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Aslan N, Yildizdas D, Horoz OO, Arslan D, Coban Y, Sertdemir Y. Effects of Sedation and/or Sedation/Analgesic Drugs Administered during Central Venous Catheterization on the Level of End-tidal Carbon Dioxide Measured by Nasal Cannula in Our PICU. Indian J Crit Care Med 2020; 24:705-708. [PMID: 33024379 PMCID: PMC7519592 DOI: 10.5005/jp-journals-10071-23529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and objectives Sedatives and analgesics are commonly used in pediatric intensive care units during minor invasive procedures. Here, we aimed to measure the changes in end-tidal carbon dioxide (EtCO2) levels with different sedation/analgesic drug administrations (midazolam, ketamine, midazolam + ketamine/fentanyl) during central venous catheterization. Materials and methods This prospective study included 44 patients who needed sedation/analgesia for central venous catheterization. Patients were sedated with midazolam, ketamine, or midazolam + fentanyl/ketamine. End-tidal carbon dioxide values were measured before and after sedation-analgesia with nasal cannula and recorded from the capnograph. Oxygen saturation (SO2) was monitored by pulse oximetry. Whether respiratory depression occurred during the process was recorded. Results During the procedure, 15 (34%) patients were given 0.1 mg/kg dose of midazolam described as group I, 18 (41%) patients were given 1 mg/kg dose of ketamine only described as group II, and 11 (25%) patients who could not be effective sedated with a single sedative-analgesic agent were given either 1 mg/kg dose of ketamine or 2 μg/kg dose of fentanyl together with 0.1 mg/kg dose of midazolam described as group III. According to our findings, hypoxia (54.5%) and hypercarbia (45.5%) were detected higher in group III but it was not statistically significant (p = 0.255, p = 0.364). Hypercarbia was detected in 29.5% patients, in 62% of these patients hypercarbia was accompanied by hypoxia, and 38% had only hypercarbia. When presedation and postsedation EtCO2 values were compared, we detected a statistically significant difference in all groups. Conclusion We detected hypercarbia unaccompanied by hypoxemia in 38% patients. And we think that we have identified these patients early due to measurement of EtCO2 by nasal cannula. This study demonstrated that EtCO2 monitoring via nasal cannula is a feasible and practical way to follow ventilation during sedation/analgesia. How to cite this article Aslan N, Yildizdas D, Horoz OO, Arslan D, Coban Y, Sertdemir Y. Effects of Sedation and/or Sedation/Analgesic Drugs Administered during Central Venous Catheterization on the Level of End-tidal Carbon Dioxide Measured by Nasal Cannula in Our PICU. Indian J Crit Care Med 2020;24(8):705-708.
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Affiliation(s)
- Nagehan Aslan
- Department Pediatric Intensive Care, Faculty of Medicine, Çukurova University, Adana, Turkey; Department of Biostatistics, Cukurova University Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Dincer Yildizdas
- Department Pediatric Intensive Care, Faculty of Medicine, Çukurova University, Adana, Turkey; Department of Biostatistics, Cukurova University Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ozden Ozgur Horoz
- Department Pediatric Intensive Care, Faculty of Medicine, Çukurova University, Adana, Turkey; Department of Biostatistics, Cukurova University Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Didar Arslan
- Department Pediatric Intensive Care, Faculty of Medicine, Çukurova University, Adana, Turkey; Department of Biostatistics, Cukurova University Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Yasemin Coban
- Department Pediatric Intensive Care, Faculty of Medicine, Çukurova University, Adana, Turkey; Department of Biostatistics, Cukurova University Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Yasar Sertdemir
- Department Pediatric Intensive Care, Faculty of Medicine, Çukurova University, Adana, Turkey; Department of Biostatistics, Cukurova University Faculty of Medicine, Çukurova University, Adana, Turkey
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Saunders R, Struys MMRF, Pollock RF, Mestek M, Lightdale JR. Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis. BMJ Open 2017; 7:e013402. [PMID: 28667196 PMCID: PMC5734204 DOI: 10.1136/bmjopen-2016-013402] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery relative to visual assessment and pulse oximetry alone. DESIGN AND SETTING Systematic literature review and random effects meta-analysis of randomised controlled trials (RCTs) reporting sedation-related adverse event incidence when adding capnography to visual assessment and pulse oximetry in patients undergoing PSA during ambulatory surgery in the hospital setting. Searches for eligible studies published between 1 January 1995 and 31 December 2016 (inclusive) were conducted in PubMed, the Cochrane Library and EMBASE without any language constraints. Searches were conducted in January 2017, screening and data extraction were conducted by two independent reviewers, and study quality was assessed using a modified Jadad scale. INTERVENTIONS Capnography monitoring relative to visual assessment and pulse oximetry alone. PRIMARY AND SECONDARY OUTCOME MEASURES Predefined endpoints of interest were desaturation/hypoxaemia (the primary endpoint), apnoea, aspiration, bradycardia, hypotension, premature procedure termination, respiratory failure, use of assisted/bag-mask ventilation and death during PSA. RESULTS The literature search identified 1006 unique articles, of which 13 were ultimately included in the meta-analysis. Addition of capnography to visual assessment and pulse oximetry was associated with a significant reduction in mild (risk ratio (RR) 0.77, 95% CI 0.67 to 0.89) and severe (RR 0.59, 95% CI 0.43 to 0.81) desaturation, as well as in the use of assisted ventilation (OR 0.47, 95% CI 0.23 to 0.95). No significant differences in other endpoints were identified. CONCLUSIONS Meta-analysis of 13 RCTs published between 2006 and 2016 showed a reduction in respiratory compromise (from respiratory insufficiency to failure) during PSA with the inclusion of capnography monitoring. In particular, use of capnography was associated with less mild and severe oxygen desaturation, which may have helped to avoid the need for assisted ventilation.
