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Veger ML, van Iterson J, Bakx R, Ridderikhof ML. The Role of Nitrous Oxide in Minor Pediatric Procedures in the Emergency Department: A Systematic Review. J Pediatr Surg 2024; 59:1154-1162. [PMID: 38368199 DOI: 10.1016/j.jpedsurg.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Pediatric patients undergoing minor, but painful procedures in an Emergency Department (ED) need adequate relief of pain and distress to prevent long term negative effects and adversely impact procedures. Inhaled nitrous oxide (N2O) is a needle-free pain management option. We conducted a systematic review to determine whether N2O is as effective as local anesthesia in minor procedures. The purpose of this study was to evaluate available evidence regarding analgesic effectiveness of N2O in pediatric patients. METHODS We searched MEDLINE, Embase, Cochrane and Cinahl databases for controlled trials published in English with pediatric patients in an ED treated with N2O compared to local anesthesia and with pain as primary outcome. Adverse events was one of the secondary outcomes. The GRADE system was used to rate the overall quality of evidence. RESULTS We included seven studies with a total of 371 patients. Two studies showed N2O was equally effective in pain treatment as local anesthesia. Five studies showed N2O combined with local anesthesia is more effective in reducing pain than local anesthesia alone. None of the included studies reported major adverse effects. The quality of evidence is low. CONCLUSIONS N2O can have an important contribution in pain management, but should be combined with local anesthesia for optimal pain management in pediatric patients undergoing minor, but painful procedures in an ED. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marlies L Veger
- University of Amsterdam, Faculty of Medicine, Amsterdam UMC - Location AMC, 1105 AZ Amsterdam, the Netherlands.
| | - Jozua van Iterson
- University of Amsterdam, Faculty of Medicine, Amsterdam UMC - Location AMC, 1105 AZ Amsterdam, the Netherlands
| | - Roel Bakx
- Department of Pediatric Surgery, Amsterdam UMC - Location AMC, 1105 AZ Amsterdam, the Netherlands
| | - Milan L Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC - Location AMC, 1105 AZ Amsterdam, the Netherlands
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2
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Mondesert E, Eiden C, Peyriere H, Formoso A, Corti L, Cristol JP, Badiou S. Functional vitamin B 12 deficiency is a consistent feature in hospital admissions for neurological disorders due to the use of nitrous oxide. Clin Toxicol (Phila) 2023; 61:674-679. [PMID: 37917184 DOI: 10.1080/15563650.2023.2274282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
Introduction: Misuse of inhaled nitrous oxide is a growing concern in France. It is known to alter concentrations of vitamin B12, which is required as a cofactor for methionine synthase and methylmalonyl-CoA mutase activity. Hence, measurement of the concentrations of cobalamin metabolism biomarkers, including vitamin B12, homocysteine, and methylmalonic acid, could assist in the management of patients with a complex clinical presentation or in those who deny the consumption of nitrous oxide.Methods: We retrospectively collected clinical and biological data in patients hospitalized for nitrous oxide use in a university hospital in southern France between January 2020 and October 2022.Results: Thirty-one patients were identified during 34 months; 79% were men with a median age of 23.7 years. Most (97%) presented with peripheral polyneuropathy and/or myelopathy. The median vitamin B12 concentration was 134.6 pmol/L, with 17 of 31 patients having values less than 145 pmol/L (the lower limit of the normal range). The median plasma folate concentration was 20.1 nmol/L, which is within the normal range. The median plasma homocysteine concentration was 87.7 µmol/L (normal range <15 µmol/L), and the median plasma methylmalonic acid concentration was 3.8 µmol/L (normal range <0.5 µmol/L).Conclusion: Nitrous oxide use is an emerging public health problem in France, as shown by the number of patients admitted to our hospital. The presence of a functional vitamin B12 deficiency was a consistent feature that could be helpful in diagnosis in complex cases.
