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Das PP, Tiwari T, Raman R, Gautam S, Kushwaha BB, Kumar Y. Clinical Performance of I-gel ® and BlockBuster™ Laryngeal Mask Airway in Adult Patients during General Anesthesia: A Randomized Comparison. Int J Appl Basic Med Res 2024; 14:108-113. [PMID: 38912364 PMCID: PMC11189260 DOI: 10.4103/ijabmr.ijabmr_520_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: 11/27/2023] [Revised: 02/19/2024] [Accepted: 03/18/2024] [Indexed: 06/25/2024] Open
Abstract
Background Supraglottic devices have revolutionized the current practice of airway management. We compared the clinical performance of a recently introduced BlockBuster™ Laryngeal mask airway with i-gel® in adult patients under general anesthesia. Methods Following Institutional ethical clearance, the present study was conducted on 62 patients belonging to American Society of Anesthesiologists physical status 1 and 2 of either sex in the age group of 20-60 years under general anesthesia. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups (31 per group). Time for successful insertion, insertion success rate, ease of insertion, oropharyngeal leak pressures (OLPs), and complications were assessed. Results Mean insertion time of device was less in Group I (13.52 ± 2.58 s) than that of Group B (14.10 ± 2.04 s), which was neither clinically nor statistically significant (P = 0.330). OLP in Group B (24.52 ± 2.77 cm of H2O) was found to be significantly higher compared to Group I (20.81 ± 2.56 cm of H2O) with P < 0.001. Overall insertion and first attempt success was similar (i-gel® 31/31 [100%] and 29/31 [93.5%] and BlockBuster™ 31/31 [100%] and 29/31 [93.5%], respectively). Ease of insertion (P = 0.684) and complications (P = 0.782) of both the devices were comparable. Conclusions Both the devices are useful and effective for airway management in adult under general anesthesia. Having a high OLP and comparable insertion time, risk of aspiration may be further reduced with the use of BlockBuster™ in comparison to i-gel®.
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Affiliation(s)
- Prerna Prabhat Das
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tanmay Tiwari
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh Raman
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shefali Gautam
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - B. B. Kushwaha
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Yatendra Kumar
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
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Shetabi H, Naserzadeh Z. Impact of Oropharyngeal Stimulation during Laryngeal Mask Insertion on Cardiovascular Response in adult patients. A Double-blind Clinical Trial Study. Bull Emerg Trauma 2024; 12:58-66. [PMID: 39224468 PMCID: PMC11366265 DOI: 10.30476/beat.2024.101902.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/24/2024] [Indexed: 09/04/2024] Open
Abstract
Objective Laryngeal mask airway (LMA) insertion has been found to reduce cardiovascular responses when compared to laryngoscopy and intubation. This research aimed to examine the impact of various techniques employed for LMA insertion on cardiovascular response. Methods This randomized, double-blind clinical trial included 90 elective surgery candidates divided into three groups of 30. All patients underwent similar anesthesia. The LMA was inserted using the classical technique, 180° rotation technique, and face-to-face triple maneuver technique (FFTMT). The cardiovascular responses, the success rate of LMA placement, and other outcomes were documented and compared among the three methods. Results The study revealed that the blood pressure of patients 10 minutes after LMA insertion using the rotational technique was higher than the standard technique (p=0.019). The pulse rate in the third (p=0.044, p=0.024) and fifth minutes (p=0.028, p=0.048) following the insertion of LMA demonstrated higher values when utilizing the FFTMT than the standard and rotational technique groups, respectively. Moreover, the incidence of sore throat following surgery in the FTFTM group was slightly greater than that observed with the standard and rotation techniques (p=0.389 and p=0.688, respectively). Conclusion The findings of the present investigation indicated that implementing the classic technique for LMA placement resulted in a more consistent blood pressure (BP) and pulse rate (PR) response than the 180° rotation and FFTMT. Furthermore, the classical method exhibited a marginally lower success rate in terms of LMA insertion than the alternative methods.
