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Fang L, Chen L, Wu B, Xu Y, Chen L. Using Clinical-based Discharge Criteria to Discharge Patients After Endoscopy Procedures Under Drug-induced Intravenous Sedation in the Outpatient Care Unit: An Observational Study. J Perianesth Nurs 2024:S1089-9472(23)01113-9. [PMID: 38864800 DOI: 10.1016/j.jopan.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 06/13/2024]
Abstract
PURPOSE To verify the feasibility of clinical-based discharge (CBD) criteria and to find out the reasons for the delayed discharge of outpatients after endoscopy procedures under drug-induced intravenous sedation. DESIGN A prospectively observational study conducted at a tertiary endoscopy center. METHODS Medical records were collected from outpatients admitted for endoscopy procedures under drug-induced intravenous sedation from June 1, 2021 to December 30, 2021. Patients were scheduled to discharge at least 30 minutes based on the time-based discharge (TBD) method. Postanesthetic discharge scoring system in the outpatient post-anesthesia care unit (PACU) recorded the time of patients discharged home on the CBD criteria. Postoperative complications were recorded in the PACU and within 24 hours after discharge. Multivariate analysis was applied to identify the factors relating to late discharges. FINDINGS 10,597 patients were safely and successfully discharged home, and we were informed of no serious emergency or accidental readmissions to the hospital. The mean CBD time (21.77 ± 11.35 minutes) was compared with the TBD time (30 minutes) and actual TBD discharge time (61.56 ± 4.93 minutes), which were statistically significant, without changes in the patient's vital signs (P < .01). Primarily, further univariate and multivariate analyses showed that abdominal pain and fatigue were key factors accountable for delay in PACU discharge (P < .05). CONCLUSIONS The study concluded that in patients undergoing ambulatory endoscopy procedures with drug-induced intravenous sedation, discharge times based on physiological scoring systems can efficiently and safely guide ambulatory patient discharge as compared to the traditional TBD method. Postoperative fatigue and pain were the main factors affecting patients discharge associated with a relatively long PACU length of stay.
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Affiliation(s)
- Liangyu Fang
- Nursing Department, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
| | - Lina Chen
- Nursing Department, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Bingbing Wu
- Nursing Department, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yinchuan Xu
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Laijuan Chen
- Nursing Department, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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Zheng X, Huang J, Wei S, Tao Y, Shen Y, Wang Y, He P, Zhang M, Sun Y. Efficacy and safety comparison of esketamine-propofol with nalbuphine-propofol for upper gastrointestinal endoscopy in children: a multi-center randomized controlled trial. Front Pediatr 2023; 11:1126522. [PMID: 37441574 PMCID: PMC10333751 DOI: 10.3389/fped.2023.1126522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Background and Aims Anesthetics such as propofol, esketamine and nalbuphine are used during the upper gastrointestinal endoscopy to achieve and maintain the desired sedation level. The aim of the study was to evaluate the effectiveness and safety of propofol-nalbuphine and propofol-esketamine in children. Methods A multi-centered study was performed at three tertiary class-A hospitals. Children between 3 and 12 years old undergoing diagnostic painless upper gastrointestinal endoscopy were included and randomly divided into esketamine or nalbuphine group to estimate the primary outcome of successful endoscope insertion. The patients were given esketamine 0.5 mg/kg and propofol 2 mg/kg intravenously in esketamine group, with nalbuphine 0.2 mg/kg and propofol 2 mg/kg in the nalbuphine group. The primary outcome was success rate for the first attempt of endoscope insertion in each group. Secondary outcomes included the safety of both anesthesia regimens and gastroenterologist's satisfaction. We used the Face, Leg, Activity, Cry and Consolability (FLACC) scale to evaluate the level of pain before and during the procedure and the Pediatric Anesthesia Emergence Delirium (PAED) scale to assess the level of agitation and delirium after awakening from anesthesia. Results Among 246 patients, 200 were randomly included in the final intention-to-treat analysis, with 100 patients in each group. The success rate for the first attempt of endoscope insertion in the esketamine group was higher than the nalbuphine group (97% vs. 66%; P < 0.01). The heart rate and mean arterial pressure after intraoperative administration in the esketamine group were higher than those in the nalbuphine group, while the delirium incidence during awakening was higher in esketamine group (all P < 0.05). Conclusion The success rate for the first attempt of endoscope insertion of children undergoing upper gastrointestinal endoscopy in the esketamine group was higher than the nalbuphine group, propofol-related hemodynamic changes were reduced accordingly, while the incidence of esketamine-related adverse effects could be high. Clinical Trial Registration Chinese Clinical Trial Registry: ChiCTR2000040500.