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Affiliation(s)
- Etienne Mondesert
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France
| | - Céline Eiden
- Addictovigilance Center, Department of Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
| | - Hélène Peyriere
- Addictovigilance Center, Department of Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
| | - Aude Formoso
- Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Lucas Corti
- Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Stéphanie Badiou
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
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3
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Kunihiro N, Tsukamoto M, Taura S, Hitosugi T, Miki Y, Yokoyama T. Sevoflurane concentration for cannulation in developmental disabilities. BMC Anesthesiol 2022; 22:148. [PMID: 35578184 PMCID: PMC9109363 DOI: 10.1186/s12871-022-01695-5] [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] [Received: 01/24/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
Objective The goal of this study was to compare the end-tidal sevoflurane concentration and time for intravenous cannulation at induction of anesthesia using sevoflurane with or without nitrous oxide in healthy children and in those with developmental disabilities. Methods Normal and developmentally disabled children were anesthetized by inhalation of sevoflurane with nitrous oxide or with nitrous oxide-free oxygen, and intravenous cannulae were introduced. Nitrous oxide was stopped after loss of consciousness. The following parameters were recorded for each patient: age, gender, height, weight, BMI, duration of intravenous cannulation, end-tidal concentration of sevoflurane at the completion of intravenous cannulation, and use of nitrous oxide. For each parameter except gender, p-value were calculated by one-way analysis of variance (ANOVA). For gender, p-value were calculated using the Fisher method. Two-way ANOVA was performed to evaluate the effect of patient health status and nitrous oxide use on the end-tidal concentrations of sevoflurane and the time required for intravenous cannulation. Results The end-tidal sevoflurane concentrations at the completion of the intravenous cannulation had received a significant main effect of the factor "the use of nitrous oxide" (F(1,166) = 25.8, p < 0.001, η2 = 0.13) and a small effect of the factor "the patient health status" (F(1,166) = 0.259, p = 0.611, η2 = 0.001). However, the time required for intravenous cannulation was not significantly affected by either of the two factors, "the use of nitrous oxide" (F(1,166) = 0.454, p = 0.501, η2 = 0.003) and "the patient health status" (F(1,166) = 0.308, p = 0.579, η2 = 0.002). Conclusions Between the healthy children and the children with developmental disabilities, no significant differences in the time required for the intravenous cannulation from the beginning of anesthetic induction. However, the end-tidal sevoflurane concentrations at the completion of the intravenous cannulation was significantly different. Sevoflurane in alveoli might be diluted by nitrous oxide. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01695-5.
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Affiliation(s)
- Naou Kunihiro
- Kyushu University Graduate School of Dental Science, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Masanori Tsukamoto
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
| | - Shiori Taura
- Department of Dental Anesthesiology, Graduate School of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takashi Hitosugi
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yoichiro Miki
- Faculty of Arts and Science, Kyushu University, Fukuoka, Japan
| | - Takeshi Yokoyama
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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4
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Desprairies C, Imbard A, Koehl B, Lorrot M, Gaschignard J, Sommet J, Pichard S, Holvoet L, Faye A, Benkerrou M, Benoist JF, Schiff M. Nitrous oxide and vitamin B12 in sickle cell disease: Not a laughing situation. Mol Genet Metab Rep 2020; 23:100579. [PMID: 32195121 PMCID: PMC7078522 DOI: 10.1016/j.ymgmr.2020.100579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/07/2020] [Indexed: 11/21/2022] Open
Abstract
Nitrous oxide (N2O) is widely used as an anesthetic or an analgesic. N2O prolonged and recurrent administration is known to affect vitamin B12 metabolism with subsequent clinical consequences. We report herein the case of a 13-year-old girl with sickle cell disease exhibiting severe neurological and biochemical signs of functional vitamin B12 deficiency due to prolonged and repeated exposure to N2O. This was an incentive to prospectively investigate functional vitamin B12 deficiency in patients affected by sickle cell disease regularly exposed to N2O. We measured plasma concentrations of vitamin B12, total homocysteine, methionine and methylmalonic acid in 39 patients with sickle cell disease between 2015 and 2016. No patients developed neurological symptoms related to N2O administration but 19 patients (49%) had biochemical abnormalities suggesting mildly disturbed vitamin B12 metabolism e.g. decreased B12 vitamin, hypomethioninemia, or slightly increased methylmalonic acid or homocysteine. The clinical case highlight the potential severe deleterious effects of N2O over exposure on B12 vitamin metabolism in particular in patients affected with sickle cell disease. Conversely, when used without excess even repeatedly, there seem to be no overt clinically relevant abnormalities in vitamin B12 metabolism as observed on the cohort of 39 sickle cell disease affected patients. Nitrous oxide (N2O) overexposure has a deleterious impact on vitamin B12 metabolism. Regular use of N2O in sickle cell disease patients can induce minor abnormalities in vitamin B12 metabolism. N2O administration should be carefully monitored and quantified as any drug. Functional vitamin B12 deficiency should be investigated prior to N2O administration in at-risk patients.
