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Bartoszko J, Miles S, Ansari S, Grewal D, Li M, Callum J, McCluskey SA, Lin Y, Karkouti K. Postoperative intravenous iron to treat iron-deficiency anaemia in patients undergoing cardiac surgery: a protocol for a pilot, multicentre, placebo-controlled randomized trial (the POAM trial). BJA OPEN 2024; 11:100303. [PMID: 39161801 PMCID: PMC11332809 DOI: 10.1016/j.bjao.2024.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/01/2024] [Indexed: 08/21/2024]
Abstract
Background Iron-deficiency anaemia, occurring in 30-40% of patients undergoing cardiac surgery, is an independent risk factor for adverse outcomes. Our long-term goal is to assess if postoperative i.v. iron therapy improves clinical outcomes in patients with preoperative iron-deficiency anaemia undergoing cardiac surgery. Before conducting a definitive RCT, we first propose a multicentre pilot trial to establish the feasibility of the definitive trial. Methods This internal pilot, double-blinded, RCT will include three centres. Sixty adults with preoperative iron-deficiency anaemia undergoing non-emergency cardiac surgery will be randomised on postoperative day 2 or 3 to receive either blinded i.v. iron (1000 mg ferric derisomaltose) or placebo. Six weeks after surgery, patients who remain iron deficient will receive a second blinded dose of i.v. iron according to their assigned treatment arm. Patients will be followed for 12 months. Clinical practice will not be otherwise modified. For the pilot study, feasibility will be assessed through rates of enrolment, protocol deviations, and loss to follow up. For the definitive study, the primary outcome will be the number of days alive and out of hospital at 90 days after surgery. Ethics and dissemination The trial has been approved by the University Health Network Research Ethics Board (REB # 22-5685; approved by Clinical Trials Ontario funding on 22 December 2023) and will be conducted in accordance with the Declaration of Helsinki, Good Clinical Practices guidelines, and regulatory requirements. Clinical trial registration NCT06287619.
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Affiliation(s)
- Justyna Bartoszko
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada
| | - Sarah Miles
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Saba Ansari
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Deep Grewal
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle Li
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Jeannie Callum
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
| | - Stuart A. McCluskey
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Yulia Lin
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Poston JN, Andrews J, Arya S, Chou ST, Cohn C, Covington M, Crowe EP, Goel R, Gupta GK, Haspel RL, Hess A, Ipe TS, Jacobson J, Khan J, Murphy M, O'Brien K, Pagano MB, Panigrahi AK, Salazar E, Saifee NH, Stolla M, Zantek ND, Ziman A, Metcalf RA. Current advances in 2024: A critical review of selected topics by the Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee. Transfusion 2024. [PMID: 39087455 DOI: 10.1111/trf.17975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/14/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Jacqueline N Poston
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Jennifer Andrews
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Stella T Chou
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Claudia Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mischa Covington
- Transfusion Medicine, Harvard University, Boston, Massachusetts, USA
| | - Elizabeth P Crowe
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Internal Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Gaurav K Gupta
- Transfusion Medicine and Cellular therapy, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard L Haspel
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron Hess
- Departments of Anesthesiology and Pathology & Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Tina S Ipe
- Center for Apheresis and Regenerative Medicine, Little Rock, Arkansas, USA
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jessica Jacobson
- Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Jenna Khan
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - Mike Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust, and the University of Oxford, Oxford, UK
| | - Kerry O'Brien
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Anil K Panigrahi
- Departments of Anesthesiology and Pathology, Stanford University, Stanford, California, USA
| | - Eric Salazar
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Nabiha H Saifee
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Moritz Stolla
- Bloodworks Northwest Research Institute, Seattle, Washington, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ryan A Metcalf
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
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Arya S, Howell A, Vernich L, Lin Y, Pavenski K, Freedman J. Re-evaluating treatment thresholds in patient blood management: Female patients experience more perioperative anaemia and higher transfusion rates in major elective surgery. Vox Sang 2024. [PMID: 39048294 DOI: 10.1111/vox.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/24/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND OBJECTIVES By optimizing erythropoiesis, patient blood management (PBM) programmes can reduce transfusions, lower mortality and provide cost-effective care. While definitions of anaemia have historically varied by sex, for the purposes of PBM, anaemia is defined as a haemoglobin <130 g/L. Our objective was to describe whether perioperative anaemia and transfusion rates in the PBM setting vary by sex. MATERIALS AND METHODS We conducted a retrospective study of the Ontario Nurse Transfusion Coordinators Program (ONTraC) database from 2018 to 2022. ONTraC collects data from 25 Ontario hospitals which together account for >70% of Ontario's provincial blood use (~400,000 units per year). We collected data on patients undergoing elective isolated coronary artery bypass graft surgery (CABG), open heart valve replacement, CABG plus valve replacement, single-knee arthroplasty and single-hip arthroplasty. RESULTS From 2018 to 2022, 17,700 patients were included in the ONTraC program; 47% were females (N = 8376). Across almost all years and procedures, females were found to have a significantly lower pre-operative, nadir and discharge haemoglobin as compared with males, irrespective of PBM interventions. Transfusion rates were significantly higher for females; this was most pronounced in cardiac surgery. CONCLUSION Females experienced more perioperative anaemia and higher transfusion rates. Historic sex-specific definitions of anaemia may contribute to a greater tolerance of anaemia in females. Prioritizing females for multimodal PBM and consistently achieving a pre-operative haemoglobin >130 g/L may reduce the amount of red blood cell (RBC) transfusions that female patients receive.
