov, searched up to March 21st, 2023; rapid sequence induction and anesthesia were used as key word for the research. In recent years at least three significant innovations which have improved the procedure: firstly the possibility of using drugs which rapidly reverse the action of the myorelaxants and which have made it possible to give up the use of succinylcholine, replaced by rocuronium; secondly, the possibility of using much more effective pre-oxygenation methods than in the past, also through apneic oxygenation techniques which allow longer apnea time, and finally new monitoring systems much more effective than pulse oximetry in identifying and predicting periprocedural hypoxemia and indicating the need for ventilation in patients at risk of hypoxemia and preventing it. The description of three main scientifically consolidated innovations in recent years, in pharmacology, oxygen method of administration and monitoring, have been the subject of this narrative review.
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Affiliation(s)
- Tommaso Del Santo
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Stefano Romagnoli
- Department of Health Sciences, University of Florence, Florence, Italy
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Pai SL, Grech D, Gayer S, Rodriguez L, Joshi GP, Rajan N. Should rocuronium and sugammadex replace succinylcholine for airway emergencies in class B ambulatory anesthesia settings? Minerva Anestesiol 2023; 89:197-205. [PMID: 36326774 DOI: 10.23736/s0375-9393.22.16852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In class B surgical facilities, where only oral or intravenous (IV) sedation is employed without the administration of volatile anesthetics, laryngospasm is among the most common airway complications. However, these facilities generally do not stock succinylcholine to avoid the cost of storing dantrolene for the treatment of malignant hyperthermia (MH). High dose IV rocuronium with sugammadex reversal has been suggested as an alternative to succinylcholine for airway emergencies. The aim of this paper was to evaluate the clinical utility, patient safety, and financial implications of replacing succinylcholine with rocuronium and sugammadex in lieu of stocking dantrolene in class B facilities. EVIDENCE ACQUISITION A systematic review of the literature concerning neuromuscular blockade for airway emergencies in class B settings in adult patients was conducted. The MEDLINE and EMBASE databases were searched for published studies from January 1, 1990, to October 1, 2021. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of evidence. EVIDENCE SYNTHESIS The search strategy yielded 1124 articles. After review, 107 articles were included, with 49 graded as "strong" evidence to provide recommendations for the posed questions. CONCLUSIONS The use of succinylcholine in isolation without volatile agents has a low incidence of triggering MH. Laryngospasm is a common airway emergency that requires immediate treatment to avoid morbidity and mortality. Both succinylcholine and rocuronium-sugammadex provide adequate treatment of airway emergencies and rapid return of spontaneous ventilation, but succinylcholine has a superior economic and clinical profile.
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Affiliation(s)
- Sher-Lu Pai
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA -
| | - Dennis Grech
- New Jersey Medical School, Department of Anesthesiology, Rutgers, Newark, NJ, USA
| | - Steven Gayer
- Miller School of Medicine, Department of Anesthesiology, University of Miami, Miami, FL, USA
| | - Leopoldo Rodriguez
- Anesthesiology and Perioperative Medicine, Boulder Valley Anesthesiology PLLC, Boulder, CO, USA
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX, USA
| | - Niraja Rajan
- Department of Anesthesiology and Perioperative Medicine, Penn State Health, Hershey, PA, USA
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Oflezer C, Atay Ö, Kaşdoğan ZE, Özakay G, İpekçioğlu D, Bahadır H. Does the Use of Rocuronium-Sugammadex Instead of Succinylcholine in Electroconvulsive Therapy Affect Seizure Duration? Psychiatry Investig 2022; 19:824-831. [PMID: 36327962 PMCID: PMC9633168 DOI: 10.30773/pi.2022.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/07/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We compared retrospectively the seizure variables of electroconvulsive therapy (ECT) patients after administration of rocuronium-sugammadex or succinylcholine as a muscle relaxant with propofol anesthesia. METHODS The sample comprised 134 ECT patients. The mean age was 33.6±10.48 years. Anesthesia induction was provided with propofol one mg kg-intravenously (IV) followed by succinylcholine 0.5 mg kg-1 IV (n=68) (Group S) or rocuronium 0.3 mg kg-1 IV (n=66) (Group R). For patients who were given rocuronium, reversal of the residual neuromuscular block was accomplished with sugammadex (1.5 mg kg-1 IV). First session seizure variables were compared between the two groups. We also presented the clinical outcome with Clinical Global Impression-Improvement (CGI-I) and overall adverse effects. RESULTS EEG seizure durations in Group R (55.09±36.11 s) and Group S (47.00±26.33 s) were comparable and were not significantly different (p=0.432). The clinical efficacy of ECT measured by CGI-I in both groups was comparable (p=0.075). There were no major complications or death during or after ECT. CONCLUSION The results of this study show that the use of rocuronium-sugammadex as a neuromuscular blocker instead of succinylcholine during ECT with propofol anesthesia produces similar results in terms of seizure variables and clinical outcomes.