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Affiliation(s)
- Camille Desprairies
- Reference Centre for Inborn Errors of Metabolism, Robert-Debré University Hospital, APHP, Paris 75019, France
| | - Apolline Imbard
- Biochemistry Laboratory Robert-Debré University Hospital, APHP, Paris 75019, France.,LYPSIS2, Université Paris-Saclay, Chatenay-Malabry, France
| | - Bérengère Koehl
- Department of Paediatrics, Robert-Debré University Hospital, APHP, Paris 75019, France.,University of Paris, Paris-Diderot medical school, France
| | - Mathie Lorrot
- Department of Paediatrics, Robert-Debré University Hospital, APHP, Paris 75019, France
| | - Jean Gaschignard
- Department of Paediatrics, Robert-Debré University Hospital, APHP, Paris 75019, France
| | - Julie Sommet
- Department of Paediatrics, Robert-Debré University Hospital, APHP, Paris 75019, France
| | - Samia Pichard
- Reference Centre for Inborn Errors of Metabolism, Robert-Debré University Hospital, APHP, Paris 75019, France
| | - Laurent Holvoet
- Department of Child Haematology, Robert-Debré University Hospital, APHP, Paris 75019, France
| | - Albert Faye
- Department of Paediatrics, Robert-Debré University Hospital, APHP, Paris 75019, France.,University of Paris, Paris-Diderot medical school, France.,INSERM U1123, France
| | - Malika Benkerrou
- Department of Child Haematology, Robert-Debré University Hospital, APHP, Paris 75019, France
| | - Jean-François Benoist
- Biochemistry Laboratory Robert-Debré University Hospital, APHP, Paris 75019, France.,LYPSIS2, Université Paris-Saclay, Chatenay-Malabry, France
| | - Manuel Schiff
- Reference Centre for Inborn Errors of Metabolism, Robert-Debré University Hospital, APHP, Paris 75019, France.,Reference Centre for Inborn Errors of Metabolism, Necker University Hospital, APHP, Paris, France.,INSERM U1163, Imagine Institute, France.,University of Paris, Paris-Descartes medical school, France
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5
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van Luijk JAKR, Popa M, Swinkels J, Menon JML, Alkema W, Roeleveld N, Hoffmann SE, Schlünssen V, Mandrioli D, Ritskes-Hoitinga M, Scheepers PTJ. Establishing a health-based recommended occupational exposure limit for nitrous oxide using experimental animal data - A systematic review protocol. ENVIRONMENTAL RESEARCH 2019; 178:108711. [PMID: 31520819 DOI: 10.1016/j.envres.2019.108711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/24/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
Nitrous oxide (N 2 O) is widely used as inhalation analgesic and anaesthetic in medical, paramedical, and veterinary practice. Previous evaluations resulted in classification of N 2 O as a possible risk factor for adverse reproductive health outcomes based on evidence from animal data. Available human data were considered inadequate, partly due to the possibility that other risk factors, such as co-exposures to other inhalation anaesthetics may have contributed to the adverse outcomes. As no substantial new human evidence has emerged since previous evaluations, this protocol describes a planned systematic review of the evidence obtained from animal studies. The aim is to assess the available evidence on the effects of N 2 O on reproductive and developmental outcomes in animals to inform a health-based recommended occupational exposure limit (OEL) for N 2 O. Comprehensive search strategies were designed to retrieve animal studies addressing N 2 O exposure from PubMed, EMBASE, and Web of Science. Screening of the studies retrieved will be performed by at least two independent reviewers, while discrepancies will be resolved by reaching consensus through repeated review and discussions. Articles will be included according to criteria specified in this protocol. Outcome data relevant for reproduction and development will be extracted and risk of bias will be assessed by two independent reviewers using the SYRCLE's risk of bias tool. Primary reproductive and developmental outcomes of interest will be the number of resorptions, malformations, and birth weight. We will focus on dose-response studies that allow to derive an OEL with the benchmark dose (BMD) approach. Adverse outcomes occurring at doses that are equivalent to the exposures occurring in human occupational settings will be particularly relevant for dose-response modelling. The proposed review has not been performed before. We will follow the procedures specified in this protocol. We will adhere to guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), adapted for animal studies. Ethical approval will not be required, as the review will use existing data available in the public domain.
