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Somogye RH, Roberts CJ, Spoerl E, Pillunat KR, Pillunat LE, Small RH. Estimating pulsatile ocular blood volume from intraocular pressure, ocular pulse amplitude, and axial length. PLoS One 2023; 18:e0283387. [PMID: 36952489 PMCID: PMC10035833 DOI: 10.1371/journal.pone.0283387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
The purpose of this study was to develop a method of estimating pulsatile ocular blood volume (POBV) from measurements taken during an ophthalmic exam, including axial length and using a tonometer capable of measuring intraocular pressure (IOP) and ocular pulse amplitude (OPA). Unpublished OPA data from a previous invasive study was used in the derivation, along with central corneal thickness (CCT) and axial length (AL), as well as IOP from the PASCAL dynamic contour tonometer (DCT) and intracameral (ICM) measurements of IOP for 60 cataract patients. Intracameral mean pressure was set to 15, 20, and 35 mmHg (randomized sequence) in the supine position, using a fluid-filled manometer. IOP and OPA measurements were acquired at each manometric setpoint (DCT and ICM simultaneously). In the current study, ocular rigidity (OR) was estimated using a published significant relationship of OR to the natural log of AL in which OR was invasively measured through fluid injection. Friedenwald’s original pressure volume relationship was then used to derive the estimated POBV, delivered to the choroid with each heartbeat as a function of OR, systolic IOP (IOPsys), diastolic IOP (IOPdia), and OPA, according to the derived equation POBV = log (IOPsys/IOPdia) / OR. Linear regression analyses were performed comparing OPA to OR and calculated POBV at each of the three manometric setpoints. POBV was also compared to OPA/IOPdia with all data points combined. Significance threshold was p < 0.05. OR estimated from AL showed a significant positive relationship to OPA for both DCT (p < 0.011) and ICM (p < 0.006) at all three manometric pressure setpoints, with a greater slope for lower IOP. Calculated POBV also showed a significant positive relationship to OPA (p < 0.001) at all three setpoints with greater slope at lower IOP, and a significant negative relationship with IOPdia. In the combined analysis, POBV showed a significant positive relationship to OPA/ IOPdia (p < 0.001) in both ICM and DCT measurements with R2 = 0.9685, and R2 = 0.9589, respectively. POBV provides a straight-forward, clinically applicable method to estimate ocular blood supply noninvasively. Higher IOP in combination with lower OPA results in the lowest values of POBV. The simplified ratio, OPA/ IOPdia, may also provide a useful clinical tool for evaluating changes in ocular blood supply in diseases with a vascular component, such as diabetic retinopathy and normal tension glaucoma. Future studies are warranted.
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Affiliation(s)
- Ryan H. Somogye
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States of America
| | - Cynthia J. Roberts
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States of America
- Department of Ophthalmology & Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- * E-mail:
| | - Eberhard Spoerl
- Department of Ophthalmology, Universitatsklinikum Carl Gustav Carus, Dresden, Germany
| | - Karin R. Pillunat
- Department of Ophthalmology, Universitatsklinikum Carl Gustav Carus, Dresden, Germany
| | - Lutz E. Pillunat
- Department of Ophthalmology, Universitatsklinikum Carl Gustav Carus, Dresden, Germany
| | - Robert H. Small
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States of America
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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Flikier S, Flikier D, Flikier B, Wu L. Multimodal imaging of valsalva petaloid maculopathy secondary to acute laryngospasm and endotracheal intubation. Eur J Ophthalmol 2022. [DOI: 10.1177/11206721211032515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report the multimodal imaging findings associated to Valsalva retinopathy following acute laryngospasm and endotracheal intubation. Methods: Case report and literature review. Results: Acute laryngospasm led to pulmonary edema which necessitated endotracheal intubation. Upon extubation the patient complained of bilateral scotomata due to Valsalva retinopathy. Multimodal imaging localizes the precise anatomic site of the intraocular hemorrhages. Petaloid hemorrhages are typical of Henle fiber layer involvement. All the hemorrhages spontaneously cleared without any sequelae. Conclusion: Patients with acute laryngospasm and endotracheal intubation may develop Valsalva retinopathy. Multimodal imaging localize the hemorrhages to the specific anatomic site which is important in determining the different management options.