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Affiliation(s)
- Rhodri Saunders
- Coreva Scientific GmbH & Co. KG., Freiburg, Germany
- Ossian Health Economics and Communications, Basel, Switzerland
| | - Michel M R F Struys
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Anesthesia, Ghent University, Ghent, Belgium
| | | | - Michael Mestek
- Minimally Invasive Therapies Group, Medtronic, Boulder, Colorado, USA
| | - Jenifer R Lightdale
- Division of Pediatric Gastroenterology, UMass Memorial Children’s Medical Center, Westborough, Massachusetts, USA
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Abstract
Gastrointestinal endoscopic sedation has improved procedural and patient outcomes but is associated with attendant risks of oversedation and hemodynamic compromise. Therefore, close monitoring during endoscopic procedures using sedation is critical. This monitoring begins with appropriate staff trained in visual assessment of patients and analysis of basic physiologic parameters. It also mandates an array of devices widely used in practice to evaluate hemodynamics, oxygenation, ventilation, and depth of sedation. The authors review the evidence behind monitoring practices and current society recommendations and discuss forthcoming technologies and techniques that are poised to improve noninvasive monitoring of patients under endoscopic sedation.
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Affiliation(s)
- Nadim Mahmud
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA.
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Garah J, Adiv OE, Rosen I, Shaoul R. The value of Integrated Pulmonary Index (IPI) monitoring during endoscopies in children. J Clin Monit Comput 2015; 29:773-8. [PMID: 25666393 DOI: 10.1007/s10877-015-9665-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 01/27/2015] [Indexed: 12/15/2022]
Abstract
The Integrated Pulmonary Index (IPI) is an algorithm included in commercially available monitors that constitutes a representation of 4 parameters: EtCO2, RR, SpO2 and PR. The IPI index has been validated for adults and children older than 1 year of age. In this study we aimed to study the value of IPI monitoring during pediatric endoscopic procedures. Our data consisted of 124 measurements of 109 patients undergoing different procedures (upper endoscopy 84 patients, colonoscopy 6 patients, both 9 patients). The data was divided into 3 groups based on the drug type used: propofol only, 5 patients (group 1); propofol & midazolam, 89 patients (group 2); propofol, midazolam and Fentanyl, 15 patients (group 3). Patients in group 2 and 3 had significantly higher IPI levels than group 1. Significantly lower IPI values were found between ages 4-6 compared to 7-12 years old. High midazolam dose was associated with lower IPI levels during the procedure. No significant differences were found for propofol doses. Patients who had an anesthetist present had lower IPI levels during the procedure compared to those who did not. No differences were noted between the different procedures. IPI alerted all apnea episodes (58 events, IPI = 1) and hypoxia (26 events, IPI ≤ 3) episodes, whereas pulse oximetry captured only the hypoxia episodes (IPI sensitivity = 1, specificity 0.98, positive predictive value 0.95). Younger patient age, use of propofol alone, higher midazolam doses and presence of anesthetist are all associated with lower IPI levels.
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Affiliation(s)
- Jamal Garah
- Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel.,Technion Faculty of the Medicine, Haifa, Israel
| | - Orly Eshach Adiv
- Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel.,Technion Faculty of the Medicine, Haifa, Israel
| | - Irit Rosen
- Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel.,Technion Faculty of the Medicine, Haifa, Israel
| | - Ron Shaoul
- Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel. .,Technion Faculty of the Medicine, Haifa, Israel.