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Affiliation(s)
- Xiaosu Zheng
- Department of Anesthesiology, Shanghai Children’s Medical Centre, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinjin Huang
- Department of Anesthesiology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Sisi Wei
- Department of Anesthesiology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingying Tao
- Department of Anesthesiology, Shanghai Children’s Medical Centre, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Shen
- Department of Anesthesiology, Shanghai Children’s Medical Centre, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanting Wang
- Department of Anesthesiology, Shanghai Children’s Medical Centre, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Pan He
- Department of Anesthesiology, Shanghai Children’s Medical Centre, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mazhong Zhang
- Department of Anesthesiology, Shanghai Children’s Medical Centre, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Sun
- Department of Anesthesiology, Shanghai Children’s Medical Centre, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Cai Y, Chen L, Dong D, Ye M, Jin X, Liu F. The utility of a multi-orifice epidural catheter when using the "Spray-as-You-Go" technique for topical Airway Anesthesia during Flexible Bronchoscopy, a randomised trial. J Clin Monit Comput 2023; 37:55-62. [PMID: 35441943 DOI: 10.1007/s10877-022-00856-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/29/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Lidocaine administered through the working channel of a flexible bronchoscope can provide effective local anesthesia but cannot achieve good distribution in the airway. This study was undertaken to determine whether lidocaine delivered via a multi-orifice epidural catheter (three orifices/openings) is superior to conventional method and if a better distribution and decreased the cough reflex can be achieved. METHODS The patients (N = 100; 50 in each group) were randomized to receive either topical airway anesthesia by the "spray-as-you-go" technique via conventional application (group C) through the working channel of the bronchoscope or via a triple-orifice epidural catheter (group E). The primary outcome measurement was the cough severity, which was documented using a 4-point scale. Bronchoscopists and nurses assessed the coughing. The visual analogue scale (VAS) score for cough, total consumption of propofol and lidocaine, requirement frequency of propofol and topical anesthesia, PACU retention time, and adverse events were also compared. RESULTS There was a significant difference in the median cough severity scores between the two groups (group C: 3 vs. group E: 2, P = 0.004). The median visual analogue scale (VAS) scores for the cough, were significantly higher in group C than those in group E (bronchoscopist: 3 vs. 2 P = 0.002; nurse: 3 vs. 2, P < 0.001). The incidence of cough was significantly higher in group C in the trachea, left and right bronchi. The highest respiratory rate was higher in group C than in group E (P < 0.01). Eight patients in group C and two patients in group E had an oxygen saturation below 90% during flexible bronchoscopy(FB) (P = 0.046). More patients in group C required extra topical anesthesia than in group E (P < 0.001). The total lidocaine consumption was also higher in group C than that in group E (P < 0.001). CONCLUSIONS Endotracheal topical anesthesia via the multi-orifice epidural catheter (three holes/openings) during flexible bronchoscopy using the "spray-as-you-go" technique was appeared to be superior to the conventional method.
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Affiliation(s)
- Yaoyao Cai
- Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, 325000, Zhejiang, Zhejiang Province, China
| | - Limei Chen
- Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, 325000, Zhejiang, Zhejiang Province, China.,, Wenzhou City, China
| | - Dongmei Dong
- Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, 325000, Zhejiang, Zhejiang Province, China
| | - Min Ye
- Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, 325000, Zhejiang, Zhejiang Province, China.,Department of Pneumology, the First Affiliated Hospital, Wenzhou Medical University, 325000, Wenzhou City, Zhejiang Province, China
| | - Xiuling Jin
- Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, 325000, Zhejiang, Zhejiang Province, China
| | - Fuli Liu
- Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, 325000, Zhejiang, Zhejiang Province, China.
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Abstract
SUMMARY For the task of estimating a target benchmark dose such as the ED50 (the dose that would be effective for half the population), an adaptive dose-finding design is more effective than the standard approach of treating equal numbers of patients at a set of equally spaced doses. Up-and-down is the most popular family of dose-finding designs and is in common use in anesthesiology. Despite its widespread use, many aspects of up-and-down are not well known, implementation is often misguided, and standard, up-to-date reference material about the design is very limited. This article provides an overview of up-and-down properties, recent methodologic developments, and practical recommendations, illustrated with the help of simulated examples. Additional reference material is offered in the Supplemental Digital Content.