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Affiliation(s)
| | | | | | - Lihteh Wu
- Asociados de Macula Vitreo y Retina de Costa Rica, San José, Costa Rica
- Illinois Eye and Ear Infirmary, Department of Ophthalmology, University of Illinois School of Medicine Chicago, Chicago, IL, USA
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Young ME, Mears SC, Sallam AB, Sanders RN, Barnes CL, Stambough JB. Corneal Abrasions in Total Joint Arthroplasty. Geriatr Orthop Surg Rehabil 2021; 12:21514593211060101. [PMID: 34868725 PMCID: PMC8641105 DOI: 10.1177/21514593211060101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Corneal abrasion (CA) is the most common ocular complication in patients undergoing nonocular surgery. Corneal abrasions can be caused by a variety of mechanisms, the most common being drying of the cornea due to reduced tear secretions, loss of eyelid reflex, and the loss of pain recognition during surgery. Though CA heals well with eye lubricants, it can result in significant ocular pain and some cases may go on to develop ocular complications. With the current switch to outpatient total joint replacement, CA could potentially lead to discharge delays. Materials and Methods We examined the results of a quality improvement project to reduce CA during general anesthesia to determine the rates of CA during hip and knee total joint replacement. We compared rates of CA for 6 months before and 6 months after the intervention. Results A total of 670 hip and knee arthroplasty procedures were performed during this period. Two events of CA occurred, one occurred before and one after the intervention to decrease eye injuries. Both incidences occurred during total hip arthroplasty (THA) procedures with the patient in the lateral decubitus position and recovered without long-term deficit. Discussion Surgeons and anesthesiologists alike should be cognizant of this avoidable complication and take precaution to protect the eyes during surgery, especially during THA when the patient is placed in the lateral decubitus position. Conclusion Corneal abrasion during total joint arthroplasty is a rare complication and is infrequently addressed in the literature. CA is mostly self-limiting, however, but may lead to patient dissatisfaction and to delays if same-day discharge is attempted. Preventative measures and attentive care may help reduce the incidence of CA in patients undergoing total joint arthroplasty. The lateral decubitus position and longer surgeries times are risk factors for CA.
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Affiliation(s)
- Megan E Young
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed B Sallam
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Riley N Sanders
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Ongaigui C, Fiorda-Diaz J, Dada O, Mavarez-Martinez A, Echeverria-Villalobos M, Bergese SD. Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review. Front Surg 2020; 7:45. [PMID: 32850944 PMCID: PMC7403195 DOI: 10.3389/fsurg.2020.00045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/17/2020] [Indexed: 12/29/2022] Open
Abstract
Fluid management has been widely recognized as an important component of the perioperative care in patients undergoing major procedures including spine surgeries. Patient- and surgery-related factors such as age, length of the surgery, massive intraoperative blood loss, and prone positioning, may impact the intraoperative administration of fluids. In addition, the type of fluid administered may also affect post-operative outcomes. Published literature describing intraoperative fluid management in patients undergoing major spine surgeries is limited and remains controversial. Therefore, we reviewed current literature on intraoperative fluid management and its association with post-operative complications in spine surgery.
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Affiliation(s)
- Corinna Ongaigui
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Juan Fiorda-Diaz
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Olufunke Dada
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Ana Mavarez-Martinez
- Department of Anesthesiology, School of Medicine, Stony Brook University, Health Sciences Center, Stony Brook, NY, United States
| | | | - Sergio D Bergese
- Department of Anesthesiology, School of Medicine, Stony Brook University, Health Sciences Center, Stony Brook, NY, United States
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Shmygalev S. [59-year-old male to spinal surgery : Preparation for the medical specialist examination: part 50]. Anaesthesist 2019; 68:307-310. [PMID: 31624886 DOI: 10.1007/s00101-019-00669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S Shmygalev
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
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Kim YS, Han NR, Seo KH. Changes of intraocular pressure and ocular perfusion pressure during controlled hypotension in patients undergoing arthroscopic shoulder surgery: A prospective, randomized, controlled study comparing propofol, and desflurane anesthesia. Medicine (Baltimore) 2019; 98:e15461. [PMID: 31045821 PMCID: PMC6504298 DOI: 10.1097/md.0000000000015461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The aim of the present study is to evaluate the effects of deliberate hypotensive anesthesia on intraocular pressure (IOP) and ocular perfusion pressure (OPP) and compare the effects of propofol total intravenous anesthesia (TIVA) and desflurane anesthesia on IOP and OPP. METHODS A total of 50 patients undergoing arthroscopic shoulder surgery in the lateral decubitus position were randomized to receive desflurane or propofol anesthesia. Mean arterial pressure (MAP) was maintained in the range of 60-75 mm Hg during hypotensive anesthesia. IOP was measured using a handheld tonometer at 7 time points: before induction (T1, baseline); immediately after endotracheal intubation (T2); 10 minutes after position change to lateral decubitus (T3); 10, 30, and 50 minutes after the start of hypotensive anesthesia (T4-T6); and at the end of surgery (T7). RESULTS MAP decreased about 35% to 38% during hypotensive anesthesia. Compared to baseline values, the IOP at T6 in dependent and non-dependent eyes decreased by 0.43 and 2.74 mm Hg, respectively in desflurane group; 3.61 and 6.05 mm Hg, respectively in the propofol group. IOP of both eyes in the propofol group was significantly lower than in the desflurane group from T2 to T7. OPP of both eyes in both groups was significantly lower than at baseline, except at T2 in the desflurane group. OPP of both eyes in the propofol group was significantly higher than that in the desflurane group at T5 and T6. CONCLUSIONS Hypotensive anesthesia reduced IOP and OPP, but propofol TIVA maintained higher OPP than desflurane anesthesia. These findings suggest that propofol TIVA can help mitigate the decrease of OPP during hypotensive anesthesia.
