1
|
Luo Q, Wang X, Lei Q. Goal-directed fluid therapy for a patient undergoing liver resection for giant hepatic alveolar echinococcosis based on hypotension prediction index. Asian J Surg 2023; 46:5959-5961. [PMID: 37690899 DOI: 10.1016/j.asjsur.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Qingyong Luo
- Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, 610000, China
| | - Xie Wang
- Department of Anesthesiology, Sichuan Provincial People's Hospital, 610000, China
| | - Qian Lei
- Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, 610000, China.
| |
Collapse
|
2
|
Suh SW, Lee SE, Choi YS. Influence of Intraoperative Blood Loss on Tumor Recurrence after Surgical Resection in Hepatocellular Carcinoma. J Pers Med 2023; 13:1115. [PMID: 37511728 PMCID: PMC10381288 DOI: 10.3390/jpm13071115] [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: 05/17/2023] [Revised: 07/03/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
The high incidence of hepatocellular carcinoma (HCC) recurrence after surgical resection worsens the long-term prognosis. Besides tumor-related factors, operative factors such as perioperative blood transfusion have been reported to be related to HCC recurrence. However, excessive intraoperative blood loss (IBL) always necessitates blood transfusion, where IBL and blood transfusion may influence oncologic outcomes. We enrolled 142 patients with newly diagnosed single HCC who underwent hepatic resection between March 2010 and July 2021. Patients were stratified into two groups by IBL volume: Group A (IBL ≥ 700 mL, n = 47) and Group B (IBL < 700 mL, n = 95). The clinic-pathologic findings, operative outcomes, and cumulative probability of tumor recurrence and overall survival were compared between the two groups. In the study, increased IBL (1351 ± 698 vs. 354 ± 166, p < 0.001) and blood transfusion (63.8% vs. 6.3%, p < 0.001) were common in Group A, with a greater HCC recurrence (p = 0.001) and poor overall survival (p = 0.017) compared to those in Group B. Preoperative albumin (hazard ratio [HR], 0.471; 95% confidence interval [CI], 0.244-0.907, p = 0.024), microvascular invasion (HR, 2.616; 95% CI, 1.298-5.273; p = 0.007), and IBL ≥ 700 mL (HR, 2.325; 95% CI, 1.202-4.497; p = 0.012) were significant risk factors for tumor recurrence after surgical resection for HCC. In conclusion, efforts to minimize IBL during hepatic resection are important for improving long-term prognosis in HCC patients.
Collapse
Affiliation(s)
- Suk-Won Suh
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of Korea
| | - Seung Eun Lee
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of Korea
| | - Yoo Shin Choi
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of Korea
| |
Collapse
|
3
|
Halawa NM, El Sayed AM, Ibrahim ES, Khater YH, Yassen KA. The respiratory and hemodynamic effects of alveolar recruitment in cirrhotic patients undergoing liver resection surgery: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2023; 39:113-120. [PMID: 37250262 PMCID: PMC10220178 DOI: 10.4103/joacp.joacp_188_21] [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: 04/20/2021] [Revised: 06/03/2021] [Accepted: 06/21/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Extensive surgical retraction combined with general anesthesia increase alveolar collapse. The primary aim of our study was to investigate the effect of alveolar recruitment maneuver (ARM) on arterial oxygenation tension (PaO2). The secondary aim was to observe its effect on hemodynamics parameters in hepatic patients during liver resection, to investigate its impact on blood loss, postoperative pulmonary complications (PPC), remnant liver function tests, and on the outcome. Material and Methods Adult patients scheduled for liver resection were randomized into two groups: ARM (n = 21) and control (C) (n = 21). Stepwise ARM was initiated after intubation and was repeated post-retraction. Pressure-control ventilation mode was adjusted to deliver a tidal volume (Vt) of 6 mL/kg and an inspiratory-to-expiratory time (I:E) ratio of 1:2 with an optimal positive end-expiratory pressure (PEEP) for the ARM group. In the C group, a fixed PEEP (5 cmH2O) was applied. Invasive intra-arterial blood pressure (IBP), central venous pressure (CVP), electrical cardiometry (EC), alanine transaminase (ALT, U/L), and aspartate aminotransferase (AST, U/L) blood levels were monitored. Results ARM increased PEEP, dynamic compliances, and arterial oxygenation, but reduced ventilator driving pressure compared to group C (P < 0.01). IBP, cardiac output (CO), and stroke volume variation were not affected by the higher PEEP in the ARM group (P > 0.05) but the CVP increased significantly (P = 0.001). Blood loss was not different between the ARM and C groups (1700 (1150-2000) mL vs 1110 (900-2400) mL, respectively and P = 0.57). ARM reduced postoperative oxygen desaturation; however, it did not affect the increase in remnant liver enzymes and was comparable to group C (ALT, P = 0.54, AST, P = 0.41). Conclusions ARM improved intraoperative lung mechanics and reduced oxygen desaturation episodes in recovery, but not PPC or ICU stay. ARM was tolerated with minimal cardiac and systemic hemodynamic effects.