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Affiliation(s)
- Sumedha Arya
- Canadian Blood Services, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Alanna Howell
- Ontario Nurse Transfusion Coordinators Program (ONTraC), Toronto, Ontario, Canada
- Department of Laboratory Medicine, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Lee Vernich
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Transfusion Medicine & Tissue Bank, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - John Freedman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Ontario Nurse Transfusion Coordinators Program (ONTraC), Toronto, Ontario, Canada
- Department of Laboratory Medicine, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
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Ozawa S, Ozawa-Morriello J, Rock R, Sromoski M, Walbolt S, Hall T, Pearse BL. Patient Blood Management as an Emerging Concept in Quality: The Role of Nurses. J Nurs Care Qual 2024; 39:129-135. [PMID: 37350618 DOI: 10.1097/ncq.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Transfusion of blood components has long been considered lifesaving therapy. While blood transfusion may be clinically indicated as a treatment option for some patients, the benefits of transfusion in asymptomatic, hemodynamically stable patients are questionable. PROBLEM Blood component transfusion is routinely used as a default therapy when not clinically indicated, increasing the risk of poor patient outcomes, adverse events, pressures on blood supply and availability, and increased health care costs. APPROACH Nurses have the responsibility to advocate for patients and reduce/avoid unnecessary blood transfusion through the implementation of patient blood management (PBM). The PBM paradigm includes treatment of anemia, minimizing blood loss and bleeding, optimization of coagulation, and employing true patient-centered decision making. CONCLUSIONS PBM should become the standard of care with the goal of improving health care quality and patient outcomes while using the multidisciplinary team for its implementation. As advocates for their patients, nurses can play a major role in the development, implementation, and promotion of PBM.
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Affiliation(s)
- Sherri Ozawa
- Author Affiliations: Deparment of Patient Blood Management (Mss Ozawa and Hall), Accumen Incorporated, Phoenix, Arizona; Department of Clinical Training and Evaluation Center, The University of Western Australia, Perth, Western Australia (Ms Ozawa); Department of Bloodless Medicine and Patient Blood Management, Englewood Health, Englewood, New Jersey (Ms Ozawa and Mr Ozawa-Morriello); Society for the Advancement of Patient Blood Management (SABM), Mt Royal, New Jersey (Ms Ozawa, Rock, Sromoski, Walbolt, and Hall and Mr Ozawa-Morriello); Department of Patient Blood Management and Center for Bloodless Medicine, Geisinger Health System, Danville, Pennsylvania (Mr Ozawa-Morriello and Ms Sromoski); Departments of Bloodless Medicine and Surgery, and Cardiac Surgery Services, Hackensack University Medical Center, Hackensack, New Jersey (Mr Ozawa-Morriello); Department of Patient Blood Management, Alberta Health Services, Calgary, Alberta, Canada (Ms Rock); Association for the Advancement of Blood & Biotherapies (AABB), Bethesda, Maryland (Ms Sromoski); ProMedica Health System, Toledo, Ohio (Ms Walbolt); Department of Patient Blood Management The Prince Charles Hospital, Brisbane, Queensland, Australia (Dr Pearse); and Department of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia (Dr Pearse)
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Arya S, Xiang T, Tang GH, Pavenski K. Including the patient in patient blood management: Development and assessment of an educational animation tool. Transfusion 2023; 63:1488-1494. [PMID: 37317645 DOI: 10.1111/trf.17458] [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: 02/23/2023] [Revised: 04/28/2023] [Accepted: 05/19/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Patient blood management (PBM) programs are effective at reducing transfusion-associated mortality and morbidity; however, patient engagement within the realm of PBM remains relatively unstudied. Our objectives were to develop a novel educational tool utilizing animation to educate preoperative patients about anemia and to evaluate the effectiveness of this intervention. STUDY DESIGN AND METHODS We created a patient-facing animation for preoperative surgical patients. The animation addressed characters' health journeys from diagnosis to treatment, addressing the role of PBM. We utilized the concept of patient activation as a means to empower patients, and developed the animation to be as accessible as possible. Post-viewing, patients provided feedback utilizing an electronic survey. RESULTS A final version of the animation can be found here: https://vimeo.com/495857315. A total of 51 participants viewed our animation, the majority of whom were planned to undergo joint replacement or cardiac surgery. Almost all (94%, N = 4) agreed that taking an active role in their health was the most important factor in determining their ability to function. The video was felt to be easy to understand (96%, N = 49), and 92% (N = 47) agreed that they had a better understanding of anemia and its treatment. After watching the animation, patients felt more certain that they could follow through with their PBM plan (98%, N = 50). DISCUSSION To the best of our knowledge, there are no other PBM-specific patient education animations. Patients enjoyed learning about PBM though animation, and patient education may lead to better uptake of PBM interventions. We hope that other hospitals will be inspired to pursue this approach.