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Affiliation(s)
- Judith A K R van Luijk
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands.
| | - Madalina Popa
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands.
| | - Janne Swinkels
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands.
| | - Julia M L Menon
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands.
| | - Wynand Alkema
- Center for Molecular and Biomolecular Informatics, Radboud Institue for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands.
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands.
| | - Sebastian E Hoffmann
- The Evidence-Based Toxicology Collaboration (EBTC), Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Vivi Schlünssen
- Aarhus University, Aarhus, and National Research Center for the Working Environment, Copenhagen, Denmark.
| | - Daniele Mandrioli
- Cesare Maltoni Cancer Research Center, Ramazzini Institute, Bologna, Italy.
| | - Merel Ritskes-Hoitinga
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands.
| | - Paul T J Scheepers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands.
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Jabłońska M, Palkovits R. Perovskite-based catalysts for the control of nitrogen oxide emissions from diesel engines. Catal Sci Technol 2019. [DOI: 10.1039/c8cy02458h] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Nitrogen oxides removal over a wide range of perovskite-based catalysts together with their property-activity relationships.
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Affiliation(s)
- Magdalena Jabłońska
- Chair of Heterogeneous Catalysis and Chemical Technology
- Institut für Technische und Makromolekulare Chemie
- RWTH Aachen University
- 52074 Aachen
- Germany
| | - Regina Palkovits
- Chair of Heterogeneous Catalysis and Chemical Technology
- Institut für Technische und Makromolekulare Chemie
- RWTH Aachen University
- 52074 Aachen
- Germany
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7
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Kloesel B, Holzman RS. Anesthetic Management of Patients With Inborn Errors of Metabolism. Anesth Analg 2017; 125:822-836. [DOI: 10.1213/ane.0000000000001689] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Spinelli G, Vargas M, Aprea G, Cortese G, Servillo G. Pediatric anesthesia for minimally invasive surgery in pediatric urology. Transl Pediatr 2016; 5:214-221. [PMID: 27867842 PMCID: PMC5107376 DOI: 10.21037/tp.2016.09.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Laparoscopic or robotic minimally invasive approaches have become the standard of care for many urological pediatric surgical procedures. Anesthetic concerns for conventional and robotic laparoscopy are similar since they both require insufflations of CO2 to allow visualization of surgical field and perform surgery. Even if required insufflation pressures and volumes are lower in pediatric patients (given the small size of the abdomen and laxity of the abdominal walls), the associated increase of intra-abdominal pressure, along with absorption of CO2 and surgical positioning requirement, may result in neurendocrine and mechanical impact capable to mine cardiopulmonary function. Moreover, laparoscopic approach may require specific positioning. A correct positioning is essential to allow the surgical team to optimally and safely access to the patient. The knowledge of patient's health status, along with the multiple physiologic changes that can occur and specific potential complications, allow the anesthesiologist to provide a safer an aesthesia.
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Affiliation(s)
- Gianmario Spinelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Gianfranco Aprea
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Cortese
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Jabłońska M, Palkovits R. It is no laughing matter: nitrous oxide formation in diesel engines and advances in its abatement over rhodium-based catalysts. Catal Sci Technol 2016. [DOI: 10.1039/c6cy01126h] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
N2O appears as one of the undesired by-products in exhaust gases emitted from diesel engine aftertreatment systems, such as diesel oxidation catalysts (DOC), lean NOx trap (LNT, also known as NOx storage and reduction (NSR)) or selective catalytic reduction (NH3-SCR and HC-SCR) and ammonia slip catalysts (ASC, AMOX, guard catalyst).