Collapse
Affiliation(s)
- Naglaa Moustafa Halawa
- Anaesthesia Department, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
| | - Amani Mamdouh El Sayed
- Anaesthesia Department, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
| | - Ezzeldin Saleh Ibrahim
- Anaesthesia Department, Faculty of Medicine, Menoufia University, Sheeben Elkom City, Egypt
| | - Yehia H. Khater
- Anaesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled Ahmed Yassen
- Anaesthesia Department, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
- Surgery Department, College of Medicine, King Faisal University, Al Hasa, Saudi Arabia
| |
Collapse
|
4
|
Wang Z, Qian Y, Farajtabar A. Milrinone solubility in aqueous cosolvent solutions revisited: Inter/intra-molecular interactions, enthalpy-entropy compensation, and preferential solvation. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.119452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
5
|
Sakai T, Ko JS, Crouch CE, Kumar S, Choi GS, Hackl F, Han DH, Kaufman M, Kim SH, Luzzi C, McCluskey S, Shin WJ, Sirianni J, Song KW, Sullivan C, Hendrickse A. Perioperative management of living donor liver transplantation: Part 2 - Donors. Clin Transplant 2022; 36:e14690. [PMID: 35477939 DOI: 10.1111/ctr.14690] [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: 12/10/2021] [Revised: 02/26/2022] [Accepted: 04/23/2022] [Indexed: 01/10/2023]
Abstract
Living donor liver transplantation was first developed to mitigate the limited access to deceased donor organs in Asia in the 1990s. This alternative liver transplantation method has become a widely practiced and established transplantation option for adult patients suffering with end-stage liver disease, and it has successfully helped address the shortage of deceased donors. The Society for the Advancement of Transplant Anesthesia and the Korean Society of Transplantation Anesthesiologists jointly reviewed published studies on the perioperative management of adult live liver donors undergoing donor hemi-hepatectomy. The goal of the review is to offer transplant anesthesiologists and critical care physicians a comprehensive overview of the perioperative management of adult live donors. We featured the current status, donor selection process, outcomes and complications, surgical procedure, anesthetic management, Enhanced Recovery After Surgery protocols, avoidance of blood transfusion, and considerations for emergency donation. Recent surgical advances, including laparoscopic donor hemi-hepatectomy and robotic laparoscopic donor surgery, are also addressed.
Collapse
Affiliation(s)
- Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Justin Sangwook Ko
- Department of Anesthesiology & Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cara E Crouch
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sathish Kumar
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Florian Hackl
- Department of Anesthesiology and Interventional Pain Management, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Dai Hoon Han
- Department of HBP Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Michael Kaufman
- Department of Anesthesiology and Interventional Pain Management, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Seong Hoon Kim
- Organ Transplantation Center, National Cancer Center, Gyeonggi-do, Republic of Korea
| | - Carla Luzzi
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stuart McCluskey
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Won Jung Shin
- Department of Anesthesiology & Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joel Sirianni
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ki Won Song
- Department of Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Cinnamon Sullivan
- Department of Anesthesiology, Emory University, Atlanta, Georgia, USA
| | - Adrian Hendrickse
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
6
|
Preoperative volume assessment using bioelectrical impedance analysis for minimizing blood loss during hepatic resection. HPB (Oxford) 2022; 24:568-574. [PMID: 34702628 DOI: 10.1016/j.hpb.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Maintaining low central venous pressure (CVP) is an effective strategy to reduce blood loss during hepatic resection. As an alternative to measuring CVP, which requires the placement of a central venous catheter, bioelectrical impedance analysis (BIA) is a noninvasive method recently used for monitoring volume status in critically ill patients. METHODS We investigated 192 patients who underwent hepatic resection from January 2017 to December 2020. The ratio of extracellular water:total body water (ECW/TBW), as an index of volume status, was measured using InBody S10 (Biospace, Seoul, Korea). The correlation between the ECW/TBW and CVP was determined, and their influences on operative outcomes were analyzed. RESULTS ECW/TBW and CVP showed a significant correlation; an ECW/TBW <0.378 correlated with a CVP <5 mmHg (R2 = 0.839, P<0.001). Estimated blood loss (EBL) was significantly increased in patients with an ECW/TBW ≥0.378 compared to those with a ratio <0.378 (508 ± 321 vs. 324 ± 193, mL, P<0.001). Identified predictors for an EBL ≥500 mL were operative time (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.001-1.015; P = 0.021) and an ECW/TBW <0.378 (OR, 0.263; 95% CI, 0.121-0.572; P = 0.001). CONCLUSIONS BIA can be utilized for preoperative volume assessment to minimize blood loss during hepatic resection.
