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Rustagi PS, Yadav A, Nellore SS. Ultrasonographic evaluation of diaphragmatic excursion changes after major laparoscopic surgeries in the Trendelenburg position under general anaesthesia: A prospective observational study. Indian J Anaesth 2023; 67:S274-S280. [PMID: 38187984 PMCID: PMC10768898 DOI: 10.4103/ija.ija_643_23] [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: 07/06/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims Laparoscopic surgeries result in increased intra abdominal pressure and cephalad displacement of the diaphragm. The Trendelenburg position can augment these respiratory changes. The primary objective of this study was to compare diaphragmatic excursions before and after a major laparoscopic pelvic surgery under general anaesthesia in the Trendelenburg position using ultrasonography (USG). Methods This prospective observational study included 90 patients of either gender, aged 20-60 years, with American Society of Anesthesiologists physical status I/II. M-mode USG was used to assess diaphragm inspiratory amplitude (DIA) before induction of anaesthesia and 10 minutes after tracheal extubation. Factors such as age, gender, body mass index, positive end-expiratory pressure (PEEP), pain, peak airway pressures, duration of pneumoperitoneum, duration and degree of Trendelenburg position and duration of anaesthesia were recorded. Pearson's correlation and multiple linear regression were used to analyse the factors affecting change in DIA (ΔDIA). Results The mean difference (95% confidence interval (CI)) of measured DIA was 0.70 (0.598-0.809), P < 0.001. ΔDIA had a weak positive significant correlation with age, anaesthesia duration, pneumoperitoneum, and visual analogue scale (VAS) score 10 minutes after extubation. Multiple linear regression analysis showed 14.86% of the variance in DIA. Age (β = 0.008, P = 0.049), duration of anaesthesia (β = 0.002, P = 0.02) and VAS score 10 minutes after extubation (β = 0.128, P = 0.001) were significant independent predictors. Conclusion DIA decreased significantly after pelvic laparoscopic surgeries performed in the Trendelenburg position. Age, duration of anaesthesia and pain after the procedure were significant independent predictors.
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Affiliation(s)
- Preeti Sachin Rustagi
- Department of Anaesthesiology, 4 Floor, Lokmanya Tilak Municipal Medical College Building, Sulochana Shetty Road, Sion, Mumbai, Maharashtra, India
| | - Akshay Yadav
- Department of Anaesthesiology, 4 Floor, Lokmanya Tilak Municipal Medical College Building, Sulochana Shetty Road, Sion, Mumbai, Maharashtra, India
| | - Shalaka Sandeep Nellore
- Department of Anaesthesiology, 4 Floor, Lokmanya Tilak Municipal Medical College Building, Sulochana Shetty Road, Sion, Mumbai, Maharashtra, India
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Popescu M, Olita MR, Stefan MO, Mihaila M, Sima RM, Tomescu D. Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery. BMC Anesthesiol 2022; 22:356. [PMID: 36411445 PMCID: PMC9677621 DOI: 10.1186/s12871-022-01900-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Video-assisted surgery has become an increasingly used surgical technique in patients undergoing major thoracic and abdominal surgery and is associated with significant perioperative respiratory and cardiovascular changes. The aim of this study was to investigate the effect of intraoperative pneumoperitoneum during video-assisted surgery on respiratory physiology in patients undergoing robotic-assisted surgery compared to patients undergoing classic laparoscopy in Trendelenburg position. METHODS Twenty-five patients undergoing robotic-assisted surgery (RAS) were compared with twenty patients undergoing classic laparoscopy (LAS). Intraoperative ventilatory parameters (lung compliance and plateau airway pressure) were recorded at five specific timepoints: after induction of anesthesia, after carbon dioxide (CO2) insufflation, one-hour, and two-hours into surgery and at the end of surgery. At the same time, arterial and end-tidal CO2 values were noted and arterial to end-tidal CO2 gradient was calculated. RESULTS We observed a statistically significant difference in plateau pressure between RAS and LAS at one-hour (26.2 ± 4.5 cmH2O vs. 20.2 ± 3.5 cmH2O, p = 0.05) and two-hour intervals (25.2 ± 5.7 cmH2O vs. 17.9 ± 3.1 cmH2O, p = 0.01) during surgery and at the end of surgery (19.9 ± 5.0 cmH2O vs. 17.0 ± 2.7 cmH2O, p = 0.02). Significant changes in lung compliance were also observed between groups at one-hour (28.2 ± 8.5 mL/cmH2O vs. 40.5 ± 13.9 mL/cmH2O, p = 0.01) and two-hour intervals (26.2 ± 7.8 mL/cmH2O vs. 54.6 ± 16.9 mL/cmH2O, p = 0.01) and at the end of surgery (36.3 ± 9.9 mL/cmH2O vs. 58.2 ± 21.3 mL/cmH2O, p = 0.01). At the end of surgery, plateau pressures remained higher than preoperative values in both groups, but lung compliance remained significantly lower than preoperative values only in patients undergoing RAS with a mean 24% change compared to 1.7% change in the LAS group (p = 0.01). We also noted a more significant arterial to end-tidal CO2 gradient in the RAS group compared to LAS group at one-hour (12.9 ± 4.5 mmHg vs. 7.4 ± 4.4 mmHg, p = 0.02) and two-hours interval (15.2 ± 4.5 mmHg vs. 7.7 ± 4.9 mmHg, p = 0.02), as well as at the end of surgery (11.0 ± 6.6 mmHg vs. 7.0 ± 4.6 mmHg, p = 0.03). CONCLUSION Video-assisted surgery is associated with significant changes in lung mechanics after induction of pneumoperitoneum. The observed changes are more severe and longer-lasting in patients undergoing robotic-assisted surgery compared to classic laparoscopy.
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Affiliation(s)
- Mihai Popescu
- grid.8194.40000 0000 9828 7548Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 2nddistrict, 022328 Bucharest, Romania ,grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihaela Roxana Olita
- grid.8194.40000 0000 9828 7548Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 2nddistrict, 022328 Bucharest, Romania ,grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Mara Oana Stefan
- grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Mariana Mihaila
- grid.415180.90000 0004 0540 9980Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Romina-Marina Sima
- grid.8194.40000 0000 9828 7548Department of Obstetrics and Gynecology, Bucur Maternity, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Dana Tomescu
- grid.8194.40000 0000 9828 7548Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 2nddistrict, 022328 Bucharest, Romania ,grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
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Patel SK, Bansal S, Puri A, Taneja R, Sood N. Correlation of Perioperative Atelectasis With Duration of Anesthesia, Pneumoperitoneum, and Length of Surgery in Patients Undergoing Laparoscopic Cholecystectomy. Cureus 2022; 14:e24261. [PMID: 35475248 PMCID: PMC9018945 DOI: 10.7759/cureus.24261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/05/2022] Open
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Vanamail PV, Balakrishnan K, Prahlad S, Chockalingam P, Dash R, Soundararajan DK. Ultrasonographic Assessment of Diaphragmatic Inspiratory Amplitude and Its Association with Postoperative Pulmonary Complications in Upper Abdominal Surgery: A Prospective, Longitudinal, Observational Study. Indian J Crit Care Med 2021; 25:1031-1039. [PMID: 34963722 PMCID: PMC8664028 DOI: 10.5005/jp-journals-10071-23962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Diaphragmatic dysfunction following upper abdominal surgery is less recognized due to a lack of diagnostic modality for bedside evaluation. We used point-of-care ultrasound to evaluate the diaphragmatic inspiratory amplitude (DIA) in upper abdominal surgery for cancer. Our primary hypothesis was DIA would be reduced in the immediate postoperative period in patients with postoperative pulmonary complications (PPCs). Our aim was to identify an optimal cutoff of DIA for the diagnosis of PPCs. Methods We conducted a prospective, observational study in patients aged 18-75 years undergoing elective, upper abdominal oncological surgeries under combined general and epidural anesthesia. Ultrasound evaluation of the diaphragm was done by measuring the DIA in the right and left hemidiaphragms during quiet and deep breathing on the day before surgery and postoperative days (PODs) 1, 2, and 3. Patients were followed up for PPCs until POD 7. The linear mixed-effects model examined the association between DIA and PPCs and other perioperative factors. Receiver-operating characteristics analysis was done to determine the optimal cutoff of DIA in diagnosing PPCs. Results DIA measured in the 162 patients showed a significant decrease in their absolute values postoperatively from its preoperative baseline measurement. This decrease in DIA was significantly associated with PPC [right hemidiaphragm, β = -0.17, 95% confidence interval (CI) -0.31 to -0.02, p = 0.001 during quiet breathing; left hemidiaphragm, β = -0.24, 95% CI = -0.44 to -0.04, p = 0.018 and β = -0.40, 95% CI = -0.71 to -0.09, p = 0.012 during quiet and deep breathing, respectively]. A cutoff value of DIA of left hemidiaphragm at 1.3 cm during quiet breathing and 1.6 cm during deep breathing had a sensitivity of 77 and 75%, respectively, in their ability to diagnose PPCs [left hemidiaphragm quiet breathing, area under the curve (AUC): 0.653, 95% CI 0.539-0.768, p = 0.015; left hemidiaphragm deep breathing, AUC: 0.675, 95% CI 0.577-0.773, p = 0.007]. Conclusion Following upper abdominal surgery, the DIA is decreased and associated with PPCs. DIA of left hemidiaphragm less than 1.3 cm during quiet breathing and 1.6 cm during deep breathing has a sensitivity of 77 and 75%, respectively, in diagnosing PPCs following upper abdominal surgery. How to cite this article Vanamail PV, Balakrishnan K, Prahlad S, Chockalingam P, Dash R, Soundararajan DK. Ultrasonographic Assessment of Diaphragmatic Inspiratory Amplitude and Its Association with Postoperative Pulmonary Complications in Upper Abdominal Surgery: A Prospective, Longitudinal, Observational Study. Indian J Crit Care Med 2021;25(9):1031-1039.
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Affiliation(s)
- Prasanna V Vanamail
- Department of Anaesthesiology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Kalpana Balakrishnan
- Department of Anaesthesiology, Pain and Palliative Care, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Sarojini Prahlad
- Department of Radiology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Punitha Chockalingam
- Department of Anaesthesiology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Radhika Dash
- Department of Anaesthesiology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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Farag E, Rivas E, Bravo M, Hussain S, Argalious M, Khanna S, Seif J, Pu X, Mao G, Bain M, Elgabaly M, Esa WAS, Sessler DI. Sugammadex Versus Neostigmine for Reversal of Rocuronium Neuromuscular Block in Patients Having Catheter-Based Neurointerventional Procedures: A Randomized Trial. Anesth Analg 2021; 132:1666-1676. [PMID: 34032663 DOI: 10.1213/ane.0000000000005533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Catheter-based endovascular neurointerventions require deep neuromuscular blocks during the procedure and rapid subsequent recovery of strength to facilitate neurological evaluation. We tested the primary hypothesis that sugammadex reverses deep neuromuscular blocks faster than neostigmine reverses moderate neuromuscular blocks. METHODS Patients having catheter-based cerebral neurointerventional procedures were randomized to: (1) deep rocuronium neuromuscular block with posttetanic count 1 to 2 and 4-mg/kg sugammadex as the reversal agent or (2) moderate rocuronium neuromuscular block with train-of-four (TOF) count 1 during the procedure and neuromuscular reversal with 0.07-mg/kg neostigmine to a maximum of 5 mg. Recovery of diaphragmatic function was assessed by ultrasound at baseline before the procedure and 90 minutes thereafter. The primary outcome-time to reach a TOF ratio ≥0.9 after administration of the designated reversal agent-was analyzed with a log-rank test. Secondary outcomes included time to successful tracheal extubation and the difference between postoperative and preoperative diaphragmatic contraction speed and distance. RESULTS Thirty-five patients were randomized to sugammadex and 33 to neostigmine. Baseline characteristics and surgical factors were well balanced. The median time to reach TOF ratio ≥0.9 was 3 minutes (95% confidence interval [CI], 2-3 minutes) in patients given sugammadex versus 8 minutes (95% CI, 6-10 minutes) in patients given neostigmine. Sugammadex was significantly faster by a median of 5 minutes (95% CI, 3-6 minutes; P < .001). However, times to tracheal extubation and diaphragmatic function at 90 minutes did not differ significantly. CONCLUSIONS Sugammadex reversed deep rocuronium neuromuscular blocks considerably faster than neostigmine reversed moderate neuromuscular blocks. However, times to extubation did not differ significantly, apparently because extubation was largely determined by the time required for awaking from general anesthesia and because clinicians were willing to extubate before full neuromuscular recovery. Sugammadex may nonetheless be preferable to procedures that require a deep neuromuscular block and rapid recovery.
