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Si J, Li X, Wang Y, Feng N, Cui M. Effects of adding low-dose esketamine to sufentanil and propofol sedation during cervical conization: a single-centre, randomized controlled trial. BMC Anesthesiol 2024; 24:15. [PMID: 38178016 PMCID: PMC10765731 DOI: 10.1186/s12871-023-02389-2] [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: 05/03/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Cervical conization is a brief but painful procedure that can be performed under sufficient sedation with propofol and opioids. However, this sedation approach comes with a high risk of sedation-related adverse events (SRAEs). Esketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, causes less cardiorespiratory depression than opioids. The aim of this study was to assess the efficacy and safety of adding a low dose of esketamine to propofol and sufentanil sedation as an opioid-reduced regimen. METHODS A total of 122 consecutive patients with ASA I-II, body mass index < 30, and STOP-BANG score < 3 who underwent cervical conization were enrolled and randomly divided into Group S and Group ES. Using a closed-loop target-controlled infusion (TCI) pump with a target bispectral index (BIS) value of 60 ± 5, patients in Group S were sedated with 0.2 mcg·kg-1 sufentanil and propofol, while patients in Group ES were sedated with 0.15 mg·kg-1 esketamine, 0.1 mcg·kg-1 sufentanil and propofol. The primary outcome was the incidence and severity of SRAEs, while the secondary outcomes included effectiveness of sedation, awakening time, psychotomimetic side effects, postoperative pain, postoperative nausea and vomiting, and patient and gynaecologist satisfaction. RESULTS Data from 120 patients were analysed. The incidence of composite SRAEs was significantly higher in Group S than in Group ES (85.0% vs. 56.7%, P < 0.05). Furthermore, the severity of SRAEs was higher in Group S than in Group ES (P < 0.001). There were no significant differences in the effectiveness of sedation, awakening time, psychotomimetic side effects, postoperative pain, postoperative nausea and vomiting, or patient and gynaecologist satisfaction between the two groups. CONCLUSION Adding low-dose esketamine to propofol and sufentanil sedation reduces the incidence and severity of SRAEs in patients undergoing cervical conization, with equal sedation efficacy, recovery quality, and no additional psychomimetic side effects. TRIAL REGISTRATION ChiCTR2000040457 , 28/11/2020.
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Affiliation(s)
- Jiguo Si
- Department of Anesthesiology, Zibo Central Hospital, Zibo, China
| | - Xiaomin Li
- Department of Anesthesiology, Zibo Central Hospital, Zibo, China
| | - Yuqi Wang
- Department of Anesthesiology, Zibo Central Hospital, Zibo, China
| | - Nianhai Feng
- Department of Anesthesiology, Zibo Central Hospital, Zibo, China
| | - Min Cui
- Department of Anesthesiology, Zibo Maternal and Child Health Care Hospital, Zibo, China.
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Fukano K, Iizuka Y, Ueda T, Fukuda Y, Otsuka Y, Sanui M. Comparison of Sedation With Ketamine-Propofol Versus Propofol-Fentanyl for Elderly Patients Undergoing Prostate Biopsy: A Retrospective Observational Study. Cureus 2023; 15:e42650. [PMID: 37644922 PMCID: PMC10461593 DOI: 10.7759/cureus.42650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Procedural sedation is increasingly used for elderly patients, but there is no established ideal method for elderly patients who are prone to respiratory and circulatory depression. This study aims to investigate the association of respiratory complications and the combination of ketamine-propofol versus fentanyl-propofol in elderly patients undergoing prostate biopsy requiring deep sedation. METHODS This was a single-center, retrospective, observational study conducted from April 2020 to March 2021. We included male patients aged 65 years and older scheduled for prostate biopsy under procedural sedation. Ketamine-propofol and fentanyl-propofol were administered at the discretion of the anesthesiologist. The primary outcome was the need for assisted ventilation. The secondary outcome was the duration of oxygen saturation (SpO2) below 90%. RESULTS We enrolled 120 patients over 65 years, and 92 patients were included in the final analysis. The anesthesiologist administered an initial dose of ketamine and propofol of 1:1 to 1:4 of 1.0 mg kg-1 (interquartile range: 0.98 to 1.17) or administered an initial dose of fentanyl of 0.05 to 0.1 mg and a target-controlled infusion of propofol of 2.8 μg ml-1 (interquartile range: 2.0 to 3.0) followed by additional doses at the discretion of the anesthesiologist. Ketamine-propofol was associated with a reduced need for assisted ventilation and a shorter duration of SpO2 below 90% than propofol-fentanyl (95.7% vs. 4.3%, P < 0.05; 0.64 minutes vs. 0.17 minutes, P = 0.26). CONCLUSIONS Ketamine-propofol is associated with a significantly reduced need for assisted ventilation compared to propofol-fentanyl during procedural sedation and analgesia for procedures requiring deep sedation for the elderly.
