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Peršec J, Šribar A, Ilić M, Mamić I, Kifer D, Domijan AM, Maleš Ž, Turčić P. Effects of epidurally administered dexmedetomidine and dexamethasone on postoperative pain, analgesic requirements, inflammation, and oxidative stress in thoracic surgery. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2023; 73:691-708. [PMID: 38147472 DOI: 10.2478/acph-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 12/28/2023]
Abstract
The aim of this study was to compare the effects of dexmedetomidine and dexamethasone as adjuvants to preoperative epidural administration of local anesthetic (ropivacaine) in thoracic surgery on the postoperative level of pain, use of analgesics, inflammation, and oxidative stress. The study enrolled 42 patients who underwent elective thoracic surgery in a one-year period at the University Hospital Dubrava (Zagreb, Croatia). Based on a computer-generated randomization list the patients were assigned to the dexmedetomidine (n = 18) or dexamethasone (n = 24) group. Postoperatively, patients of dexmedetomidine group reported lower pain (VAS value 1 h post surgery, 3.4 ± 2.7 vs. 5.4 ± 1.8, dexmedetomidine vs. dexamethasone, p < 0.01) and had lower anal-gesic requirements in comparison with dexamethasone group. Thus, dexmedetomidine in comparison with dexamethasone was more efficient in lowering pain and analgesia requirements 24 h after the surgery. On the contrary, dexamethasone had better anti-inflammatory properties (CRP level 24 h post surgery, 131.9 ± 90.7 vs. 26.0 ± 55.2 mg L-1, dexmedetomidine vs. dexamethasone, p < 0.01). Both dexmedetomidine and dexamethasone exhibited antioxidant effects, however, their antioxidant properties should be further explored. The results of this study improve current knowledge of pain control in thoracic surgery.
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Affiliation(s)
- Jasminka Peršec
- 1Clinical Department for Anesthesiology Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Croatia
- 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Andrej Šribar
- 1Clinical Department for Anesthesiology Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Croatia
- 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Monika Ilić
- 1Clinical Department for Anesthesiology Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Croatia
| | - Ivan Mamić
- 3University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmacology, Zagreb, Croatia
| | - Domagoj Kifer
- 4University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Biophysics, Zagreb, Croatia
| | - Ana-Marija Domijan
- 5University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmaceutical Botany, Zagreb, Croatia
| | - Željan Maleš
- 5University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmaceutical Botany, Zagreb, Croatia
| | - Petra Turčić
- 3University of Zagreb Faculty of Pharmacy and Biochemistry, Department of Pharmacology, Zagreb, Croatia
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Abdildin YG, Tapinova K, Nabidollayeva F, Viderman D. Epidural dexamethasone for acute postoperative pain management: a systematic review with meta-analysis. Pain Manag 2023; 13:129-141. [PMID: 36718798 DOI: 10.2217/pmt-2022-0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Aim: To study the effect of epidural dexamethasone in postoperative pain management. Methods: Random-effects meta-analysis was conducted in RevMan 5.4. Results: We included nine randomized-controlled trials (RCT) with 657 patients. Dexamethasone demonstrated longer analgesia duration (mean difference 266.18 minutes, 95% CI [3.21,529.14]; p 0.05), lower incidence of nausea and vomiting during the first postoperative day (risk ratio 0.36, 95% CI [0.18,0.71]; p 0.004), and lower antiemetic requirements (risk ratio 0.33, 95% CI [0.14,0.79]; p 0.01). No difference in pain reduction and the length of hospital stay was observed between the groups. Conclusion: Dexamethasone was associated with a longer analgesic effect, a lower number of patients requiring antiemetics, and lower incidences of nausea and vomiting.