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The role of capnography during upper endoscopy in morbidly obese patients: a prospective study. Surg Obes Relat Dis 2015; 11:193-8. [DOI: 10.1016/j.soard.2014.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/21/2014] [Accepted: 05/19/2014] [Indexed: 02/07/2023]
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Kroh M. Safe and effective performance of endoscopy in obese patients: are we adequately prepared to provide the best outcomes. Surg Obes Relat Dis 2014; 11:199-200. [PMID: 25543311 DOI: 10.1016/j.soard.2014.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Matthew Kroh
- Director, Surgical Endoscopy Cleveland Clinic Lerner College of MedicineCleveland, Ohio.
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Evaluation of Pharyngeal Function between No Bolus and Bolus Propofol Induced Sedation for Advanced Upper Endoscopy. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2014; 2014:248097. [PMID: 24723747 PMCID: PMC3958785 DOI: 10.1155/2014/248097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/16/2014] [Accepted: 01/30/2014] [Indexed: 12/13/2022]
Abstract
This study aimed to assess pharyngeal function between no bolus and bolus propofol induced sedation during gastric endoscopic submucosal dissection. A retrospective study was conducted involving consecutive gastric cancer patients. Patients in the no bolus group received a 3 mg/kg/h maintenance dose of propofol after the initiation of sedation without bolus injection. All patients in the bolus group received the same maintenance dose of propofol with bolus 0.5 mg/kg propofol injection. Pharyngeal functions were evaluated endoscopically for the first 5 min following the initial administration of propofol. Fourteen patients received no bolus propofol induction and 13 received bolus propofol induction. Motionless vocal cords were observed in 2 patients (14%) in the no bolus group and 3 (23%) in the bolus group. Trachea cartilage was not observed in the no bolus group but was apparent in 6 patients (46%) in the bolus group (P < 0.01). Scope stimulated pharyngeal reflex was observed in 11 patients (79%) in the no bolus group and in 3 (23%) in the bolus group (P < 0.01). Propofol induced sedation without bolus administration preserves pharyngeal function and may constitute a safer sedation method than with bolus.
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McConnell RA, Kim S, Ahmad NA, Falk GW, Forde KA, Ginsberg GG, Jaffe DL, Makar GA, Long WB, Panganamamula KV, Kochman ML. Poor discriminatory function for endoscopic skills on a computer-based simulator. Gastrointest Endosc 2012; 76:993-1002. [PMID: 22968094 DOI: 10.1016/j.gie.2012.07.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/12/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND Computer-based endoscopy simulators may enable trainees to learn and develop technical skills before performing on patients. Simulators require validation as adequate models of live endoscopy before being used for training or assessment purposes. OBJECTIVE To evaluate content and criterion validity of the CAE EndoscopyVR Simulator colonoscopy and EGD modules as predictors of clinical endoscopic skills. DESIGN Prospective, observational, non-randomized, parallel cohort study. SETTING Single academic center with accredited gastroenterology training program. PARTICIPANTS Five novice first-year gastroenterology fellows and 6 expert gastroenterology attending physicians. INTERVENTION Participants performed 18 simulated colonoscopies and 6 simulated EGDs. The simulator recorded objective performance parameters. Participants then completed feedback surveys. MAIN OUTCOME MEASUREMENTS The 57 objective performance parameters measured by the endoscopy simulator were compared between the two study groups. Novice and expert survey responses were analyzed. RESULTS Significant differences between novice and expert performance were detected in only 19 of 57 (33%) performance metrics. Eight of these 19 (42%) were time-related metrics, such as total procedure time, time to anatomic landmarks, and time spent in contact with GI mucosa. Of 49 non-time related measures, the few additional statistically significant differences between novices and experts involved air insufflation, sedation management, endoscope force, and patient comfort. These findings are of uncertain clinical significance. Survey data found multiple aspects of the simulation to be unrealistic compared with human endoscopy. LIMITATIONS Small sample size. CONCLUSION The CAE EndoscopyVR Simulator displays poor content and criterion validity and is thereby incapable of predicting skill during in vivo endoscopy.