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Affiliation(s)
- Hamidreza Shetabi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Naserzadeh
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
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Totonchi Z, Siamdoust SAS, Zaman B, Rokhtabnak F, Alavi SA. Comparison of laryngeal mask airway (LMA) insertion with and without muscle relaxant in pediatric anesthesia; a randomized clinical trial. Heliyon 2022; 8:e11504. [PMID: 36406720 PMCID: PMC9672355 DOI: 10.1016/j.heliyon.2022.e11504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/14/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction This study aimed to evaluate the effectiveness of using muscle relaxant on the ease of laryngeal mask airway (LMA) insertion and possibility of its related complications. Methods This double-blind, randomized clinical trial was performed on 60 children aged 1–4 years with ASA (American Society of Anesthesiology) I or II with upper limb injuries who were candidates for surgery. The patients were randomly allocated to the two groups receiving atracurium group as muscle relaxant (MR) or saline group (S). Results Regarding ease of placement, the LMA was inserted in 66.7% and 63.3% of patients straightforwardly in the MR and S groups, respectively. While it was performed with one maneuver in 23.3% and 26.7% of cases in the MR and S groups, respectively (p = 0.955). Moreover, LMA dislodgment in the two groups was 36.7% in the MR group and 20.0% in the S group without a meaningful difference (P = 0.152). The only complication observed in the two groups was laryngospasm, which occurred in 0.10% and 13.3% in the MR and S groups, respectively (p = 0.688). Conclusion In some pediatric anesthesia, the use of atracurium, as a muscle relaxant had no significant effect on capability of LMA insertion, maintaining airway patency, LMA seal pressure and oxygenation variations. Moreover, it did not have a preventive effect on the occurrence of complications such as laryngospasm.
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Lakshmi TC, Tiwari T, Agrawal J, Kapoor R, Vasanthakumar V. Comparison of the clinical performance of the i-gelTM, LMA SupremeTM, and Ambu AuraGainTM in adult patients during general anesthesia: a prospective and randomized study. Korean J Anesthesiol 2022; 75:316-322. [PMID: 34673744 PMCID: PMC9346280 DOI: 10.4097/kja.21212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Supraglottic airway devices (SADs) are routinely used for securing the airway. In this study, the clinical performance of three SADs in adult patients under general anesthesia was compared. METHODS American Society of Anesthesiologists physical status I-III subjects were randomly assigned to the i-gelTM (I), LMA SupremeTM (L), or Ambu AuraGainTM (A) group (30 per group). The primary objective of this study was to compare insertion times. Additionally, the ease of insertion, number of attempts, oropharyngeal leak pressure (OLP), airway maneuver requirement, difficulty with gastric tube placement, and complications were assessed. RESULTS Demographic data did not differ between the groups. Group I (16.9 ± 4.9 s) had a significantly shorter time of insertion than Group L (19.6 ± 5.2 s) and Group A (22.1 ± 5.7 s) (P = 0.001). The OLP for Group A (29.8 ± 3.0 cmH2O) was higher than those for Group L (24.1 ± 6.3 cmH2O) and Group I (9.4 ± 6.1 cmH2O) (P < 0.001). The number of insertion attempts (P = 0.232), ease of insertion (P = 0.630), airway maneuver requirement (P = 0.585), difficulty with gastric tube placement (P = 0.364), and complications (P = 0.873) were not significantly different between the groups. CONCLUSIONS All three devices are convenient and effective for airway management in adults under general anesthesia. However, the shorter insertion time required for the i-gel may make it more suitable for resuscitation and emergencies, while aspiration risk may be reduced with the Ambu AuraGain, given its high OLP.
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Affiliation(s)
| | - Tanmay Tiwari
- Department of Anesthesiology and Critical Care, King George’s Medical University, Lucknow, India
| | - Jyotsna Agrawal
- Department of Anesthesiology and Critical Care, King George’s Medical University, Lucknow, India
| | - Rajni Kapoor
- Department of Anesthesiology and Critical Care, King George’s Medical University, Lucknow, India
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Wahba RM, Ragaei MZ, Metry AA, Nakhla GM. Supraglottic Airway Devices for Elective Pediatric Anesthesia: I-gel versus Air-Q, Which is the Best? Anesth Essays Res 2021; 14:461-466. [PMID: 34092859 PMCID: PMC8159035 DOI: 10.4103/aer.aer_107_20] [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: 12/08/2020] [Revised: 01/01/2021] [Accepted: 02/15/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: The objectives of the study were to compare the insertion facility, the effect on hemodynamic parameters, and effective ventilation using I-gel versus Air-Q supraglottic airway devices (SADs) for pediatric patients undergoing short-duration surgical procedures. Patients and Methods: One hundred and fifty children aged 3–10 years were randomly divided into two equal groups: Group I received I-gel and Group Q received Air-Q SAD. All patients were anesthetized by sevoflurane inhalation using a face mask without neuromuscular blockade. Study outcomes included SAD insertion success rate (SR), insertion time, anatomic alignment of the SAD to the larynx as judged using fiberoptic bronchoscope (FOB) inserted through the SAD, and tidal volume leak, and incidence of postoperative complications. Results: Total and first attempt SRs were 97.3% and 85.3% for I-gel and 94.7% and 82.7% respectively, for Air-Q with nonsignificant differences. However, I-gel insertion time (12.3 ± 3.6 s.) was significantly (P = 0.034) shorter than Air-Q (13.7 ± 4.2 s). FOB grading of laryngeal view through SAD was better with I-gel but without significant difference for patients who had view Grades 1-2. Percentage of tidal volume loss was significantly decreased at 5 min after insertion than immediately after insertion, in all patients, with a nonsignificant difference in favor of I-gel. Intraoperative hemodynamic changes and postoperative complications showed a nonsignificant difference between both the groups. Conclusion: Both Air-Q and I-gel SAD provided advantages for pediatric anesthesia during short-duration surgical procedure with nonsignificant differences. However, I-gel SAD required a shorter insertion time and provided a high SR which is satisfactory for trainees and during an emergency. I-gel SAD allowed minimization of tidal volume leak and gastric inflation and is associated with infrequent complications.