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Affiliation(s)
- Yerkin G Abdildin
- School of Engineering & Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana, 010000, Kazakhstan
| | - Karina Tapinova
- Nazarbayev University School of Medicine (NUSOM), 5/1 Kerei & Zhanibek Khans Str., Astana, 020000, Kazakhstan
| | - Fatima Nabidollayeva
- School of Engineering & Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana, 010000, Kazakhstan
| | - Dmitriy Viderman
- Nazarbayev University School of Medicine (NUSOM), 5/1 Kerei & Zhanibek Khans Str., Astana, 020000, Kazakhstan.,Department of Anesthesiology, Intensive Care & Pain Medicine, National Research Oncology Center, 5/1 Kerei & Zhanibek Khans Str., Astana, 020000, Kazakhstan
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Zhou W, Liu F, Fang J, Han L. Dexamethasone in preventive analgesia alleviates pain and complications after jaw cyst enucleation: a randomized controlled trial. BMC Anesthesiol 2022; 22:344. [DOI: 10.1186/s12871-022-01895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Dexamethasone is widely used in the prevention of postoperative complications in oral surgery and strengthening the analgesic effect after anesthesia, but the efficacy is controversial, and the relationship between postoperative complications and pain is still unclear. The purpose of this study was to evaluate the analgesic effect of dexamethasone in the treatment of jaw cyst and to explore the relationship between postoperative complications and pain.
Methods
We conducted a prospective, randomized, double-blind clinical trial. 120 patients were divided into two groups, dexamethasone group ( group D) and control group (Group C). All patients were given 0.02 mg·kg−1 of hydromorphone to relieve pain in advance at 10 min before the beginning of operation. Meanwhile, dexamethasone was injected 0.2 mg·kg−1 intravenously in group D and normal saline was injected in group C. The primary endpoint was pain intensity at 2 h, 6 h, 12 h, 24 h and 48 h after surgery. The secondary endpoints were the incidence and extent of complications after surgery, including facial swelling and trismus.
Results
Compared with group C, the visual analogue scale (VAS) scores and occurrence of painful event postoperatively in group D were significantly lower both at rest (P < 0.0001 and P = 0.0014) and during mobilization (P < 0.0001 both). The degree of facial swelling and trismus in group D were significantly lower than that in group C at 24 h (P < 0.0001 and P = 0.00022) and 48 h (P < 0.0001 and P = 0.00015) after surgery, but there was no difference at 6 h and 12 h (P = 0.137 and P = 0.083) after surgery. The C-reactive protein (CRP) level at 24 h after operation in group D was lower than group C (P = 0.012), but there was no significant difference in blood glucose concentration between the two groups (P = 0.608).
Conclusion
Dexamethasone can reduce the degree of facial swelling and trismus after jaw cyst surgery by inhibiting the production of inflammation, which alleviated the postoperative pain of patients significantly. In addition, it did not increase the risk of hyperglycemia.
Trial registration
This study was registered with the Chinese Clinical Trial Registry on May 07, 2020 (URL: http://www.chictr.org.cn/showproj.aspx?proj=53344. Registry number: ChiCTR2000032693). Registered on 07/05/2020.
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Wasfy SF, Nofal WH, Ammar MA. Dexmedetomidine vs hyaluronidase addition to fluoroscopy-guided caudal analgesia with steroid in lumbosacral spine surgery. A comparative double blinded study. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.1981107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sanaa F. Wasfy
- Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Waleed H. Nofal
- Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mona A. Ammar
- Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abstract
Dexamethasone is a synthetic steroid that has been used for many years in the clinical routine due to its anti-inflammatory, anti-allergic and immunosuppressive properties. Furthermore, dexamethasone has been used for a long time for prophylaxis and treatment of chemotherapy-induced nausea and vomiting. In the meantime dexamethasone has been approved as standard for the prophylaxis and treatment of postoperative nausea and vomiting (PONV). This review article outlines the indications and side effects of the perioperative administration of dexamethasone.
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Affiliation(s)
- B Sinner
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93953, Regensburg, Deutschland.