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Affiliation(s)
- Ceyhan Oflezer
- Department of Anesthesiology, University of Health Sciences, Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Özge Atay
- Department of Psychiatry, University of Health Sciences, Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Zümrüt Ela Kaşdoğan
- Department of Anesthesiology, University of Health Sciences, Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Gülay Özakay
- Department of Anesthesiology, University of Health Sciences, Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Derya İpekçioğlu
- Department of Psychiatry, University of Health Sciences, Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Hakan Bahadır
- Department of Radiology, Private Practice, Betatom Medical Imaging Center, Istanbul, Turkey
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Geyik FD, Eker D, Yuce Y, Erkal KH, Yavuzer D, Ozdemir HG, Cevik B, Saracoglu KT. The Effect of Sugammadex on Time of Sciatic Block by Perineural Bupivacaine in Rats. J INVEST SURG 2022; 35:955-961. [PMID: 34486911 DOI: 10.1080/08941939.2021.1968982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/26/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to investigate the effect of sugammadex on the motor, sensory and deep sensory block in the sciatic nerve created by bupivacaine in rats. MATERIALS AND METHODS 18 Sprague-Dawley adult male rats treated with unilateral sciatic nerve block by bupivacaine (0.2 ml) were randomly divided into three groups. Control group (Group C, n = 6, 1.5 mL saline) perineural sugammadex group (Group PNS, n = 6, 16 mg/kg) and intraperitoneal sugammadex group (Group IPS, n = 6, 16 mg/kg) Motor, sensory, and deep sensory functions were evaluated every 10 minutes by a blind researcher. 6 tissue samples each belonging to the sciatic nerve, 1.5 cm in length and 0.2 cm in diameter, were taken from paraffin blocks. Sections of 3-4 micrometers were stained with Hematoxylin + Eosin, Masson Trichrome dyes and examined under a light microscope. RESULTS There was no statistically significant difference between 3 groups in terms of the time to return to normal motor, sensory and deep sensory function. There was also no significant difference in edema, extracellular matrix, and myelin. Inflammatory cells were seen in all groups, mainly epineurium, epineurium, and perineurium. CONCLUSION There are findings of no histological effects or effects on local block of sugammadex in rats undergoing sciatic nerve block.
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Affiliation(s)
- Fatih Dogu Geyik
- Kartal Dr. Lütfi Kırdar City Hospital Anesthesiology and Reanimation Clinic, Istanbul, Turkey
| | - Dilek Eker
- Kartal Dr. Lütfi Kırdar City Hospital Pediatric Surgery Clinic, Istanbul, Turkey
| | - Yucel Yuce
- Kartal Dr. Lütfi Kırdar City Hospital Anesthesiology and Reanimation Clinic, Istanbul, Turkey
| | - Kutlu Hakan Erkal
- Kartal Dr. Lütfi Kırdar City Hospital Anesthesiology and Reanimation Clinic, Istanbul, Turkey
| | - Dilek Yavuzer
- Kartal Dr. Lütfi Kırdar City Hospital Pathology Clinic, Istanbul, Turkey
| | | | - Banu Cevik
- Kartal Dr. Lütfi Kırdar City Hospital Anesthesiology and Reanimation Clinic, Istanbul, Turkey
| | - Kemal Tolga Saracoglu
- Kartal Dr. Lütfi Kırdar City Hospital Anesthesiology and Reanimation Clinic, Istanbul, Turkey
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Prevention of Oxygen Desaturation in Morbidly Obese Patients During Electroconvulsive Therapy: A Narrative Review. J ECT 2020; 36:161-167. [PMID: 32040021 DOI: 10.1097/yct.0000000000000664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In general, preoxygenation is performed using a face mask with oxygen in a supine position, and oxygenation is maintained with manual mask ventilation during electroconvulsive therapy (ECT). However, hypoxic episodes during ECT are not uncommon with this conventional method, especially in morbidly obese patients. The most important property of ventilatory mechanics in patients with obesity is reduced functional residual capacity (FRC). Thus, increasing FRC and oxygen reserves is an important step to improve oxygenation and prevent oxygen desaturation in these individuals. Head-up position, use of apneic oxygenation, noninvasive positive pressure ventilation, and high-flow nasal cannula help increase FRC and oxygen reserves, resulting in improved oxygenation and prolonged safe apnea period. Furthermore, significantly higher incidence of difficult mask ventilation is common in morbidly obese individuals. Supraglottic airway devices establish effective ventilation in patients with difficult airways. Thus, the use of supraglottic airway devices is strongly recommended in these patients. Conversely, because muscle fasciculation induced by depolarizing neuromuscular blocking agents markedly increases oxygen consumption, especially in individuals with obesity, the use of nondepolarizing neuromuscular blocking agents may contribute to better oxygenation in morbidly obese patients during ECT.
