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Su D, Zhang W, Li J, Tan X, Wei H, Wang Y, Ji Z. Supraglottic jet oxygenation and ventilation improves oxygenation during endoscopic retrograde cholangiopancreatography: a randomized controlled clinical trial. BMC Anesthesiol 2024; 24:21. [PMID: 38216874 PMCID: PMC10785419 DOI: 10.1186/s12871-024-02406-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
PURPOSE Hypoxia is one of the most frequent adverse events under deep sedation in the semiprone position. We hypothesized that supraglottic jet oxygenation and ventilation (SJOV) via Wei nasal jet tube (WNJ) can reduce the incidence of hypoxia in patients under deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS A total of 171 patients were divided into three groups: N group, supplementary oxygen via a nasopharyngeal airway (4-6 L/min); W group, supplementary oxygen via WNJ (4-6 L/min); WS group, SJOV via WNJ. The primary outcome was the incidence of adverse events, including sedation-related adverse events [SRAEs, hypoxemia (SpO2 = 75-89% lasted less than 60 s); severe hypoxemia (SpO2 < 75% at any time or SpO2 < 90% lasted more than 60 s] and subclinical respiratory depression (SpO2 = 90-95%). Other intraoperative and post-operative adverse events were also recorded as secondary outcomes. RESULTS Compared with the N group, the incidence of hypoxemia and subclinical respiratory depression in the WS group was significantly lower (21% vs. 4%, P = 0.005; 27% vs. 6%, P = 0.002). Compared with Group W, the incidence of hypoxemia and subclinical respiratory depression in Group WS was also significantly less frequent (20% vs. 4%, P = 0.009; 21% vs. 6%, P = 0.014). No severe hypoxia occurred in the group WS, while four and one instances were observed in the group N and group W respectively. There were no significant differences in other adverse events among the three groups. CONCLUSION SJOV can effectively improve oxygenation during ERCP in deeply sedated semiprone patients.
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Affiliation(s)
- Dan Su
- Department of Anesthesia, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Wei Zhang
- Department of Anesthesia, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Jingze Li
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Xi Tan
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yinglin Wang
- Department of Anesthesia, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
| | - Zhonghua Ji
- Department of Anesthesia, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
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2
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Elghamry MR, Anwar AG, Elbadry AA, Shaaban A. Efficacy of the laryngeal mask airway gastro during trans-esophageal echocardiography in pediatrics: A randomized trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2023. [DOI: 10.1080/11101849.2023.2180577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- Mona Raaft Elghamry
- Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Atteia Gad Anwar
- Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr Arafa Elbadry
- Lecturer in Anesthesia, Surgical Intensive Care, and Pain Medicine, Tanta University, Tanta, Egypt
| | - Aliaa Shaaban
- Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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3
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Zhang L, Li L, Wang J, Zhao C, Zhao E, Li Y, Lv Y. Comparison of the Jcerity endoscoper airway and the endotracheal tube in endoscopic esophageal variceal ligation: a prospective randomized controlled trial. Sci Rep 2023; 13:11849. [PMID: 37481684 PMCID: PMC10363148 DOI: 10.1038/s41598-023-39086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 07/20/2023] [Indexed: 07/24/2023] Open
Abstract
Various airway techniques have been used in endoscopic esophageal variceal ligation (EVL). In this respect, Jcerity endoscoper airway (JEA) is a novel laryngeal mask airway that is designed for use in gastrointestinal endoscopy. In the present study, 164 patients who underwent EVL were randomly divided into JEA group or endotracheal tube (ETT) group (ratio: 1:1). Success rate of endoscopic procedure, endoscope insertion time, procedure duration, recovery time, airway technique extubation time, anesthesia costs, hospital stay duration, complications, and hemodynamic parameters were recorded. The success rate of EVL in the JEA group was noninferior to that in the ETT group (98.8% vs. 100.0%). The airway insertion time, anesthesia duration, and recovery time were significantly shorter in the JEA group than in the ETT group (p < 0.001). Furthermore, the blood pressure during extubation was more stable in the JEA group (p < 0.001). Moreover, there were less heart rate variations during intubation (p < 0.005) and extubation (p < 0.05) in the JEA group. Nonetheless, the endoscopists' satisfaction scores were comparable between the two groups. Overall, our findings suggest that JEA is efficient and safe for clinical use in EVL.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000031892, Registered April 13, 2020, https://www.chictr.org.cn/searchproj.html .