Collapse
|
7
|
Hu W, Li Z, Hu Z. A commentary on "Milrinone is better choice for controlled low central venous pressure during hepatectomy: A randomized, controlled trial comparing with nitroglycerin" [Int. J. Surg. (2021) 94: 106080]. Int J Surg 2021; 94:106130. [PMID: 34619376 DOI: 10.1016/j.ijsu.2021.106130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Wang Hu
- Department of Pediatric Surgery, Ruijin Maternal and Child Health Hospital, Ganzhou, China Department of Ultrasound, Jinhua First People's Hospital, Jinhua, China Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | | |
Collapse
|
8
|
Ren YS, Li LF, Peng T, Tan YJ, Sun Y, Cheng GL, Zhang GM, Li J. The effect of milrinone on mortality in adult patients who underwent CABG surgery: a systematic review of randomized clinical trials with a meta-analysis and trial sequential analysis. BMC Cardiovasc Disord 2020; 20:328. [PMID: 32640988 PMCID: PMC7346403 DOI: 10.1186/s12872-020-01598-8] [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: 09/10/2019] [Accepted: 06/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background As an inodilator, milrinone is commonly used for patients who undergo coronary artery bypass graft (CABG) surgery because of its effectiveness in decreasing the cardiac index and mitral regurgitation. The aim of this study was to perform a systematic review and meta-analysis of existing studies from the past 20 years to evaluate the impact of milrinone on mortality in patients who undergo CABG surgery. Methods We performed a systematic literature search on the application of milrinone in patients who underwent CABG surgery in studies published between 1997 and 2017 in BioMed Central, PubMed, EMBASE, and the Cochrane Central Register. The included studies evaluated milrinone groups compared to groups receiving either placebo or standard treatment and further compared the systemic administration. Results The network meta-analysis included 723 patients from 16 randomized clinical trials. Overall, there was no significant difference in mortality between the milrinone group and the placebo/standard care group when patients underwent CABG surgery. In addition, 9 trials (with 440 randomized patients), 4 trials (with 212 randomized patients), and 10 trials (with 470 randomized patients) reported that the occurrence of myocardial infarction (MI), myocardial ischemia, and arrhythmia was lower in the milrinone group than in the placebo/standard care group. Between the milrinone treatment and placebo/standard care groups, the occurrence of myocardial infarction, myocardial ischemia, and arrhythmia was significantly different. However, the occurrence of stroke and renal failure, the duration of inotropic support (h), the need for an intra-aortic balloon pump (IABP), and mechanical ventilation (h) between these two groups showed no differences. Conclusions Based on the current results, compared with placebo, milrinone might be unable to decrease mortality in adult CABG surgical patients but can significantly ameliorate the occurrence of MI, myocardial ischemia, and arrhythmia. These results provide evidence for the further clinical application of milrinone and of therapeutic strategies for CABG surgery. However, along with milrinone application in clinical use, sufficient data from randomized clinical trials need to be collected, and the potential benefits and adverse effects should be analyzed and reevaluated.