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Affiliation(s)
- Rami Mounir Wahba
- Department of Anesthesia and ICU, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Milad Zekry Ragaei
- Department of Anesthesia and ICU, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ayman Anis Metry
- Department of Anesthesia and ICU, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - George Mikhael Nakhla
- Department of Anesthesia and ICU, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Cho CK, Change M, Lee SJ, Sung TY. Effects of neuromuscular blocking agents on the clinical performance of i-gel ® and surgical condition in elderly patients undergoing hand surgery: a prospective randomized controlled trial. Int J Med Sci 2021; 18:2381-2388. [PMID: 33967615 PMCID: PMC8100647 DOI: 10.7150/ijms.57489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/02/2021] [Indexed: 12/05/2022] Open
Abstract
Background: The effects of neuromuscular blocking agents on the clinical performance of supraglottic airway devices and surgical condition in elderly patients undergoing hand surgery have not been established. We evaluated the effects of rocuronium on the clinical performance of an i-gel® supraglottic device and surgical condition in elderly patients undergoing orthopedic hand surgery. Methods: Patients aged 65-85 years were randomized to receive either rocuronium (rocuronium group) or saline (control group). We compared the rates of successful insertion of the i-gel on the first attempt as a primary outcome and also assessed the adequacy of i-gel maintenance during controlled ventilation, anesthetic requirement, surgical condition, and recovery time. Results: The rates of successful insertion of the i-gel on a first attempt were 93.1% in the rocuronium group versus 82.1% in the control group (P = 0.423). Peak inspiratory pressure (PIP) was lower in the rocuronium group than in the control group (15.2 vs. 17.9 cmH2O, respectively, P = 0.028). Spontaneous breathing was less common in the rocuronium group (24.1% vs. 57.1%, respectively, P = 0.011). The requirement of additional fentanyl to suppress spontaneous breathing or patient movement was less in the rocuronium group than in the control group (24.1% vs. 50.0%, respectively, P = 0.043). Surgical condition did not differ between the two groups. Recovery time was shorter in the rocuronium group than in the control group (8.4 vs. 9.9 min, respectively, P = 0.030). Conclusions: Rocuronium did not enhance the success rate of inserting the i-gel® or the surgical condition in elderly patients. However, using rocuronium reduced PIP, the frequency of spontaneous breathing, the requirement for additional fentanyl and patients' recovery time.