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Affiliation(s)
- Le Zhang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Lu Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Jun Wang
- Department of Operation Room, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Can Zhao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Erxian Zhao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Yanrong Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Yunqi Lv
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China.
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4
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Gupta A, Subramaniam R, Rathod PR, Agha M. Gastrointestinal endoscopy procedures under intravenous sedation in the prone position: keep LMA gastro handy! J Clin Monit Comput 2023; 37:715-716. [PMID: 36074225 DOI: 10.1007/s10877-022-00912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Gastrointestinal endoscopies are often done in the prone position and anesthesiologists are needed to provide sedation. Airway access is limited in the prone position and may make timely airway management difficult in case of airway obstruction during sedation. Specialized laryngeal mask airway devices customized for endoscopy procedures like LMA® Gastro™ can be inserted in the prone position and may help anesthesiologists tide over such crisis situations while simultaneously allowing the endoscopy procedures through the dedicated conduit available for inserting the endoscopes. We have described one such case managed successfully by inserting LMA® Gastro™ in the prone position.
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Affiliation(s)
- Anju Gupta
- Department of Anaesthesiology, Pain Medicine and Critical care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Rajeshwari Subramaniam
- Department of Anaesthesiology, Pain Medicine and Critical care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Pyarelal R Rathod
- Department of Anaesthesiology, Pain Medicine and Critical care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Mussavvir Agha
- Department of Anaesthesiology, Pain Medicine and Critical care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Bidaye S, Sommerville A, Straker T. When is it Safe to Use a Supraglottic Airway Device? Advanced Uses for SGA Devices. CURRENT ANESTHESIOLOGY REPORTS 2023. [DOI: 10.1007/s40140-023-00548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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6
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Gowd U, Bajwa SJS, Kurdi M, Sindwani G. In pursuit of the right plan for airway management in gastrointestinal endoscopic procedures…the battle half won? Indian J Anaesth 2022; 66:683-686. [PMID: 36437973 PMCID: PMC9698298 DOI: 10.4103/ija.ija_846_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Upender Gowd
- Department of Anaesthesiology, Asian Institute of Gastroenterology, Gachibowli, Hyderabad, Telangana, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - Madhuri Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka, India
| | - Gaurav Sindwani
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences (ILBS), Delhi, India
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7
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Gamal M, Kamal MA, Abuelazm M, Yousaf A, Abdelazeem B. Meta-analysis comparing the efficiency of high-flow nasal cannula versus low-flow nasal cannula in patients undergoing endoscopic retrograde cholangiopancreatography. Proc AMIA Symp 2022; 35:485-491. [PMID: 35754579 PMCID: PMC9196677 DOI: 10.1080/08998280.2022.2062554] [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: 02/21/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) identifies and treats pancreatic and biliary diseases. We conducted a systematic review and meta-analysis examining relevant papers in five databases to examine the frequency of hypoxia throughout the surgery and the lowest oxygen saturation level in patients under sedation. Our meta-analysis included three randomized controlled trials with 390 participants, 196 in the high-flow oxygen (HFNC) group and 194 in the low-flow oxygen (LFNC) group. Their ages ranged from 65.3 to 79 years. The pooled effect estimate showed that HFNC decreased the incidence of hypoxia during the procedure when compared to LFNC (odds ratio -0.84; 95% confidence interval [CI] -1.65, -0.02; P = 0.04), and the mean of lowest oxygen saturation in patients during sedation was significantly lower in LFNC compared to HFNC (mean difference 2.34; 95% CI 1.35, 3.32; P = 0.001). The pooled effect estimate showed that the HFNC group had a lower incidence rate of jaw thrusting adverse events during anesthesia than the LFNC group (risk difference -0.12; 95% CI -0.21, -0.04; P = 0.001). In summary, HFNC systems reduced the incidence of hypoxia for patients undergoing ERCP and had a higher mean lowest oxygen saturation during sedation.