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Affiliation(s)
- Magdalena Jabłońska
- Chair of Heterogeneous Catalysis and Chemical Technology
- Institut für Technische und Makromolekulare Chemie
- RWTH Aachen University
- 52074 Aachen
- Germany
| | - Regina Palkovits
- Chair of Heterogeneous Catalysis and Chemical Technology
- Institut für Technische und Makromolekulare Chemie
- RWTH Aachen University
- 52074 Aachen
- Germany
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10
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Ktena YP, Ramstad T, Baker EH, Sloan JL, Mannes AJ, Manoli I, Venditti CP. Propofol administration in patients with methylmalonic acidemia and intracellular cobalamin metabolism disorders: a review of theoretical concerns and clinical experiences in 28 patients. J Inherit Metab Dis 2015; 38:847-53. [PMID: 25985870 PMCID: PMC5577977 DOI: 10.1007/s10545-015-9816-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/18/2015] [Accepted: 01/22/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Methylmalonic acidemia and intracellular cobalamin metabolism disorders represent a heterogeneous group of inborn errors of metabolism. Most patients will require diagnostic and/or therapeutic procedures frequently requiring sedation or anesthetic management due to neurological and neurocognitive impairments. It has been stated that propofol is contraindicated in this population. We report our experience with propofol administration in a large series of patients. METHODS Twenty eight patients (14 mut, seven cblC, three cblA, three cblB, one cblG) aged 2-35.6 years enrolled in a natural history study (ClinicalTrials.gov identifier: NCT00078078) and required anesthetics for 39 diagnostic or therapeutic procedures. Data were collected on the anesthetic technique, perianesthetic course, and adverse events related to propofol. RESULTS Propofol was used as the sole induction agent in most cases (36/39) and as the primary maintenance agent in all cases. Infusion rates were 100-400 mcg kg(-1) min(-1) (mean = 214). Infusion duration was 60-325 min (mean = 158) and total doses ranged between 270-3610 mg (mean = 1217). Adverse events were recorded in two cases; neither appeared to be related to propofol administration. CONCLUSIONS Propofol is an effective, safe induction and maintenance agent for elective short procedures requiring anesthesia in patients with MMA and cobalamin metabolism disorders. Despite multiple comorbidities and propensity toward instability, those affected can receive anesthesia with an acceptable safety profile, if metabolically and hemodynamically stabilized prior to the event. SYNOPSIS A review of the perianesthetic records of 28 patients with isolated MMA and intracellular cobalamin metabolism disorders suggests that propofol anesthesia can be administered safely to these patients, in the setting of metabolic stability.
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Affiliation(s)
- Yiouli P Ktena
- Organic Acid Research Section, Genetics and Molecular Biology Branch, National Human Genome Research Institute, National Institutes of Health, 49 Convent Drive, Building 49, Room 4A18, Bethesda, MD, USA
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11
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Duma A, Cartmill C, Blood J, Sharma A, Kharasch ED, Nagele P. The hematological effects of nitrous oxide anesthesia in pediatric patients. Anesth Analg 2015; 120:1325-30. [PMID: 25658315 DOI: 10.1213/ane.0000000000000642] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Prolonged administration of nitrous oxide causes an increase in plasma homocysteine in children via vitamin B12 inactivation. However, it is unclear whether nitrous oxide doses used in clinical practice cause adverse hematological effects in pediatric patients. METHODS This retrospective study included 54 pediatric patients undergoing elective spinal surgery: 41 received nitrous oxide throughout anesthesia (maintenance group), 9 received nitrous oxide for induction and/or emergence (induction/emergence group), and 4 did not receive nitrous oxide (nitrous oxide-free group). Complete blood counts obtained before and up to 4 days after surgery were assessed for anemia, macrocytosis/microcytosis, anisocytosis, hyperchromatosis/hypochromatosis, thrombocytopenia, and leukopenia. The change (Δ) from preoperative to the highest postoperative value was calculated for mean corpuscular volume (MCV) and red cell distribution width (RDW). RESULTS No pancytopenia was present in any patient after surgery. All patients had postoperative anemia, and none had macrocytosis. Postoperative MCV (mean [99% confidence interval]) peaked at 86 fL (85-88 fL), 85 fL (81-89 fL), and 88 fL (80-96 fL) and postoperative RDW at 13.2% (12.8-13.5%), 13.3% (12.7-13.8%), and 13.0% (11.4-14.6%) for the maintenance group, the induction/emergence group, and the nitrous oxide-free group. Two patients in the maintenance group (5%) developed anisocytosis (RDW >14.6%), but none in the induction/emergence group or in the nitrous oxide-free group (P = 0.43). Both ΔMCV (P = 0.52) and ΔRDW (P = 0.16) were similar across all groups. CONCLUSIONS Nitrous oxide exposure for up to 8 hours is not associated with megaloblastic anemia in pediatric patients undergoing major spinal surgery.