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van Zuylen ML, ten Hoope W, Bos EME, Hermanides J, Stevens MF, Hollmann MW. Safety of epidural drugs: a narrative review. Expert Opin Drug Saf 2019; 18:591-601. [DOI: 10.1080/14740338.2019.1617271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- ML van Zuylen
- Department of Anesthesiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W ten Hoope
- Department of Anesthesiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - EME Bos
- Department of Anesthesiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Hermanides
- Department of Anesthesiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - MF Stevens
- Department of Anesthesiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - MW Hollmann
- Department of Anesthesiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Acharya R, Sriramka B, Panigrahi S. Comparison of 4 mg dexamethasone versus 8 mg dexamethasone as an adjuvant to levobupivacaine in fascia iliaca block-a prospective study. Korean J Pain 2018; 31:261-267. [PMID: 30310551 PMCID: PMC6177541 DOI: 10.3344/kjp.2018.31.4.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 12/21/2022] Open
Abstract
Background To compare the effects of adding two different doses of dexamethasone on the duration and quality of the fascia iliaca block in patients undergoing proximal femoral fracture surgery. Methods A total of 60 patients (age 18-70 years) undergoing proximal femoral nailing surgery under spinal anesthesia were given fascia iliaca block after random assignment to one of the two groups: Group H received an injection of levobupivacaine (0.5%) 28 ml with 2 ml (8 mg) dexamethasone, and Group L received an injection of levobupivacaine (0.5%) 28 ml with dexamethasone 1 ml (4 mg) with 1 ml normal saline. Assessment of the duration of analgesia and the total tramadol requirement over 48 hours were noted after a successful block. Results The duration of analgesia was found to be significantly longer in Group H (17.02 ± 0.45 h) than in the Group L patients (14.29 ± 0.45 h) with a p-value of 0.000. Postoperative analgesic requirement (amount of tramadol in mg) was significantly higher in Group L (Q2: 200.0; IQR: 100.0, 200.0) as compared to Group H (Q2: 100.0; IQR: 100.0, 200.0) with a p-value of 0.034. No patient showed any sign of neurotoxicity. Conclusions Dexamethasone, in a dose of 8 mg, is superior to 4 mg when used as an adjuvant with levobupivacaine in the FIB. Though both prolonged analgesia and were effective in reducing oral/intravenous analgesics, 8 mg dexamethasone can be recommended as a more efficacious adjuvant to local anesthetics in the FIB.
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Affiliation(s)
- Ranjita Acharya
- Department of Psychiatry, IMS and SUM Hospital, Bhubaneswar, India
| | - Bhavna Sriramka
- Department of Anesthesiology, IMS and SUM Hospital, Bhubaneswar, India
| | - Sandeep Panigrahi
- Department of Community Medicine, IMS and SUM Hospital, Bhubaneswar, India
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Omar H. Magnesium Sulfate as a Preemptive Adjuvant to Levobupivacaine for Postoperative Analgesia in Lower Abdominal and Pelvic Surgeries under Epidural Anesthesia(Randomized Controlled Trial). Anesth Essays Res 2018; 12:256-261. [PMID: 29628592 PMCID: PMC5872875 DOI: 10.4103/aer.aer_194_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Magnesium (Mg) has been evaluated as an adjuvant to local anesthetics for prolongation of postoperative epidural and intrathecal analgesia but not with epidural levobupivacaine in lower abdominal surgeries. Aim of the Study: The aim of the study was to evaluate the preemptive analgesic effect of Mg added to epidural levobupivacaine anesthesia in infraumbilical abdominal surgeries. Settings and Design: This study design was a prospective randomized controlled trial. Patients and Methods: Two groups, each with fifty patients undergoing lower abdominal and pelvic surgeries with epidural anesthesia. Group M received 15 ml of a mixture of 14 ml levobupivacaine 0.5%, 0.5 ml magnesium sulfate 10% (50 mg), and 0.5 ml 0.9 NaCl at induction. Group L received 15 ml of 14 ml levobupivacaine 0.5% and 1 ml 0.9 NaCl at induction. Then, continuous infusion was used as 5 ml/h of the specific mixture of each group till the end of the surgery. Statistical Analysis: Chi-square test, unpaired t-test or Mann–Whitney, and Wilcoxon sign rank test were used. Results: No statistically significant difference between the two groups regarding intraoperative hemodynamics (P > 0.05). Sensory and motor block onset was significantly shorter in Group M (14.5 [±1.51] and 12.42 [±1.69]) compared to Group L (19.86 [±1.39] and 19.34 [±1.62]) (P = 0.001). Group M showed lower visual analog scale (VAS) pain score compared to Group L from the 2nd to the 5th h postoperatively. Time for first analgesic dose was longer in Group M (294.98 [±21.67]) compared to Group L (153.96 [±10.04]) (P = 0.001). Conclusions: Preoperative and intraoperative epidural Mg infusion with levobupivacaine resulted in prolonged postoperative analgesia and lower VAS.