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Affiliation(s)
- Kentaro Fukano
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Yusuke Iizuka
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Takahiro Ueda
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Yu Fukuda
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Yuji Otsuka
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
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Fang L, Chen X, Zhang H, Bao X, Duan G, Cao T, Jin M, Li H. Laryngeal mask general anaesthesia versus spinal anaesthesia for promoting early recovery of cervical conisation: A randomised, controlled clinical study. Heliyon 2023; 9:e15121. [PMID: 37095968 PMCID: PMC10121804 DOI: 10.1016/j.heliyon.2023.e15121] [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: 07/12/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/26/2023] Open
Abstract
Background Although both spinal and general anaesthesia provides good anaesthesia for cervical conization, spinal anaesthesia delays the return of lower limb movements and urinary function, whereas general anaesthesia requires the patient to be unconscious. It is unclear which anaesthetic technique is more conducive to early postoperative recovery in patients undergoing cervical conization. Patients and methods 140 patients undergoing cervical conization underwent either laryngeal mask general anaesthesia (LMA, n = 70) or spinal anaesthesia (SA, n = 70). In the LMA group, an i-gel mask was used for airway management. In the SA group, spinal anaesthesia was received with 0.75% ropivacaine (15 mg) in the L3-4 interval. The quality of recovery score (QoR-15) was the primary endpoint of the study. Secondary endpoints included incidence of adverse 24-h analgesia (NRS>3); return of lower limb activity; first bed activity and feeding; and the number of catheters removed at 6, 12 and 24 h postoperatively. Result The LMA group significantly improved QoR-15 scores (136.62 ± 11.02 vs 119.97 ± 12.75; P < 0.001); and reduced the incidence of poor analgesia (NRS >3) within 24 h postoperatively (20% vs 42.8%, P = 0.006); reduced time in bed (15.62 ± 3.83 h vs 18.27 ± 5.57 vs, P = 0.001); improved patient satisfaction (86% vs 27%; P < 0.001); and catheters removal within 24 h (70/70 vs 42/70, P < 0.001). Conclusion LMA general anaesthesia can facilitate early postoperative recovery in patients undergoing cervical conization compared with conventional spinal anaesthesia. Trial registration Chinese Clinical Trial Registry (ID: ChiCTR1800019384), http://www.chictr.org.cn/listbycreater.aspx (08/11/2018).
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Affiliation(s)
- Liang Fang
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Xiyuan Chen
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Haolin Zhang
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Xiaohang Bao
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Guangyou Duan
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Ting Cao
- Department of Gynecology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Man Jin
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Hong Li
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
- Corresponding author. Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, People's Liberation Army of China(PLA), No.83 Xinqiao Street, Shapingba District, Chongqing, 400037, China.