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Affiliation(s)
- Andreas Duma
- From the *Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri; and †Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
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12
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Mynbaev OA, Eliseeva MY, Tinelli A, Malvasi A, Kosmas IP, Medvediev MV, Babenko TI, Mazitova MI, Kalzhanov ZR, Stark M. A personalized adhesion prevention strategy: E. Arslan, T. Talih, B. Oz, B. Halaclar, K. Caglayan, M. Sipahi, Comparison of lovastatin and hyaluronic acid/carboxymethyl cellulose on experimental created peritoneal adhesion model in rats, Int. J. Surg. 12 (2) (2014) 120-124. Int J Surg 2014; 12:901-5. [PMID: 25072704 DOI: 10.1016/j.ijsu.2014.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/02/2014] [Accepted: 03/14/2014] [Indexed: 11/26/2022]
Affiliation(s)
- O A Mynbaev
- The International Translational Medicine & Biomodeling Research Team, Department of Applied Mathematics, Moscow Institute of Physics & Technology (State University), Dolgoprudny, Moscow Region, Russia; The Department of Obstetrics, Gynecology & Reproductive Medicine, Peoples' Friendship, University of Russia, Moscow, Russia; Laboratory of Pilot Projects, Moscow State University of Medicine & Dentistry, Moscow, Russia; The New European Surgical Academy, Berlin, Germany.
| | - M Yu Eliseeva
- The Department of Obstetrics, Gynecology & Reproductive Medicine, Peoples' Friendship, University of Russia, Moscow, Russia
| | - A Tinelli
- Department of Obstetrics and Gynaecology, Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy and Technology, Vito Fazzi Hospital, Piazza Muratore, Lecce, Italy
| | - A Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy
| | - I P Kosmas
- Xatzikosta General Hospital, Ioannina, Ioannina, Greece
| | - M V Medvediev
- State Establishment "Dnepropetrovsk Medical Academy of Health Ministry of Ukraine", Dnepropetrovsk, Ukraine
| | - T I Babenko
- Stavropol State Medical Academy, Stavropol, Russia
| | | | - Zh R Kalzhanov
- School of Health and Human Sciences, University of Essex, UK
| | - M Stark
- The New European Surgical Academy, Berlin, Germany
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Toward adhesion-free endoscopy? Fertil Steril 2014; 101:e38. [DOI: 10.1016/j.fertnstert.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/03/2014] [Indexed: 11/20/2022]
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Mynbaev OA, Biro P, Eliseeva MY, Tinelli A, Malvasi A, Kosmas IP, Medvediev MV, Babenko TI, Mazitova MI, Simakov SS, Stark M. A surgical polypragmasy: Koninckx PR, Corona R, Timmerman D, Verguts J, Adamyan L. Peritoneal full-conditioning reduces postoperative adhesions and pain: a randomised controlled trial in deep endometriosis surgery. J Ovarian Res. 2013 Dec 11;6(1):90. J Ovarian Res 2014; 7:29. [PMID: 24606970 PMCID: PMC3984740 DOI: 10.1186/1757-2215-7-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/04/2014] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ospan A Mynbaev
- The International Translational Medicine & Biomodeling Research Group, Department of Applied Mathematics, Moscow Institute of Physics & Technology (State University), 9 institutsky per, Dolgoprudny, Moscow Region 141700, Russia.
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Mandel JE. Considerations for the use of short-acting opioids in general anesthesia. J Clin Anesth 2014; 26:S1-7. [PMID: 24485553 DOI: 10.1016/j.jclinane.2013.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/25/2013] [Indexed: 11/26/2022]
Abstract
Anesthesiologists play a critical role in facilitating a positive perioperative experience and early recovery for patients. Depending on the kind of procedure or surgery, a wide variety of agents and techniques are currently available to anesthesiologists to administer safe and efficacious anesthesia. Notably, the fast-track or ambulatory surgery environment requires the use of agents that enable rapid induction, maintenance, and emergence combined with minimal adverse effects. Short-acting opioids demonstrate a safe and rapid onset/offset of effect; that short effect is both predictable and precise. It also ensures easier titration and reduced or rapidly reversed side effects. Due to their distinct pharmacokinetic and pharmacodynamic properties, and, in one case, rapid extra-hepatic clearance of remifentanil, these agents have several applications in general anesthesia.