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Affiliation(s)
- Sumedha Arya
- Department of Medicine, Canadian Blood Services, Medical Affairs and Innovation, University of Toronto, Toronto, Ontario, Canada
| | - Tracy Xiang
- Biomedical Communications, Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Grace H Tang
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Katerina Pavenski
- Department of Medicine and Laboratory Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Al-Mozain N, Arora S, Goel R, Pavenski K, So-Osman C. Patient Blood Management in adults and children: what have we achieved, and what still needs to be addressed? Transfus Clin Biol 2023:S1246-7820(23)00041-1. [PMID: 36965848 DOI: 10.1016/j.tracli.2023.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
An overview of Patient Blood Management (PBM), with its main scope to preserve the patient's own blood to improve the patient's outcome, is presented here, including the research gaps that needs to be addressed, particularly in the pediatric age group. Next, novel techniques to analyse PBM data and the challenges and strategies of PBM implementation will also be discussed.
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Affiliation(s)
- Nour Al-Mozain
- Department of Pathology & Laboratory Medicine, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
| | - Satyam Arora
- Department of Transfusion Medicine. Post Graduate Institute of Child Health, Noida, UP, India.
| | - Ruchika Goel
- Department of Pathology, Div. of Transfusion Medicine, Johns Hopkins University, Baltimore, MD, Department of Internal Medicine and Pediatrics, Div. of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine, USA.
| | - Katerina Pavenski
- Departments of Laboratory Medicine and Medicine, St. Michael's Hospital - Unity Health Toronto, Toronto, Canada, Departments of Laboratory Medicine & Pathobiology and Medicine, University of Toronto, Toronto, Canada.
| | - Cynthia So-Osman
- Department of Transfusion medicine, Sanquin Blood Supply, Amsterdam and Department of Haematology, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Gammon RR. Patient blood management using dedicated personnel in the operating room-you get what you pay for. Br J Haematol 2023; 200:543-544. [PMID: 36444962 DOI: 10.1111/bjh.18554] [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: 10/24/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/30/2022]
Abstract
A patient blood management (PBM) strategy can be applied to the process of intraoperative cell salvage for re-infusion during surgery. Stoneham et al. describe an effective PBM strategy applied to abdominal aortic aneurysm repair and emphasise the importance of a qualified and experienced intraoperative cell salvage practitioner to improve the safety and effectiveness of the approach. Commentary on: Stoneham et al. Intraoperative cell salvage using swab wash and serial thromboelastography in elective abdominal aortic aneurysm surgery involving massive blood loss. Br J Haematol 2023;200:652-659.
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Affiliation(s)
- Richard R Gammon
- OneBlood, Scientific, Medical, Technical Direction, Orlando, Florida, USA
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Al-Riyami AZ, Bielby L, Moss R, Rahimi-Levene N, O'Kane A, Hess JR, Saba NE, Kim KH, Arora S, Dua S, Barrett CL, Gonzalez CA, Ferrari DM, Cini PV, Kumagawa M, O'Reilly C, Thrift L, Wendel S, Fachini R, Dias LFS, Tran D, Steinsvåg CT, Dunbar N. International Forum on Transfusion Education for Healthcare Professionals Who Administer Blood to Patients in Hospitals and Health Services: Summary. Vox Sang 2023; 118:310-318. [PMID: 36762626 DOI: 10.1111/vox.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
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Gloff MS, Mazzeffi M, Eaton M. Preoperative Anemia Treatment in Cardiac Surgery: Past Due and Time to Act. J Cardiothorac Vasc Anesth 2023; 37:276-278. [PMID: 36379832 DOI: 10.1053/j.jvca.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Marjorie S Gloff
- University of Rochester, Department of Anesthesiology, Rochester, NY
| | - Michael Mazzeffi
- University of Virginia Health, Department of Anesthesiology, Charlottesville, VA.
| | - Michael Eaton
- University of Rochester, Department of Anesthesiology, Rochester, NY
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