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Han K, Zhang Y, Bai R, An R, Zhang S, Xue M, Shen X. Application of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Nalbuphine Patient-Controlled Intravenous Analgesia in Postoperative Analgesia After Laparotomy: A Randomized Controlled Trial. Pain Ther 2022; 11:627-641. [PMID: 35420393 PMCID: PMC9098735 DOI: 10.1007/s40122-022-00379-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Pain is a common postoperative complication. The ideal postoperative analgesia is awake, safe, mobile, and without side effects. The objective of this study is to provide new ideas for postoperative analgesia by observing the safety and analgesic effect of different analgesic methods in patients undergoing laparotomy after surgery. Methods Patients, who underwent laparotomy between September 2019 and December 2020, were randomly divided into three groups: group S received sufentanil, group N received nalbuphine, group T + N received postoperative bilateral transversus abdominis plane block (TAPB) and nalbuphine. The primary outcomes included visual analog scale (VAS) score and the use of postoperative analgesic pump. Secondary outcomes included quality of life recovery (QoR-15) scale score and incidence of postoperative adverse reactions. Results Compared with group S and N, there were significant differences in the resting VAS score within 48 h after surgery, dynamic VAS score within 12 h after surgery, the first compression time, and cumulative use of patient-controlled intravenous analgesia (PCIA) drugs at 24 h in group T + N (P < 0.05). The QoR-15 score within 48 h after surgery in group T + N was significantly higher than group N (P < 0.05). The first exhaust time and the incidence of nausea and vomiting in group T + N were significantly lower than those in group N (P < 0.05). Conclusions Sufentanil PCIA and nalbuphine PCIA have equivalent analgesic effects, while TAPB combined with nalbuphine PCIA can ensure a good analgesic effect, thereby reducing the incidence of adverse reactions.
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Affiliation(s)
- Kunyu Han
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yuhe Zhang
- Department of Anesthesiology, Xianyang Hospital of Yan'an University, Xianyang, 712000, Shaanxi, China
| | - Ruiping Bai
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Rui An
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Simei Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Mengwen Xue
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Xin Shen
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Li S, Wang Y, Chen X, Huang T, Li N. Effective Doses of Nalbuphine Combined With Propofol for Painless Gastroscopy in Adults: A Randomized Controlled Trial. Front Pharmacol 2021; 12:673550. [PMID: 34924999 PMCID: PMC8672217 DOI: 10.3389/fphar.2021.673550] [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] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/03/2021] [Indexed: 01/14/2023] Open
Abstract
Objective: This prospective study evaluated the 50% effective dose (ED50) and 95% effective dose (ED95) of nalbuphine combined with propofol during painless gastroscopy. Methods: Seventy-five patients who underwent painless gastroscopy were randomly divided into five groups (group N0, N0.05, N0.1, N0.15, and N0.2), with doses of 0, 0.05, 0.1, 0.15, or 0.2 mg/kg nalbuphine in each group. Propofol was given to all groups as the sedative. The bispectral index (BIS) value, propofol dose, examination time, and awakening time were recorded. The number of patients with intolerance indexes (coughing, retching, swallowing, or limb movement) was recorded in each group. The ED50/ED95 of nalbuphine combined with propofol for gastroscopy were calculated. Results: Compared with those of groups N0, N0.05, or N0.1, the propofol dose and awakening time were significantly reduced in group N0.15 or N0.2 (p < 0.05). The successful rate of painless gastroscopy in group N0.15 or N0.2 significantly increased compared to that of group N0 or N0.05 (p < 0.05). When combined with propofol, nalbuphine had an ED50 and ED95 for painless gastroscopy of 0.078 mg/kg (95% CI, 0.056–0.098 mg/kg) and 0.162 mg/kg (95% CI, 0.134–0.217 mg/kg), respectively. Conclusion: The ED50/ED95 of nalbuphine combined with propofol are 0.078 and 0.162 mg/kg, respectively, for painless gastroscopy. Nalbuphine at 0.162 mg/kg combined with propofol is effective and safe for painless gastroscopy in adults.
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Affiliation(s)
- Shuangfeng Li
- Department of Anesthesiology, Haikou Women and Children's Hospital, Haikou Maternity and Child Health Hospital, Haikou, China
| | - Ying Wang
- Department of Anesthesiology, Hainan General Hospital, Haikou, China
| | - Xiaojian Chen
- Department of Anesthesiology, Hainan General Hospital, Haikou, China
| | - Tingwan Huang
- Department of Anesthesiology, Haikou Women and Children's Hospital, Haikou Maternity and Child Health Hospital, Haikou, China
| | - Na Li
- Department of Anesthesiology, Hainan General Hospital, Haikou, China
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The Effect of Epidural Nalbuphine Combined With Ropivacaine on Epidural Analgesia During Labor: A Multicenter, Randomized, Double-blind, Controlled Study. Clin J Pain 2021; 37:437-442. [PMID: 33758132 DOI: 10.1097/ajp.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The addition of a small dose of opioids during epidural labor analgesia can enhance the local analgesic effect, reduce the dose of local anaesthetic required, and minimize motor blockade. For the treatment of visceral pain, studies have shown that κ-opioid receptor agonist are more effective than μ-receptor agonists. This study compared the effectiveness of epidural nalbuphine and sufentanil in combination with ropivacaine for labor analgesia, respectively. MATERIALS AND METHODS We conducted a prospective, randomized, double-blind, multicentre clinical trial. Parturients who requested labor pain relief were randomly assigned to either the nalbuphine group or sufentanil group. After 5 minutes of initial dose, parturients in nalbuphine group received 10 mL 0.1% ropivacaine plus 0.3 mg/mL nalbuphine solution. The sufentanil group received the same ropivacaine dose plus 0.3 μg/mL sufentanil. The primary outcome was the duration of analgesia (the time to the first requirement for additional medication). Secondary outcomes included the ropivacaine dose per hour, and adverse reactions. RESULTS Between November 2018 and February 2019, 180 parturients were recruited for the study. The study showed that the duration of analgesia was shorter in the nalbuphine group as compared with the sufentanil group (P=0.040). The ropivacaine dose per hour in nalbuphine group 9.3 (2.4) mg was significantly greater versus sufentanil group 8.4 (2.5) mg (P=0.024). No serious adverse events directly associated with the analgesics were observed. DISCUSSION The analgesia effects of 0.3 mg/mL nalbuphine with ropivacaine are inferior to 0.3 μg/mL sufentanil with ropivacaine in labor analgesia. No serious side effects, either in the mother or in the fetus, were observed.