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Affiliation(s)
- Jeff E Mandel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Banchs R, Lerman J, Wald SH. The use of nitrous oxide as an adjuvant for inhalation inductions with sevoflurane: a pro-con debate. Paediatr Anaesth 2013; 23:557-64. [PMID: 23627270 DOI: 10.1111/pan.12168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Richard Banchs
- Department of Anesthesia, Women and Children's Hospital of Buffalo, State University of Buffalo, Buffalo, NY 14222, USA
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Lee S, Cheng S, Ng S, Lim S. Single-breath vital capacity high concentration sevoflurane induction in children: with or without nitrous oxide? Br J Anaesth 2013; 110:81-6. [DOI: 10.1093/bja/aes319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Victor C Baum
- The Departments of Anesthesiology and Pediatrics, University of Virginia, Charlottesville, VA 22908-0710, USA.
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[General anaesthesia in children: a French survey of practices]. ACTA ACUST UNITED AC 2012; 31:709-23. [PMID: 22776772 DOI: 10.1016/j.annfar.2012.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 06/04/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France. MATERIAL AND METHODS One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated. RESULTS There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N(2)O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the airway 42% used a tracheal tube, 30% a laryngeal mask and 20% a facial mask. Emergence agitation was an important concern for two thirds of respondents, while epileptoid signs were considered as important by only 20%. Eighty-nine percent of respondents practiced anesthesia for adenoidectomy. Anesthesia was induced by inhalation of SEVO 7-8% (41%), 6% (39%) or 4% (12%), 66% put an intravenous line (less frequently in LIBERAL). 67% of the responders managed adenoidectomy without any device to control the airway (more frequently in LIBERAL), 32% administrated a bolus of opioid (less frequently in LIBERAL). DISCUSSION This survey demonstrated that the practices regarding general anesthesia in children are relatively homogenous. Most of the differences appeared between LIBERAL and the others structures; the anaesthetic management for adenoidectomy illustrates these findings.
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Nagele P, Tallchief D, Blood J, Sharma A, Kharasch ED. Nitrous oxide anesthesia and plasma homocysteine in adolescents. Anesth Analg 2011; 113:843-8. [PMID: 21680854 DOI: 10.1213/ane.0b013e31822402f5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Nitrous oxide inactivates vitamin B(12), inhibits methionine synthase, and consequently increases plasma total homocysteine (tHcy). Prolonged exposure to nitrous oxide can lead to neuropathy, spinal cord degeneration, and even death in children. We tested the hypothesis that nitrous oxide anesthesia causes a significant increase in plasma tHcy in children. METHODS Twenty-seven children (aged 10-18 years) undergoing elective major spine surgery were enrolled, and serial plasma samples from 0 to 96 hours after induction were obtained. The anesthetic regimen, including the use of nitrous oxide, was at the discretion of the anesthesiologist. Plasma tHcy was measured using standard enzymatic assays. RESULTS The median baseline plasma tHcy concentration was 5.1 μmol/L (3.9-8.0 μmol/L, interquartile range) and increased in all patients exposed to nitrous oxide (n = 26) by an average of +9.4 μmol/L (geometric mean; 95% confidence interval, 7.1-12.5 μmol/L) or +228% (mean; 95% confidence interval, 178%-279%). Plasma tHcy peaked between 6 and 8 hours after induction of anesthesia. One patient who did not receive nitrous oxide had no increase in plasma tHcy. Several patients experienced a severalfold increase in plasma tHcy (maximum +567%). The increase in plasma tHcy was strongly correlated with the duration and average concentration of nitrous oxide anesthesia (r = 0.80; P < 0.001). CONCLUSIONS Pediatric patients undergoing nitrous oxide anesthesia develop significantly increased plasma tHcy concentrations. The magnitude of this effect seems to be greater compared with adults; however, the clinical relevance is unknown.
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Affiliation(s)
- Peter Nagele
- Department of Anesthesiology, Washington University, St. Louis, MO, USA.
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Dickinson R, Franks NP. Bench-to-bedside review: Molecular pharmacology and clinical use of inert gases in anesthesia and neuroprotection. Crit Care 2010; 14:229. [PMID: 20836899 PMCID: PMC2945072 DOI: 10.1186/cc9051] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the past decade there has been a resurgence of interest in the clinical use of inert gases. In the present paper we review the use of inert gases as anesthetics and neuroprotectants, with particular attention to the clinical use of xenon. We discuss recent advances in understanding the molecular pharmacology of xenon and we highlight specific pharmacological targets that may mediate its actions as an anesthetic and neuroprotectant. We summarize recent in vitro and in vivo studies on the actions of helium and the other inert gases, and discuss their potential to be used as neuroprotective agents.