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Affiliation(s)
| | | | | | - Amman Yousaf
- McLaren Health Care, Flint, Michigan
- Michigan State University, East Lansing, Michigan
| | - Basel Abdelazeem
- McLaren Health Care, Flint, Michigan
- Michigan State University, East Lansing, Michigan
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Zilberman P, Davidovics Z, Benson A. A bench test of a modified gastro LMA for the insertion of the duodenoscope. Indian J Anaesth 2022; 66:159-160. [PMID: 35359468 PMCID: PMC8963231 DOI: 10.4103/ija.ija_179_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/14/2021] [Accepted: 08/26/2021] [Indexed: 12/04/2022] Open
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Gupta A, Parida R, Subramaniam R, Kumar K. LMA gastro for gastro-intestinal endoscopic procedures: Pearls, pitfalls, and troubleshoots of its usage. Indian J Anaesth 2022; 66:S333-S336. [DOI: 10.4103/ija.ija_431_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
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Finlay JE, Leslie K. Sedation/analgesia techniques for nonoperating room anesthesia: new drugs and devices. Curr Opin Anaesthesiol 2021; 34:678-682. [PMID: 34419992 DOI: 10.1097/aco.0000000000001057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review new drugs and devices for nonoperating room anesthesia (NORA). RECENT FINDINGS Remimazolam is an ultra-short-acting, water-soluble intravenous benzodiazepine with a fast onset and offset that has been approved recently for use in procedural sedation. Phase III trials have established the effectiveness of remimazolam sedation compared with placebo and midazolam in gastrointestinal endoscopy and bronchoscopy. More research is required investigating remimazolam in real-world NORA settings, including comparisons with propofol sedation. Oliceridine is a μ-agonist with selectivity for the G protein pathway and low potency for β-arrestin recruitment. As such it may be associated with less nausea, vomiting and respiratory depression than traditional opioids used. Although no studies have been published about oliceridine use in NORA to date, results from surgical studies indicate a potential place in nonoperating room practice. Research continues into alternative methods of drug delivery, such as patient-controlled sedation but no new devices are described. SUMMARY Further studies are required before these new drugs and devices are embraced in NORA.
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Affiliation(s)
- Janna E Finlay
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital
| | - Kate Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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11
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Zhang S, Nie J, Tu W, Zhong C, Liu Q, Li J. Effectiveness of supraglottic ventilation by transtracheal catheter for painless ERCP. Am J Transl Res 2021; 13:8165-8171. [PMID: 34377301 PMCID: PMC8340192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/23/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE This study aimed to investigate the effect of supraglottic ventilation via transtracheal catheter in painless endoscopic retrograde cholangiopancreatography (ERCP). METHODS Sixty patients with painless ERCP who were treated in our hospital were enrolled as the study subjects and divided into a study group (n=30) and a control group (n=30) according to the method of ventilation during the operation. The control group received ventilation via modified laryngeal mask, while the study group received supraglottic ventilation through a transtracheal tube. The mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2), and End-tidal CO2 (EtCO2) at multiple time points after admission (T0), after induction of anesthesia (T1), immediately after catheter placement (T2), immediately after operation (T3), and at the time of resuscitation (T4) were compared between the two groups. The incidence of various adverse events in the perioperative period was also compared. RESULTS The two groups showed significant fluctuations in intraoperative hemodynamic parameters. However, the changes in MAP, SpO2 and ETCO2 of the study group were more stable, and better than those of the control group at the T2 and T3 (P<0.05). The intubation time, operation time and recovery time of patients in the study group were significantly lower than those in the control group (P<0.05). The total incidence of adverse events in the study group was significantly lower than that in the control group (P<0.05). CONCLUSION It is highly feasible to apply supraglottic ventilation with transvalvular catheter in painless ERCP, which can significantly stabilize the perioperative hemodynamic parameters, accelerate recovery and also help decrease the rate of postoperative complications.