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Wang L, Wang Y, Ma L, Wang Y, Mu X, Huang Z, Zheng Z, Nie H. Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial. Drug Des Devel Ther 2023; 17:1233-1243. [PMID: 37125082 PMCID: PMC10132382 DOI: 10.2147/dddt.s405057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose This study aimed to compare the cardiopulmonary safety of remimazolam and propofol in patients undergoing cervical conization. Methods This was a single-blind, parallel, randomized controlled study. A total of 204 patients scheduled for day surgery of cold knife cervical conization received either remimazolam-alfentanil anesthesia (remimazolam group) or propofol-alfentanil anesthesia (propofol group). The primary outcome was the incidence of intraoperative cardiopulmonary adverse events (a composite outcome of hypotension, bradycardia and hypoxemia). The occurrence of hypotension, bradycardia, hypoxemia and the degree of body movement were secondary outcomes, as well as the moment at which consciousness was lost, the interval between the end of anesthesia and the operating room's release of the patient, and the overall dosage of alfentanil administered during the procedure. Results The incidence of intraoperative cardiopulmonary adverse events was 45 (44.1%) in the remimazolam group and 72 (70.6%) in the propofol group (absolute risk difference [95% CI], -26.47% [-39.55% to -13.39%]; odds ratio (OR) [95% CI], 0.43 [0.28 to 0.65]; P < 0.001). The remimazolam group showed lower incidences of hypotension and hypoxemia compared to the propofol group (P = 0.01 for both). No significant differences were observed in the overall alfentanil dosages administered, bradycardia, bodily movement, or time to losing consciousness between the two groups. Conclusion In patients who underwent cold knife cervical conization, remimazolam-alfentanil anesthesia was associated with a reduced incidence of intraoperative cardiopulmonary adverse events compared with propofol-alfentanil anesthesia.
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Affiliation(s)
- Lini Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Yi Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Li Ma
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Yiting Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Xiaoxiao Mu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Zhaoxu Huang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Ziyu Zheng
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Huang Nie
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
- Correspondence: Huang Nie; Ziyu Zheng, Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Changle West Road 127, Xi’an, Shaanxi, 710032, People’s Republic of China, Email ;
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Padhi PP, Yeeda S, Nayak LK, Das S. Procedural Sedation Using Two Different Proportions of Ketamine-Propofol Combination in Short Gynecological Procedures: A Randomized Controlled Trial. Cureus 2022; 14:e21393. [PMID: 35198301 PMCID: PMC8854425 DOI: 10.7759/cureus.21393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Procedural sedation with a combination of propofol and ketamine for short-duration surgeries is a convenient technique of anesthesia as it has a faster recovery avoiding the side effects of general anesthesia. The aim of this study was to compare the sedative and analgesic effects of two different proportions of ketamine and propofol combination in patients undergoing short gynecological procedures. Methods: A randomized double-blind study was conducted in 140 patients posted for elective gynecological procedures with a duration equal to or less than 30 minutes. After premedication of all participants, sedation was induced with bolus administration (0.1 mL/kg) of the study drugs to achieve desired Ramsay sedation score (RSS) of 6, followed by infusion at 0.3 mL/kg/h (Group A, ketamine:propofol in the ratio of 1:4 and Group B, ketamine:propofol in the ratio of 1:2). The adequacy of sedation, volume of drug to induce the patient, time to achieve desired RSS, time for first bolus dose, the total volume of the drugs, hemodynamic variables, awakening time, and side effects were observed. Results: The incidence of movement of lower extremities was found to be significantly lower in the higher concentration ketamine group (Group B, P - 0.028). The volume of a drug for induction and the duration to reach RSS of 6 were significantly lower in Group B with P-values of 0.002 and <0.001, respectively. Hemodynamic variables, awakening time, and side effects were not statistically significant between the two groups. Conclusion: Ketamine-propofol combination in the ratio 1:2 provides better sedation and analgesia with no increased side-effects compared to ketamine-propofol in the ratio 1:4 for short outpatient gynecological procedures.