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Chen J, Tian L, Zhang L, Hu J, Huang S, Jiao J. Nalbuphine on postoperative gastrointestinal tract dysfunction after laparoscopic surgery for gynaecological malignancies: A randomized controlled trial. Clin Exp Pharmacol Physiol 2020; 48:170-176. [PMID: 33063882 DOI: 10.1111/1440-1681.13421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jia‐wei Chen
- Department of Anesthesiology, Obstetrics and Gynecology Hospital Fudan University Shanghai China
| | - Lin Tian
- Department of Anesthesiology, Obstetrics and Gynecology Hospital Fudan University Shanghai China
| | - Le Zhang
- Department of Anesthesiology, Obstetrics and Gynecology Hospital Fudan University Shanghai China
| | - Jian‐ying Hu
- Department of Anesthesiology, Obstetrics and Gynecology Hospital Fudan University Shanghai China
| | - Shao‐qiang Huang
- Department of Anesthesiology, Obstetrics and Gynecology Hospital Fudan University Shanghai China
| | - Jing Jiao
- Department of Anesthesiology, Obstetrics and Gynecology Hospital Fudan University Shanghai China
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Zhu X, Chen L, Zheng S, Pan L. Comparison of ED95 of Butorphanol and Sufentanil for gastrointestinal endoscopy sedation: a randomized controlled trial. BMC Anesthesiol 2020; 20:101. [PMID: 32359348 PMCID: PMC7195772 DOI: 10.1186/s12871-020-01027-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/27/2020] [Indexed: 01/07/2023] Open
Abstract
Background Butorphanol, a synthetic opioid partial agonist analgesic, has been widely used to control perioperative pain. However, the ideal dose and availability of butorphanol for gastrointestinal (GI) endoscopy are not well known. The aim of this study was to evaluated the 95% effective dose (ED95) of butorphanol and sufentanil in GI endoscopy and compared their clinical efficacy, especially regarding the recovery time. Methods The study was divided into two parts. For the first part, voluntary patients who needed GI endoscopy anesthesia were recruited to measure the ED95 of butorphanol and sufentanil needed to achieve successful sedation before GI endoscopy using the sequential method (the Dixon up-and-down method). The second part was a double-blind, randomized study. Two hundred cases of painless GI endoscopy patients were randomly divided into two groups (n = 100), including group B (butorphanol at the ED95 dose) and group S (sufentanil at the ED95 dose). Propofol was infused intravenously as the sedative in both groups. The recovery time, visual analogue scale (VAS) score, hand grip strength, fatigue severity scores, incidence of nausea and vomiting, and incidence of dizziness were recorded. Results The ED95 of butorphanol for painless GI endoscopy was 9.07 μg/kg (95% confidence interval: 7.81–19.66 μg/kg). The ED95 of sufentanil was 0.1 μg/kg (95% CI, 0.079–0.422 μg/kg). Both butorphanol and sufentanil provided a good analgesic effect for GI endoscopy. However, the recovery time for butorphanol was significantly shorter than that for sufentanil (P < 0.05, group B vs. group S:21.26 ± 7.70 vs. 24.03 ± 7.80 min). Conclusions Butorphanol at 9.07 μg/kg was more effective than sufentanil for GI endoscopy sedation and notably reduced the recovery time. Trial registration Chinese Clinical Trail Registry (Registration number # ChiCTR1900022780; Date of Registration on April 25rd, 2019).
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Affiliation(s)
- Xiaona Zhu
- Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Limei Chen
- Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Shuang Zheng
- Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Linmin Pan
- Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China.
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