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Affiliation(s)
- Ehab Farag
- From the Department of Outcomes Research.,Department of General Anesthesia, Cleveland Clinic, Cleveland, Ohio
| | - Eva Rivas
- From the Department of Outcomes Research.,Department of Anesthesia, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universidad de Barcelona, Barcelona, Spain
| | | | | | - Maged Argalious
- From the Department of Outcomes Research.,Department of General Anesthesia, Cleveland Clinic, Cleveland, Ohio
| | - Sandeep Khanna
- From the Department of Outcomes Research.,Department of General Anesthesia, Cleveland Clinic, Cleveland, Ohio
| | - John Seif
- From the Department of Outcomes Research.,Department of General Anesthesia, Cleveland Clinic, Cleveland, Ohio
| | - Xuan Pu
- From the Department of Outcomes Research.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Guangmei Mao
- From the Department of Outcomes Research.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Mark Bain
- Cerebrovascular Center, Neurological Institute and
| | | | - Wael Ali Sakr Esa
- From the Department of Outcomes Research.,Department of General Anesthesia, Cleveland Clinic, Cleveland, Ohio
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Changes in diaphragmatic excursion and lung compliance during gynaecologic surgery: open laparotomy versus laparoscopy-a prospective observational study. Sci Rep 2020; 10:21458. [PMID: 33293568 PMCID: PMC7722851 DOI: 10.1038/s41598-020-78375-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022] Open
Abstract
This study compared the effects of open versus laparoscopic radical hysterectomy on intraoperative diaphragmatic excursion and lung compliance. We enrolled 20 women per group; Group O’s members underwent open radical hysterectomy, while Group L’s members underwent laparoscopic radical hysterectomy. Diaphragmatic excursion was measured by assessing tidal ventilation using M-mode ultrasonography before intubation (T0), after intubation with mechanical ventilation (T1), 90 min after incision (T2), and at the end of the operation with recovery of muscle relaxation (T3). Peak inspiratory pressure and static lung compliance were measured using an anaesthesia machine combined with a ventilator. Diaphragmatic excursion was significantly lower in Group L than in Group O at T2 (5.3 ± 1.7 mm vs. 7.7 ± 2.0 mm, P < 0.001) and T3 (8.4 ± 1.9 vs. 10.4 ± 2.4, P = 0.011). Impaired diaphragmatic excursion at T3 (< 10 mm under mechanical ventilation) occurred in 15 patients (83.3%) in Group L and seven (38.9%) in Group O (P = 0.006). Changes over time in peak inspiratory pressure and static lung compliance differed significantly between the two groups (P < 0.001 each). Laparoscopic radical hysterectomy decreased diaphragmatic excursion and static lung compliance significantly more than open radical hysterectomy. Korean clinical trial number: Korean Clinical Trials Registry (KCT0004477) (Date of registration: November 18 2019) (https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=14963<ype=&rtype=).