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The Use of Succinylcholine in Brugada Syndrome: A Case Report and Discussion of Literature. Case Rep Anesthesiol 2019; 2019:5182672. [PMID: 31772777 PMCID: PMC6854987 DOI: 10.1155/2019/5182672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/08/2019] [Indexed: 11/18/2022] Open
Abstract
We describe a patient with a major depression and a newly discovered Brugada syndrome, who was successfully treated with 35 electroconvulsive therapy sessions using succinylcholine as muscle relaxant. We discuss the use of succinylcholine in patients with Brugada syndrome.
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Karahan MA, Büyükfırat E, Binici O, Uyanıkoğlu H, Incebıyık A, Asoğlu M, Altay N. The Effects of Rocuronium-sugammadex on Fetomaternal Outcomes in Pregnancy Undergoing Electroconvulsive Therapy: A Retrospective Case Series and Literature Review. Cureus 2019; 11:e4820. [PMID: 31404381 PMCID: PMC6682383 DOI: 10.7759/cureus.4820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction The aim of this study was to evaluate the anesthesia management of pregnant patients who received electroconvulsive therapy (ECT) at our hospital and to examine the effects of this procedure on mothers and fetuses. Methods This study was conducted with 15 pregnant patients who underwent the ECT procedure who did not benefit from medical treatment or who did not want medical treatment. We evaluated the psychiatric, obstetric, and especially anesthesiology records of these patients. All of the patients received 1 mg/kg propofol with 0.6 mg/kg rocuronium. Eight mg/kg sugammadex was used to terminate the effects of the non-depolarizing neuromuscular blocking agents. Their demographic characteristics, history of diagnosis, total ECT sessions, duration of hospitalization, discharge status, neonatal outcomes, short- and long-term maternal or fetal complications, anesthetic management, and recovery parameters were retrospectively reviewed. Results Fifteen pregnant patients received a total of 95 ECT treatments. No anesthesia-related maternal complications developed. In terms of the recovery parameters of the patients, the mean duration of the motor seizure was 28.7 ± 6.3 seconds, the mean time to spontaneous respiration was 224 ± 21.8 secs, the mean time to opening the eyes was 403.6 ± 21.1 secs, and the mean time to command compliance was 415.24 ± 81.15 secs. The mean gestational week was 14.06 ± 6.65, and the mean number of pregnancies was 2.87 ± 2.29. Seven (46,7%) patients were in the first trimester of pregnancy, six (40%) were in the second trimester, and two (13.3%) were in the third trimester. Spontaneous abortion occurred in four patients, six patients gave birth by spontaneous vaginal delivery, and five patients delivered by cesarean section. Neonatal respiratory distress developed in only one fetus. Conclusion Anesthesia management during ECT can be provided safely by using propofol and rocuronium-sugammadex in pregnancy in the postoperative period. However, there is a risk of abortion and neonatal respiratory distress in the use of ECT, especially in the first trimester period. It is advisable to inform the patient's family in detail before this procedure outcome.
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Affiliation(s)
- Mahmut A Karahan
- Anesthesiology and Critical Care, University of Harran, Sanliurfa, TUR
| | - Evren Büyükfırat
- Anesthesiology and Critical Care, University of Harran, Sanliurfa, TUR
| | - Orhan Binici
- Anesthesiology and Critical Care, University of Harran, Sanliurfa, TUR
| | | | - Adnan Incebıyık
- Obstetrics and Gynecology, University of Harran, Sanliurfa, TUR
| | | | - Nuray Altay
- Anesthesiology and Critical Care, University of Harran, Sanliurfa, TUR
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KILINÇ GÖKHAN, Atik B, Mete A. Elektrokonvülsif terapi uygulamalarında anestezi. PAMUKKALE MEDICAL JOURNAL 2019. [DOI: 10.31362/patd.414652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
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Su P, Z. Pan J. Anesthesia for Electroconvulsive Therapy. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schaller SJ, Lewald H. Clinical pharmacology and efficacy of sugammadex in the reversal of neuromuscular blockade. Expert Opin Drug Metab Toxicol 2016; 12:1097-108. [DOI: 10.1080/17425255.2016.1215426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Stefan Josef Schaller
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Heidrun Lewald
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Takazawa T, Suto T, Aihara M, Anzai T, Horiuchi T, Yamada MH, Kadoi Y, Saito S. Comparison between succinylcholine and rocuronium as neuromuscular blocking agents for electroconvulsive therapy in a patient with pseudocholinesterase deficiency. JA Clin Rep 2015; 1:7. [PMID: 29497639 PMCID: PMC5818691 DOI: 10.1186/s40981-015-0009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/21/2015] [Indexed: 11/26/2022] Open
Abstract
We report here the anesthetic management of a patient with schizophrenia and pseudocholinesterase deficiency. Electroconvulsive therapy was performed using succinylcholine and rocuronium as the neuromuscular blocking agents in the first seven and latter six treatments, respectively. The recovery time from muscle relaxation after succinylcholine administration was remarkably longer than that after rocuronium-sugammadex administration. Rocuronium and sugammadex appear to be useful in situations in which succinylcholine is contraindicated.