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Affiliation(s)
- Yong-Shin Kim
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Na-Re Han
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwon Hui Seo
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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Ozcan AA, Ulas B. Ischemic optic neuropathy in robotic-assisted gynaecologic surgery: A case report. J Obstet Gynaecol Res 2018; 45:748-750. [PMID: 30520549 DOI: 10.1111/jog.13877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/02/2018] [Indexed: 11/27/2022]
Abstract
The study was aimed to present a rare case of who developed non arteritic anterior ischemic optic neuropathy (NAION) following robotic-assisted gynaecologic surgery. A 58-year-old female patient presented with vision loss in right eye after non-complicated robotic-assisted total hysterectomy and bilateral salpingo-oopherectomy. We observed on fundoscopy optic disc edema and splinter hemorrhages at the optic disc edges. Fluorescein angiography showed hypofluorescence of the optic disc in the early phases due to filling delay followed by hyperfluorescence with leakage from disc capillaries in the late phases of the angiogram. From these findings, we diagnosed NAION in the right eye. When NAION was diagnosed, the patient received intravenous methylprednisolone. Topical brimonidin and coenzyme-Q were given. On 1-month follow-up, recovery of visual loss was observed. Here, we present a case of NAION that is an uncommon cause of perioperative visual loss after robotic-assisted gyneacologic surgery.
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Affiliation(s)
- Altan A Ozcan
- Faculty of Medicine Ophthalmology Department, Cukurova University, Adana, Turkey
| | - Burak Ulas
- Ceyhan State Hospital Ophthalmology Department, Adana, Turkey
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Abstract
Perioperative vision loss (POVL) may cause devastating visual morbidity. A prompt anatomical and etiologic diagnosis is paramount to guide management and assess prognosis. Where possible, steps should be undertaken to minimize risk of POVL for vulnerable patients undergoing high-risk procedures. We review the specific risk factors, pathophysiology, and management and prevention strategies for various etiologies of POVL.
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Affiliation(s)
- Bart Chwalisz
- a Department of Neuro-Ophthalmology , Massachusetts Eye and Ear and Harvard Medical School , Boston , MA , USA
| | - Aubrey L Gilbert
- a Department of Neuro-Ophthalmology , Massachusetts Eye and Ear and Harvard Medical School , Boston , MA , USA
| | - John W Gittinger
- a Department of Neuro-Ophthalmology , Massachusetts Eye and Ear and Harvard Medical School , Boston , MA , USA
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Mendel E, Stoicea N, Rao R, Niermeyer W, Revilla S, Cluse M, Sandhu G, Todaro GJ, Bergese SD. Revisiting Postoperative Vision Loss following Non-Ocular Surgery: A Short Review of Etiology and Legal Considerations. Front Surg 2017; 4:34. [PMID: 28695122 PMCID: PMC5483430 DOI: 10.3389/fsurg.2017.00034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/08/2017] [Indexed: 11/15/2022] Open
Abstract
Postoperative vision loss (POVL) following non-ocular surgery is a serious complication where the causes are not fully understood. Studies have identified several causes of POVL as well as risk factors and prevention strategies. POVL research is made difficult by the fact that cases are often subject to malpractice claims, resulting in a lack of public access to case reports. This literature review was conducted in order to identify legal issues as a major barrier to studying POVL and address how this affects current knowledge. Informed consent provides an opportunity to overcome legal challenges by reducing malpractice litigation through educating the patient on this outcome. Providing pertinent information regarding POVL during the informed consent process has potential to reduce malpractice claims and increase available clinical information.