Collapse
Affiliation(s)
- Yu-Shan Ren
- Shandong New Time Pharmaceutical Co, Ltd., Linyi, China.,National Engineering and Technology Research Center of Chirality Pharmaceutica, Lunan Pharmaceutical Group Co, Ltd., Linyi, China.,State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co, Ltd., Linyi, China
| | - Lan-Fang Li
- Shandong New Time Pharmaceutical Co, Ltd., Linyi, China.,State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co, Ltd., Linyi, China
| | - Tao Peng
- Shandong New Time Pharmaceutical Co, Ltd., Linyi, China.,State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co, Ltd., Linyi, China
| | - Yu-Jun Tan
- Shandong New Time Pharmaceutical Co, Ltd., Linyi, China.,National Engineering and Technology Research Center of Chirality Pharmaceutica, Lunan Pharmaceutical Group Co, Ltd., Linyi, China.,State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co, Ltd., Linyi, China
| | - Ying Sun
- Shandong New Time Pharmaceutical Co, Ltd., Linyi, China.,State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co, Ltd., Linyi, China
| | - Guo-Liang Cheng
- Shandong New Time Pharmaceutical Co, Ltd., Linyi, China.,State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co, Ltd., Linyi, China
| | - Gui-Min Zhang
- Shandong New Time Pharmaceutical Co, Ltd., Linyi, China.,National Engineering and Technology Research Center of Chirality Pharmaceutica, Lunan Pharmaceutical Group Co, Ltd., Linyi, China.,State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co, Ltd., Linyi, China
| | - Jie Li
- Shandong New Time Pharmaceutical Co, Ltd., Linyi, China. .,National Engineering and Technology Research Center of Chirality Pharmaceutica, Lunan Pharmaceutical Group Co, Ltd., Linyi, China. .,State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co, Ltd., Linyi, China.
| |
Collapse
|
9
|
Pan YX, Wang JC, Lu XY, Chen JB, He W, Chen JC, Wang XH, Fu YZ, Xu L, Zhang YJ, Chen MS, Lai RC, Zhou ZG. Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: A double-blind randomized clinical trial. Surgery 2020; 167:933-941. [DOI: 10.1016/j.surg.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 02/07/2023]
|
10
|
Two-stage goal-directed therapy protocol for non-donor open hepatectomy: an interventional before–after study. J Anesth 2019; 33:656-664. [DOI: 10.1007/s00540-019-02688-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
|
11
|
Weinberg L, Mackley L, Ho A, Mcguigan S, Ianno D, Yii M, Banting J, Muralidharan V, Tan CO, Nikfarjam M, Christophi C. Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study. BMC Anesthesiol 2019; 19:135. [PMID: 31366327 PMCID: PMC6668127 DOI: 10.1186/s12871-019-0803-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/12/2019] [Indexed: 12/27/2022] Open
Abstract
Background Right hepatectomy is a complex procedure that carries inherent risks of perioperative morbidity. To evaluate outcome differences between a low central venous pressure fluid intervention strategy and a goal directed fluid therapy (GDFT) cardiac output algorithm we performed a retrospective observational study. We hypothesized that a GDFT protocol would result in less intraoperative fluid administration, reduced complications and a shorter length of hospital stay. Methods Patients undergoing hepatectomy using an established enhanced recovery after surgery (ERAS) programme between 2010 and 2017 were extracted from a prospectively managed electronic hospital database. Inclusion criteria included adult patients, undergoing open right (segments V-VIII) or extended right (segments IV-VIII) hepatectomy. Primary outcome: amount of intraoperative fluid administration used between the two groups. Secondary outcomes: type and amount of vasoactive medications used, the development of predefined postoperative complications, hospital length of stay, and 30-day mortality. Complications were defined by the European Perioperative Clinical Outcome definitions and graded according to Clavien-Dindo classification. The association between GDFT and the amount of fluid and vasoactive medication used was investigated using logistic and linear regression models. Results Fifty-eight consecutive patients were identified. 26 patients received GDFT and 32 received Usual care. There were no significant differences in baseline patient characteristics. Less intraoperative fluid was used in the GDFT group: median (IQR) 2000 ml (1175 to 2700) vs. 2750 ml (2000 to 4000) in the Usual care group; p = 0.03. There were no significant differences in the use of vasoactive medications. Postoperative complications were similar: 9 patients (35%) in the GDFT group vs. 18 patients (56%) in the Usual care group; p = 0.10, OR: 0.41; (95%CI: 0.14 to 1.20). Median (IQR) length of stay for patients in the GDFT group was 7 days (6:8) vs. 9 days (7:13) in the Usual care group; incident rate ratio 0.72 (95%CI: 0.56 to 0.93); p = 0.012. There was no difference in perioperative mortality. Conclusions In patients undergoing open right hepatectomy with an established ERAS programme, use of GDFT was associated with less intraoperative fluid administration and reduced hospital length of stay when compared to Usual care. There were no significant differences in postoperative complications or mortality. Trial registration Australian New Zealand Clinical Trials Registry: no12619000558123 on 10/4/19.
Collapse
Affiliation(s)
- Laurence Weinberg
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia. .,Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia.
| | - Lois Mackley
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Alexander Ho
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Steven Mcguigan
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Damian Ianno
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Matthew Yii
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Jonathan Banting
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | | | - Chong Oon Tan
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Chris Christophi
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| |
Collapse
|