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Affiliation(s)
- Choon-Kyu Cho
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Minhye Change
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-Jin Lee
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
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Wang MH, Zhang DS, Zhou W, Tian SP, Zhou TQ, Sui W, Zhang Z. Effects of Peak Inspiratory Pressure-Guided Setting of Intracuff Pressure for Laryngeal Mask Airway Supreme™ Use during Laparoscopic Cholecystectomy: A Randomized Controlled Trial. J INVEST SURG 2020; 34:1137-1144. [PMID: 32354298 DOI: 10.1080/08941939.2020.1761487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the effects of peak inspiratory pressure (PIP)-guided intracuff pressure (ICP) modulation of laryngeal mask airway (LMA) Supreme™ during laparoscopic cholecystectomy. METHODS Totally 120 patients were randomly divided using computer-generated numbers into a control group (n = 60; ICP, 60 cmH2O) and a PIP group (n = 60), in which ICP was increased with 5 cmH2O each time from PIP level until no air leaks from the oropharynx. PIP, ICP, cuff volume (CV), oropharyngeal leak pressure (OLP) and leak fraction (LF) were recorded before and after pneumoperitoneum establishment. Postoperative pharyngolaryngeal complications (sore throat, dysphagia, pharyngeal hematoma, and dysphonia) were also recorded. RESULTS Demographic data were similar in the two groups. The CV and ICP before and after pneumoperitoneum were significantly lower in the PIP group (CV: 15.6 ± 2.3 mL and 21.0 ± 2.6 mL; ICP: 14.3 ± 2.9 cmH2O and 20.5 ± 3.4 cmH2O) than in the control group (CV: 33.0 ± 2.8 mL and 32.8 ± 1.9 mL; ICP: 60.0 ± 0.1 cmH2O and 60.0 ± 0.1 cmH2O) (P < 0.05). Although OLP was lower in the PIP group (P < 0.05), the LF was similar in the two groups (P > 0.05). There were fewer postoperative pharyngolaryngeal complications in the PIP group (P < 0.05). CONCLUSIONS Compared with a fixed ICP of 60 cmH2O, PIP-guided ICP modulation during LMA Supreme™ use provided effective airway sealing at a lower CV and ICP, and produced fewer postoperative pharyngolaryngeal complications in patients undergoing laparoscopic cholecystectomy.
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Affiliation(s)
- Mao-Hua Wang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Dong-Sheng Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Wei Zhou
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Shun-Ping Tian
- School of Medicine, Yangzhou University, Yangzhou, China
| | - Tian-Qi Zhou
- Preventive Health Care Office, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Wei Sui
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zhuan Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
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In J, Kang H, Kim JH, Kim TK, Ahn EJ, Lee DK, Lee S, Park JH. Tips for troublesome sample-size calculation. Korean J Anesthesiol 2020; 73:114-120. [PMID: 32229812 PMCID: PMC7113158 DOI: 10.4097/kja.19497] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/09/2020] [Indexed: 01/06/2023] Open
Abstract
Properly set sample size is one of the important factors for scientific and persuasive research. The sample size that can guarantee both clinically significant differences and adequate power in the phenomena of interest to the investigator, without causing excessive financial or medical considerations, will always be the object of concern.
In this paper, we reviewed the essential factors for sample size calculation. We described the primary endpoints that are the main concern of the study and the basis for calculating sample size, the statistics used to analyze the primary endpoints, type I error and power, the effect size and the rationale. It also included a method of calculating the adjusted sample size considering the dropout rate inevitably occurring during the research. Finally, examples regarding sample size calculation that are appropriately and incorrectly described in the published papers are presented with explanations.
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Affiliation(s)
- Junyong In
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Hae Kim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Tae Kyun Kim
- Department of Anesthesiology and Pain Medicine, Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Eun Jin Ahn
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Guro Hospital, Korea University School of Medicine, Seoul, Korea
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Hong Park
- Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Mathew J, Shen S, Liu H. Intraoperative Laryngeal Mask Airway-Related Hiccup: An Overview. ACTA ACUST UNITED AC 2019; 7:145-151. [PMID: 33869664 PMCID: PMC8048698 DOI: 10.31480/2330-4871/103] [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] [Indexed: 12/01/2022]
Abstract
Hiccup is an involuntary contraction of the diaphragm and intercostal muscles resulting in sudden inspiration and closure of the glottis. The presence of hiccup in the perioperative period can be a challenging problem. Sudden movements of the patient from hiccups can interfere preoperative diagnostic procedures, intraoperative hiccup may delay the beginning of surgery, interfere with the surgical process, and affect intraoperative monitoring, and postoperative hiccup may affect would healing and hemodynamic stability. Hiccup can lead to have increased aspiration risk. Hiccup are is an incompletely understood phenomenon with multiple etiologies. Intraoperative hiccup related to laryngeal mask airway placement has been reported, and it presents unique challenges in diagnosis and management. Both pharmacological and non-pharmacological interventions have been utilized with various level of success. All treatment strategies are primarily aimed at interrupting the hiccup reflex arc.
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Affiliation(s)
- Johann Mathew
- Department of Anesthesiology, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140, USA
| | - Shiqian Shen
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Henry Liu
- Department of Anesthesiology, Drexel University College of Medicine, Reading Hospital/Tower Health System, 420 S 5th Avenue, West Reading, PA 19611, USA
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