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Karlsson J, Fodor GH, dos Santos Rocha A, Lin N, Habre W, Wallin M, Hallbäck M, Peták F, Lönnqvist P. Determination of adequate positive end-expiratory pressure level required for carbon dioxide homeostasis in an animal model of infant laparoscopy. Acta Anaesthesiol Scand 2020; 64:1114-1119. [PMID: 32386340 DOI: 10.1111/aas.13617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Capnoperitoneum provides a ventilatory challenge due to reduction in end-expiratory lung volume and peritoneal carbon dioxide absorption in both children and adults. The primary aim of this controlled interventional trial was to determine the positive end-expiratory pressure (PEEP) level needed to ensure for adequate carbon dioxide clearance and preservation of carbon dioxide homeostasis in an experimental model of infant laparoscopy. The secondary aim was to evaluate potential effects on cardiac output of PEEP and abdominal pressure level variations in the same setting. METHODS Eight chinchilla bastard rabbits were anesthetized and mechanically ventilated. Intra-abdominal pressures were randomly set to 0, 6, and 12 mm Hg by carbon dioxide insufflation. Carbon dioxide clearance using volumetric capnography, arterial blood gas data, and cardiac output was recorded, while PEEP 3, 6, and 9 cmH2 O were applied in a random order. RESULTS A PEEP of 9 cmH2 O showed restoration of carbon dioxide clearance without causing changes in arterial partial pressure of carbon dioxide and bicarbonate and with no associated deterioration in cardiac output. CONCLUSION The results promote a PEEP level of 9 cmH2 O in this model of infant capnoperitoneum to allow for adequate carbon dioxide removal with subsequent preservation of carbon dioxide homeostasis. The use of high PEEP was not associated with any decrease in cardiac output.
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Affiliation(s)
- Jacob Karlsson
- Anestesi‐ochIntensivvårdsavdelningen Department of Physiology and Pharmacology (FYFA) C3, Eiksson I Lars Group – Section of Anesthesiology and Intensive Care Karolinska Institute Stockholm Sweden
- Pediatric Perioperative Medicine and Intensive Care Karolinska University Hospital Eugenivägen 23 Stockholm Sweden
| | - Gergely H. Fodor
- Unit for Anaesthesiological Investigations Department of Anesthesiology Pharmacology Intensive Care and Emergency Medicine University of Geneva Geneva Switzerland
| | - Andre dos Santos Rocha
- Unit for Anaesthesiological Investigations Department of Anesthesiology Pharmacology Intensive Care and Emergency Medicine University of Geneva Geneva Switzerland
| | - Na Lin
- Unit for Anaesthesiological Investigations Department of Anesthesiology Pharmacology Intensive Care and Emergency Medicine University of Geneva Geneva Switzerland
| | - Walid Habre
- Unit for Anaesthesiological Investigations Department of Anesthesiology Pharmacology Intensive Care and Emergency Medicine University of Geneva Geneva Switzerland
- Pediatric Anesthesia Unit Geneva Children’s Hospital Geneva Switzerland
| | - Mats Wallin
- Anestesi‐ochIntensivvårdsavdelningen Department of Physiology and Pharmacology (FYFA) C3, Eiksson I Lars Group – Section of Anesthesiology and Intensive Care Karolinska Institute Stockholm Sweden
- Maquet Critical Care AB Solna Sweden
| | | | - Ferenc Peták
- Departmenet of Medical Physics and Informatics University of Szeged Szeged Hungary
| | - Per‐Arne Lönnqvist
- Anestesi‐ochIntensivvårdsavdelningen Department of Physiology and Pharmacology (FYFA) C3, Eiksson I Lars Group – Section of Anesthesiology and Intensive Care Karolinska Institute Stockholm Sweden
- Pediatric Perioperative Medicine and Intensive Care Karolinska University Hospital Eugenivägen 23 Stockholm Sweden
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Abd Ellatif SE, Mowafy SMS. Ultrasonographic evaluation of the effect of recruitment maneuvers and positive end-expiratory pressure on diaphragmatic functions in obese patients undergoing laparoscopic sleeve gastrectomy: A randomized controlled study. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1762281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Shereen E. Abd Ellatif
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherif M. S. Mowafy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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