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Gahr M, Schönfeldt-Lecuona C, Kölle MA, Pfenninger E, Freudenmann RW. Electroconvulsive therapy in patients with diagnoses other than major depression and/or difficult characteristics: a combined psychiatric-anesthesiological approach based on a retrospective chart analysis. Psychiatry Res 2013; 210:159-65. [PMID: 23602135 DOI: 10.1016/j.psychres.2013.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 02/28/2013] [Accepted: 03/03/2013] [Indexed: 11/25/2022]
Abstract
Though electroconvulsive therapy (ECT) requires a close cooperation between anesthesiology and psychiatry, literature lacks of approaches that consider both disciplines in parallel. Special problems might be posed by patients with complicated features or ECT-indications other than treatment-refractory depression (TRD). Considering these patients there is a particular paucity of data, especially regarding anesthesiological aspects. Therefore, we sought (1) to discuss special issues of the peri-interventional management of non-TRD-cases from a combined psychiatric-anesthesiological point of view and (2) to assess the efficacy of ECT in the classical indication of TRD as compared to cases undergoing ECT for other indications or under difficult conditions (non-TRD) by means of Clinical Global Impression-Improvement (CGI-I) scale scores. A retrospective chart analysis of patients treated with ECT between the years 2009 and 2011 at the University of Ulm, Department of Psychiatry, was conducted. Special anesthesiological efforts were necessary in cohort non-TRD. There was no difference in the clinical outcome between cohort non-TRD (n=7) and TRD (n=22) with a median CGI-I score of 2 ("much improved") in both groups. Close cooperation between psychiatry and anesthesiology is indispensable in non-TRD patients. Our results provide preliminary evidence that ECT is equally effective in the standard indication of TRD compared to other indications.
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Affiliation(s)
- Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany.
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Schaller SJ, Fink H. Sugammadex as a reversal agent for neuromuscular block: an evidence-based review. CORE EVIDENCE 2013; 8:57-67. [PMID: 24098155 PMCID: PMC3789633 DOI: 10.2147/ce.s35675] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sugammadex is the first clinical representative of a new class of drugs called selective relaxant binding agents. It has revolutionized the way anesthesiologists think about drug reversal. Sugammadex selectively binds rocuronium or vecuronium, thereby reversing their neuromuscular blocking action. Due to its 1:1 binding of rocuronium or vecuronium, it is able to reverse any depth of neuromuscular block. So far, it has been approved for use in adult patients and for pediatric patients over 2 years. Since its approval in Europe, Japan, and Australia, further insight on its use in special patient populations and specific diseases have become available. Due to its pharmacodynamic profile, sugammadex, in combination with rocuronium, may have the potential to displace succinylcholine as the "gold standard" muscle relaxant for rapid sequence induction. The use of rocuronium or vecuronium, with the potential of reverse of their action with sugammadex, seems to be safe in patients with impaired neuromuscular transmission, ie, neuromuscular diseases, including myasthenia gravis. Data from long-term use of sugammadex is not yet available. Evidence suggesting an economic advantage of using sugammadex and justifying its relatively high cost for an anesthesia-related drug, is missing.
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Affiliation(s)
- Stefan Josef Schaller
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA, USA
| | - Heidrun Fink
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Kadoi Y, Saito S, Fujita N, Mizutani A. Effects of Balloon-Induced Pulsatile Perfusion on Postoperative Short- and Long-Term Cognitive Dysfunction in Diabetic Patients With Impaired Cerebrovascular Carbon Dioxide Reactivity. J Cardiothorac Vasc Anesth 2013; 27:238-44. [DOI: 10.1053/j.jvca.2012.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Indexed: 11/11/2022]
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