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Aydemir S, Alagöz A, Ulus F, Tunç M, Sazak H, Yilmaz Demirci N. Is there any difference between oral preemptive pregabalin vs. placebo administration on response to EBUS-TBNA under sedation? Turk J Med Sci 2021; 51:195-203. [PMID: 33172225 PMCID: PMC7991850 DOI: 10.3906/sag-2005-305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background/aim The aim of this study is to evaluate the effects of preemptive oral pregabalin on hemodynamic response, anxiety, sedation, and recovery in patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under sedation with intravenous ketamine-propofol combination. Materials and methods Sixty patients were included in this study, and patients were randomly divided into two equal groups to receive the placebo (Group 1) versus pregabalin 150 mg (Group 2) one hour prior to EBUS- TBNA procedure. Patients received 0.25 mg kg-1 ketamine and 0.25 mg kg-1 propofol mixture (ketofol) for sedation. Timing of the parameters was defined as follows; T0: in hospital ward before pregabalin or placebo administration, T1: premedication, T2: in operating room, T3: before the procedure, T4: initiation, T5: 3 min after induction, T6: 6 min after induction, T7: 9 min after induction, and T8: 12 min after induction. Hemodynamic parameters, severity of coughing, sedation and anxiety scores, and complications were recorded. The level of satisfaction of the bronchoscopist and the patients were evaluated at the end of the procedure. Results The heart rate and mean arterial pressure were significantly higher in Group 1 (P = 0.008, P = 0.04). Total doses of anesthetics, recovery time, and desaturation rate were significantly higher in Group 1 (P = 0.014, P = 0.001, P = 0.045). In Group 2, SpO2 level was significantly higher at various time periods (T1; P = 0.025, T4; P =0.043, T6; P = 0.001, T7; P = 0.003, T8; P < 0.001). The severity of coughing was found significantly lower in Group 2 (T4; P = 0.011, T5; P = 0.01, T6; P = 0.02, T7; P = 0.03, T8; P < 0.01). Anxiety scores were significantly lower in Group 2 (P < 0.001). Conclusion Preemptive oral pregabalin, in addition to sedation with ketamine-propofol combination, was effective in providing limited hemodynamic response, restricted coughing reflex, and lower anxiety during EBUS-TBNA. Besides, with pregabalin usage, decreased anesthetics consumption, lower complication rate, and shorter recovery time might have contributed to safety of the procedure and comfort of the bronchoscopist.
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Affiliation(s)
- Semih Aydemir
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Ali Alagöz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Fatma Ulus
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Mehtap Tunç
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Hilal Sazak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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Ali I, Alahdal M, Xia H, S El Moughrabi A, Shiqian H, Yao S. Ketofol performance to reduce postoperative emergence agitation in children undergoing adenotonsillectomy. Libyan J Med 2020; 15:1688450. [PMID: 31771436 PMCID: PMC6882471 DOI: 10.1080/19932820.2019.1688450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Emergence agitation is a reformed state of mindfulness, which starts with a sudden form of anesthesia and progresses through the early repossession age. Thus, the purpose of this study is to evaluate 1:3 ketofol performance on children 3–15 years old undergoing adenotonsillectomy.Methods: A total of 60 children aged 3–15 years undergoing adenotonsillectomy were randomly allocated to receive low-dose ketamine 0.15 mg/kg followed by propofol 0.45 mg/kg i.v. ketofol (1:3) about 10 min before the end of surgery in comparison to 60 children aged 3–15 years who received only normal saline and dextrose. Anesthesia was induced and maintained with sevoflurane. Postoperative pain and EA were assessed with objective pain score (OPS) and the Pediatric Anesthesia Emergence Delirium (PAED) scale, respectively. EA was defined as a PAED 10 points. Recovery profile and postoperative complications were also recorded.Results: The incidence and severity of EA were found significantly lower in the ketofol group in comparison to the control group with a percentage of (13.33% vs 48.33%) (8% vs 15%) respectively (P < 0.05). Also, the time for interaction from anesthetic tainted to extubating in the ketofol set was significantly less than in the control group (P < 0.05). Interestingly, there are no opposing events such as nausea, laryngospasm, bronchospasm, hypotension, bradycardia, bleeding, or postoperative respiratory depression (respiratory rate: <16) were noticed in the ketofol supervision (P > 0.05). Moreover, the heart rate was meaningfully higher in the control group starting at the time of tracheal extubating in comparison to the children undergone ketofol (P < 0.05). Alert score and time from painkilling tainted till liberation from PACU showed substantial significant changes at ketofol set (P < 0.05).Conclusion: Ketofol (1:3) shows significant performance to reduce postoperative agitation in the children undergone adenotonsillectomy.
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Affiliation(s)
- Idress Ali
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesia, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesiology, Alwehda Teaching Hospital, Dhamar University, Dhamar city, Yemen
| | - Murad Alahdal
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People's Hospital (The First Hospital Affiliated to Shenzhen University, Health Science Center), Shenzhen, P. R. China.,Department of Medical Laboratories, school of medicine, Hodeidah University, Al-Hudaydah city, Yemen
| | - Haifa Xia
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesia, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Arafa S El Moughrabi
- Department of Oral & Maxillofacial Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huang Shiqian
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesia, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanglong Yao
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesia, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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