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Affiliation(s)
- Robert Dickinson
- Biophysics Section, Blackett Laboratory, Imperial College London, South Kensington, London SW7 2AZ, UK.
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Jung CH, Sim JY, Ahn W. Growth suppression of four cancer cells by hyperbaric nitrous oxide and methotrexate. Korean J Anesthesiol 2010; 58:61-9. [PMID: 20498814 PMCID: PMC2872900 DOI: 10.4097/kjae.2010.58.1.61] [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: 05/19/2009] [Revised: 08/29/2009] [Accepted: 09/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nitrous oxide concentration is easily controlled by respiratory ventilation. It suppresses bone marrow via the inhibition of thymidylate synthesis. The aim of this work was to determine the optimal pressure and exposure duration of nitrous oxide, as well as methotrexate concentration that maximizes the suppression of 4 cancer cells: CCRF-CEM, K562, A549 and MDA-MB-231. METHODS Each cancer cell was cultured in a hyperbaric chamber at 1, 2 and 3 atmosphere of 74% nitrous oxide for 24, 48, and 72 hours at 0, 0.3, 0.7, 1, 2, 5 and 10 microM methotrexate (MTX), respectively. The results were expressed in the ratio of the number of cancer cells cultured under specific conditions (S cells) to that under normal conditions (N cells). RESULTS The S/N ratio of CCRF-CEM cells was 87.4% in 24-hour culture, 95.0% in 48-hour culture and 115.9% in 72-hour culture (P < 0.05). The S/N ratio of K562 cells was 103.6% at 1 atm, 102.4% at 2 atm and 115.6% at 3 atm (P < 0.05). The S/N ratio of A549 cells was 94.3% at 1 atm, 94.1% at 2 atm, 99.3% at 3 atm, 96.2% in 24-hour culture, 99.2% in 48-hour culture and 99.3% in 72-hour culture (P > 0.05). However, the S/N ratio of MDA-MB 231 cells was 66.9% in 24-hour culture, 83.1% in 48 hour culture and 87.8% in 72-hour culture (P < 0.05). CONCLUSIONS Only the growth of the MDA-MB-231 cells was significantly reduced after a longer exposure time to nitrous oxide, but those of the other cells were not.
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Affiliation(s)
- Cheol Hee Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Yeon Sim
- Department of Anesthesiology and Pain Medicine, College of Medicine, University of Ulsan, Seoul, Korea
| | - Wonsik Ahn
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Peral D, Higueras R, Onrubia X, Bellver J. [Anesthesia in a patient with homocystinuria and severe pulmonary embolism]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:191-192. [PMID: 19408788 DOI: 10.1016/s0034-9356(09)70364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
BACKGROUND There is an increasing awareness of the role of oxygen free radicals in the pathogenesis of many conditions associated with prematurity, which has led to caution in the use of oxygen in neonatal resuscitation. We surveyed the practice of UK pediatric anesthetists with regard to oxygen use in neonatal and infant anesthesia. METHODS A postal questionnaire survey of 460 UK-based members of the Association of Pediatric Anesthetists of Great Britain and Ireland. RESULTS Responses were received from 247 pediatric anesthetists (54%). Seventy-five percent of anesthetists aim to avoid the use of 100% oxygen during routine infant anesthesia and 52% aim for an FiO(2) of < 0.4 in neonates. The factors most influencing choice of carrier gas are optimal oxygenation and the avoidance of pulmonary atelectasis. Sixteen percent stated that unavailability of medical air is a factor. Opinion was divided on concern about the effects of anesthetic agents on the developing brain. Moderate levels of concern were expressed about the potential toxic effects of oxygen on the eyes and lungs of premature newborns but this concern does not extend to term newborns. Only 20% of anesthetists had any recent knowledge of these issues. CONCLUSIONS This survey indicates that there is no consistency in attitudes and practices and demonstrates considerable variation in the use of oxygen during anesthesia in premature and newborn babies and infants. This may reflect the paucity of evidence in the anesthetic literature on the potential harmful effects of high concentrations of oxygen in vulnerable groups of infants.
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Affiliation(s)
- Judith A Short
- Department of Anaesthesia, Sheffield Children's Hospital, Sheffield, UK.
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