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Affiliation(s)
- Ryan A McConnell
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Lightdale JR, Weinstock P. Simulation and training of procedural sedation. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2011. [DOI: 10.1016/j.tgie.2011.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Yarchi D, Cohen A, Umansky T, Sukhotnik I, Shaoul R. Assessment of end-tidal carbon dioxide during pediatric and adult sedation for endoscopic procedures. Gastrointest Endosc 2009; 69:877-82. [PMID: 19019361 DOI: 10.1016/j.gie.2008.05.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 05/18/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pulse oximetry has become the standard of care during endoscopic procedures, despite the fact that significant alveolar hypoventilation may be undetected. OBJECTIVE To study the value of end-tidal carbon dioxide (EtCO(2)) measurement during pediatric and adult endoscopic procedures with the patient under general anesthesia (GA) and conscious sedation (CS). DESIGN AND SETTINGS Oridion Microcap hand-held capnography by using Smart Bite Bloc with oxygen (O(2)) delivery were used for the procedures. Microstream nondispersive infrared (IR) spectroscopy is used to measure the concentration of molecules that absorb IR light in CO(2) exhaled by the subject. For each patient, we defined an "event" based on a combination of a >or=20% change (increase or decrease) in EtCO(2), with at least one of the following: O(2) saturation (SPO(2)) <or=90%, a >or=20% change of pulse rate or respiratory rate. PATIENTS We studied 57 patients, with an age range of 4 to 62 years. Nineteen patients (33.3%) had CS and 38 (66.6%) had GA. RESULTS Twenty patients had no events, 32 had 1 event, and 5 patients had 2 events. The highest observed frequency of an event was noted during upper endoscopy under GA (0.35), followed by upper endoscopy under CS (0.32). Fitted univariate logistic regression models indicated that higher variability in EtCO(2) is associated with a higher probability for an event (P < .0001) and that an increase in age is associated with a lower probability for an event (P < .0001). Significant differences in the frequencies of SPO(2) events were related to the type of procedure (P = .0002; highest estimated probability for upper endoscopy) and GA (P < .0001). Similar conclusions were obtained based on the fitted multivariate model. CONCLUSIONS EtCO(2) contributes significantly to the prediction of events during endoscopy. A lower mean of EtCO(2), higher variability of EtCO(2), younger age, GA, and upper endoscopy increase the probability of an event.
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Affiliation(s)
- Daniel Yarchi
- Anesthesia Department, Faculty of Industrial Engineering and Management, Technion, Haifa, Israel
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Mamula P, Markowitz JE, Neiswender K, Zimmerman A, Wood S, Garofolo M, Nieberle M, Trautwein A, Lombardi S, Sargent-Harkins L, Lachewitz G, Farace L, Morgan V, Puma A, Cook-Sather SD, Liacouras CA. Safety of intravenous midazolam and fentanyl for pediatric GI endoscopy: prospective study of 1578 endoscopies. Gastrointest Endosc 2007; 65:203-10. [PMID: 17258977 DOI: 10.1016/j.gie.2006.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 05/01/2006] [Indexed: 12/10/2022]
Abstract
BACKGROUND Data on safety of intravenous sedation in pediatric GI endoscopy are sparse. OBJECTIVE To evaluate safety of intravenous sedation for GI endoscopy. DESIGN/SETTING Single-center prospective series of outpatient GI endoscopies performed from February 2003 to February 2004 at The Children's Hospital of Philadelphia. The recorded information included demographic, medication, and adverse event data. PATIENTS A total of 1226 patients were studied. MAIN OUTCOME MEASUREMENTS Description of adverse events relating to intravenous sedation. RESULTS A total of 2635 endoscopies were performed, of which 1717 were outpatient procedures with the patient under intravenous sedation. Sedation data were available on 1578 procedures (92%, M/F 674/552): 758 esophagogastroduodenoscopies (EGD) alone, 116 colonoscopies (COL) alone, and 352 combined EGD and COL. The median dose of fentanyl was 2.77 microg/kg (SD 0.97, range 0-6.73), and of midazolam was 0.11 mg/kg (SD 0.06, range 0-0.39). The mean recovery time was 118 minutes (SD 47.3, range 31-375). Ten patients (0.8%) failed intravenous sedation. Serious adverse events (apnea) were noted in 2 patients (0.2%). Mild or moderate adverse events included desaturation below 92% for less than 20 seconds (100 patients, 9%), vomiting (64 patients, 5%), agitation (15 patients, 1%), desaturation below 92% for greater than 20 seconds (12 patients, 0.7%), and rash (8 patients, 0.7%). No cardiopulmonary resuscitation or sedation reversal was necessary. No patients required hospitalization. Patients younger than 6 years were more likely to develop respiratory adverse event (P < .01). CONCLUSIONS Intravenous sedation with midazolam and fentanyl is safe for pediatric GI endoscopy. Serious adverse events are rare and no patient required hospitalization.
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Affiliation(s)
- Petar Mamula
- Division of GI and Nutrition, The Children's Hospital of Philadelphia, Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Simón MA, Bordas JM, Campo R, González-Huix F, Igea F, Monés J. [Consensus document of the Spanish Association of Gastroenterology on sedoanalgesia in digestive endoscopy]. GASTROENTEROLOGIA Y HEPATOLOGIA 2006; 29:131-49. [PMID: 16507280 DOI: 10.1157/13085143] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M A Simón
- Unidad de Endoscopia Digestiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
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Beeton A. Sedation: Is it getting easier? SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2006. [DOI: 10.1080/22201173.2006.10872444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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