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Affiliation(s)
- Ehud Mendel
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Rahul Rao
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, United States
| | - Weston Niermeyer
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Stephen Revilla
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Marcus Cluse
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Gurneet Sandhu
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Sergio D Bergese
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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The Anesthetic Implications of Aqueous Drainage Devices and Glaucoma: A Report of a Patient Undergoing Urgent Prone Cervical Decompression and Fusion. ACTA ACUST UNITED AC 2017; 7:63-6. [PMID: 27258174 DOI: 10.1213/xaa.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The pathophysiology of glaucoma and perioperative visual loss is similar. A patient with glaucoma may be at increased risk of perioperative visual loss. For both, goals of management include optimizing ocular perfusion pressure and oxygen delivery. One treatment for refractory glaucoma is an aqueous drainage device; however, there is no published literature on the anesthetic management of patients with these devices. We present the case of a patient with recalcitrant glaucoma treated with an Ahmed Glaucoma Valve who underwent urgent prone surgery. Anesthetic implications of aqueous drainage devices and glaucoma are discussed, and recommendations are made.
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Hassani V, Homaei MM, Shahbazi A, Zamani MM, Safari S, Nadi S, Rahimizadeh A, Lashkari MH, Alizadeh zendehrood S. Human erythropoietin effect in postoperative visual loss following spine surgery: a case report. Anesth Pain Med 2014; 4:e7291. [PMID: 24790903 PMCID: PMC3997951 DOI: 10.5812/aapm.7291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/15/2013] [Accepted: 11/03/2013] [Indexed: 01/20/2023] Open
Abstract
Introduction: Postoperative visual loss (POVL) has become the focus of attention for anesthesiologists as a hallmark of perioperative management in spine surgery. A number of Intraoperative and postoperative factors has been documented but the exact etiology is still unclear. Nowadays, perioperative management and also complete curing of POLV is a big question of ophthalmologists and anesthesiologists. The purpose of this case report is to present a unique experience of complete curing the POLV. Case Presentation: Our patient was a 61-year-old man, with 75 kg weight and 180 cm height. The patient had no history of visual impairment except mild cataract in his right eye. The patient had a history of diffuse idiopathic skeletal hyperostosis (DISH). The patient had undergone lumbar surgery in prone position. The operation time was about 6 hours. About 30 minutes after transferring to postanesthesia care unit (PACU), patient was awake and complained of losing his eyesight. There was no vision and light perception in his right eye on primary examination. Urgent ophthalmologist consultation was requested. In ophthalmology examinations, the pupil reflex to light was absent in the right eye. After obtaining patients and his family informed consent, four hours after the operation, 40000 I.U. of recombinant human erythropoietin (rhEPO) was administered for patient in PACU (IV infusion, in 30 min). An ophthalmologist visited him every 6 hours after administration of rhEPO. The patient was transferred to intensive care unit (ICU) one hour later with total visual loss in the right eye. Ophthalmologic examination after the second dose of rhEPO, 30 hours after the operation, reported pupil reflex enhancement and light perception in his right eye. Finally the third dose of rhEPO (40000 I.U., IV infusion) was administered on the third day. Ophthalmologic examination after the third dose of rhEPO, 60 hours after the operation, reported normal pupillary light reflex of the right eye and visual acuity improvement to 20/20. The patient was discharged from hospital after six days, with normal visual acuity and without any new complications except surgical site pain. Conclusions: Our case report showed the therapeutic effect of rhEPO in complete curing of POVL. Regarding the side effects of EPO such as thrombogenic effects or mild hemodynamic changes like transient sinus tachycardia during infusion, it seems that beneficial effects of EPO is more than its disadvantages and expenses, for patients with POVL.
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Affiliation(s)
- Valiollah Hassani
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohsen Homaei
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Shahbazi
- Physiology Research Center (PRC), Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Zamani
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Safari
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Saeid Safari, Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Niayesh Av., Tehran, Iran. Tel: +98-2166509059, Fax: +98-2166515758, E-mail:
| | - Shermila Nadi
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
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