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Affiliation(s)
- Shaojin Zhang
- Department of Anesthesiology, Yichun People's Hospital Yichun 336000, Jiangxi Province, China
| | - Jiying Nie
- Department of Anesthesiology, Yichun People's Hospital Yichun 336000, Jiangxi Province, China
| | - Wencai Tu
- Department of Anesthesiology, Yichun People's Hospital Yichun 336000, Jiangxi Province, China
| | - Changgen Zhong
- Department of Anesthesiology, Yichun People's Hospital Yichun 336000, Jiangxi Province, China
| | - Qing Liu
- Department of Anesthesiology, Yichun People's Hospital Yichun 336000, Jiangxi Province, China
| | - Jianhua Li
- Department of Anesthesiology, Yichun People's Hospital Yichun 336000, Jiangxi Province, China
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Uysal H, Senturk H, Calim M, Daskaya H, Guney IA, Karaaslan K. Comparison of LMA® gastro airway and gastro-laryngeal tube in endoscopic retrograde cholangiopancreatography: a prospective randomized observational trial. Minerva Anestesiol 2021; 87:987-996. [PMID: 33982986 DOI: 10.23736/s0375-9393.21.15371-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND New generation airway devices with different designs have been developed as an alternative to endotracheal intubation in order to avoid adverse events associated with sedation in endoscopic procedures and to provide patent airway. We aimed to compare two supraglottic airway devices (SGADs), the LMA®GastroTM Airway and Gastro Laryngeal Tube (GLT), in terms of airway efficiency, performance during procedure and adverse events in Endoscopic Retrograde Cholangiopancreatography (ERCP). METHODS A hundred-three ERCP patients without high risk of aspiration were included. Patients were randomly allocated to the LMA Gastro and GLT groups. The primary study outcomes were the comparison of the two SGADs in terms of oropharyngeal leak pressure (OLP). Secondary study outcome was SGADs-related adverse events. RESULTS Procedures were completed with SGADs in fifty patients in each group. The rate of successful insertion at first attempt was 72% in GLT and 96% in LMA Gastro (p=0.004). The mean OLP of LMA Gastro Group (31.8cm H2O) was significantly higher than that of the GLT Group (26.5cm H2O), (p=0.0001). However endoscopists' satisfaction was higher in GLT (p=0.0001). Mucosal damage and sore throat were lower in LMA Gastro Group. CONCLUSIONS LMA® Gastro™ had a higher OLP than GLT. However, GLT was better for endoscopist satisfaction, as it provides more satisfying maneuverability. As to secondary outcome advers events were lower in LMA® Gastro™. The lower complication rates associated with the device and providing a more patent airway also highlighted the apparent clinical efficacy of LMA® Gastro™ than GLT, in ERCP.
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Affiliation(s)
- Harun Uysal
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey -
| | - Hakan Senturk
- Department of Gastroenterology and Hepatology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Hayrettin Daskaya
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Ibrahim A Guney
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Kazim Karaaslan
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
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Thiruvenkatarajan V, Lorenzetti M, Chung A, Wong CK, Currie J, Wahba M, Van Wijk RM, Skinner MW, Sorbello M. Airway Management Considerations for Upper Gastrointestinal Endoscopic Procedures in COVID-19 Era. Dig Dis Sci 2020; 65:2739-2742. [PMID: 32712781 PMCID: PMC7382315 DOI: 10.1007/s10620-020-06478-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/04/2020] [Indexed: 12/09/2022]
Affiliation(s)
- V. Thiruvenkatarajan
- Department of Anesthesia, The Queen Elizabeth Hospital, Woodville, Adelaide, SA 5011 Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - M. Lorenzetti
- Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - A. Chung
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Adelaide, Australia
| | - C. K. Wong
- Department of Anesthesia, The Queen Elizabeth Hospital, Woodville, Adelaide, SA 5011 Australia
| | - J. Currie
- Department of Anesthesia, The Queen Elizabeth Hospital, Woodville, Adelaide, SA 5011 Australia
| | - M. Wahba
- Department of Anesthesia, The Queen Elizabeth Hospital, Woodville, Adelaide, SA 5011 Australia
| | - R. M. Van Wijk
- Department of Anesthesia, The Queen Elizabeth Hospital, Woodville, Adelaide, SA 5011 Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - M. W. Skinner
- Surgical and Perioperative Services, Royal Hobart Hospital, Hobart, Australia
| | - M. Sorbello
- Anaesthesia and Intensive Care, AOU Policlinico San Marco University Hospital, Catania, Italy
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