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Affiliation(s)
- Heba Omar
- Department of Anaesthesia, Pain and Surgical Intensive Care, Faculty of Medicine, Cairo University, Cairo, Egypt
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Umari M, Carpanese V, Moro V, Baldo G, Addesa S, Lena E, Lovadina S, Lucangelo U. Postoperative analgesia after pulmonary resection with a focus on video-assisted thoracoscopic surgery. Eur J Cardiothorac Surg 2017; 53:932-938. [DOI: 10.1093/ejcts/ezx413] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/01/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Marzia Umari
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Valentina Carpanese
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Valeria Moro
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Gaia Baldo
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Stefano Addesa
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Enrico Lena
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Stefano Lovadina
- Department of General and Thoracic Surgery, Cattinara University Hospital, Trieste, Italy
| | - Umberto Lucangelo
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara University Hospital, Trieste, Italy
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Swain A, Nag DS, Sahu S, Samaddar DP. Adjuvants to local anesthetics: Current understanding and future trends. World J Clin Cases 2017; 5:307-323. [PMID: 28868303 PMCID: PMC5561500 DOI: 10.12998/wjcc.v5.i8.307] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/03/2017] [Accepted: 05/19/2017] [Indexed: 02/05/2023] Open
Abstract
Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action. A large array of opioids ranging from morphine, fentanyl and sufentanyl to hydromorphone, buprenorphine and tramadol has been used with varying success. However, their use has been limited by their adverse effect like respiratory depression, nausea, vomiting and pruritus, especially with its neuraxial use. Epinephrine potentiates the local anesthetics by its antinociceptive properties mediated by alpha-2 adrenoreceptor activation along with its vasoconstrictive properties limiting the systemic absorption of local anesthetics. Alpha 2 adrenoreceptor antagonists like clonidine and dexmedetomidine are one of the most widely used class of local anesthetic adjuvants. Other drugs like steroids (dexamethasone), anti-inflammatory agents (parecoxib and lornoxicam), midazolam, ketamine, magnesium sulfate and neostigmine have also been used with mixed success. The concern regarding the safety profile of these adjuvants is due to its potential neurotoxicity and neurological complications which necessitate further research in this direction. Current research is directed towards a search for agents and techniques which would prolong local anaesthetic action without its deleterious effects. This includes novel approaches like use of charged molecules to produce local anaesthetic action (tonicaine and n butyl tetracaine), new age delivery mechanisms for prolonged bioavailability (liposomal, microspheres and cyclodextrin systems) and further studies with other drugs (adenosine, neuromuscular blockers, dextrans).
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Hermeto LC, Rossi RD, Bicudo NDA, Assis KT, Escobar LL, Camargo PSD. The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study. Acta Cir Bras 2017; 32:307-318. [DOI: 10.1590/s0102-865020170040000008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/11/2017] [Indexed: 11/21/2022] Open
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Candido KD, Perozo OJ, Knezevic NN. Pharmacology of Acetaminophen, Nonsteroidal Antiinflammatory Drugs, and Steroid Medications: Implications for Anesthesia or Unique Associated Risks. Anesthesiol Clin 2017; 35:e145-e162. [PMID: 28526157 DOI: 10.1016/j.anclin.2017.01.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), and corticosteroids, historically used in perioperative management, are potent analgesic medications. They primarily inhibit the cyclooxygenase (COX) enzyme, decreasing the synthesis of prostaglandins, and modulating pain and temperature. Acetaminophen does not inhibit this synthesis at the inflammatory site. The primary mechanism of action of corticosteroids involves regulation of nuclear expression of genes involved in inflammatory pathways and other systemic effects. Metaanalyses have added purposeful perioperative indications, clarified misconceptions, and established protocols for administering these drugs. Some indications, doses, clinical considerations, and adverse effects need to be further studied.
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Affiliation(s)
- Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA; Department of Anesthesiology, University of Illinois, 1740 W. Taylor Street, Chicago, IL 60612, USA; Department of Surgery, University of Illinois, 840 S. Wood Street, Chicago, IL 60612, USA.
| | - Oscar J Perozo
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA; Department of Anesthesiology, University of Illinois, 1740 W. Taylor Street, Chicago, IL 60612, USA; Department of Surgery, University of Illinois, 840 S. Wood Street, Chicago, IL 60612, USA
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