1
|
Thanikachalam P, Govindan DK. Pain Management during Ultrasound Guided Transvaginal Oocyte Retrieval - A Narrative Review. J Hum Reprod Sci 2023; 16:2-15. [PMID: 37305768 PMCID: PMC10256939 DOI: 10.4103/jhrs.jhrs_141_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 06/13/2023] Open
Abstract
Transvaginal oocyte retrieval (TVOR), done for the purpose of assisted reproduction can instigate enormous pain and therefore requires adequate analgesia with the least adverse effects. As the procedure involves retrieving oocytes for in vitro fertilisation, the effect of the anaesthetic drugs on the oocyte quality should also be considered. This review focuses on the various modes of anaesthesia and the anaesthetic drugs which can be administered safely to provide effective analgesia in normal and in special conditions such as women with pre-existing comorbidities. Medline, Embase, PubMed and Cochrane electronic databases were searched according to modified Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. According to this review, conscious sedation appears to be the most preferred mode of anaesthesia in women undergoing TVOR owing to fewer adverse effects, faster recovery, better patient and specialist comfort and the least effect on oocyte quality and embryo development. Combining it with paracervical block resulted in lesser consumption of the anaesthetic drug, which may have a beneficial effect on the oocyte quality.
Collapse
Affiliation(s)
- Puvithra Thanikachalam
- Department of Obstetrics and Gynaecology, Chettinad Fertility Services, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Dilip Kumar Govindan
- Department of Anaesthesiology, Sri Sathya Sai Medical College and Research Institute, Balaji Vidyapeeth University, Kanchipuram, Tamil Nadu, India
| |
Collapse
|
2
|
Khetarpal R, Chatrath V, Kaur P, Trikha A. Anaesthesia for assisted reproductive technology (ART): A narrative review. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.4103/joacc.joacc_63_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
3
|
Bekele D, Bayable M, Bedane A. Chronic intracranial subdural hematoma after spinal anesthesia for a cesarean section: a case report. J Med Case Rep 2021; 15:492. [PMID: 34615533 PMCID: PMC8496000 DOI: 10.1186/s13256-021-03100-0] [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] [Received: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Subdural hematoma is a rare, potentially devastating, yet curable complication of spinal anesthesia. Differentiation between post-dural puncture headache and subdural hematoma can be difficult, resulting in a delay in diagnosis. Case presentation We present a 28-year-old Ethiopian female patient who underwent elective cesarean section under spinal anesthesia and returned to the emergency department after 1 month with a worsening headache. Brain computed tomography revealed a chronic subdural hematoma with a significant midline shift. The patient recovered completely after surgical evacuation. Conclusions A high index of suspicion and close attention to the pattern and characteristics of the headache, coupled with a meticulous neurologic examination and neuroimaging, can help to achieve timely diagnosis of this serious entity. Investigation with head computed tomography or magnetic resonance imaging is vital.
Collapse
Affiliation(s)
- Delayehu Bekele
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, P.O.Box 143079, Addis Ababa, Ethiopia.
| | - Mehari Bayable
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, P.O.Box 1271, Addis Ababa, Ethiopia
| | - Alemayehu Bedane
- Department of Radiology, Saint Paul's Hospital Millennium Medical College, P.O.Box - 143079, Addis Ababa, Ethiopia
| |
Collapse
|
4
|
Isoflurane impairs oogenesis through germ cell apoptosis in C. elegans. Sci Rep 2021; 11:14481. [PMID: 34262087 PMCID: PMC8280124 DOI: 10.1038/s41598-021-93737-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/23/2021] [Indexed: 02/08/2023] Open
Abstract
Anesthetic isoflurane has been reported to induce toxicity. However, the effects of isoflurane on fecundity remain largely unknown. We established a system in C. elegans to investigate the effects of isoflurane on oogenesis. Synchronized L4 stage C. elegans were treated with 7% isoflurane for 4 h. Dead cells, ROS, embryos, and unfertilized eggs laid by hermaphrodites were measured by fluorescence imaging and counting. The C. elegans with losses of ced-3, cep-1, abl-1, male C. elegans, and oxidative stress inhibitor N-acetyl-cysteine were used in the interaction studies. We found that isoflurane decreased the numbers of embryos and unfertilized eggs and increased the levels of dead cells and ROS in C. elegans. The isoflurane-induced impairment of oogenesis was associated with abl-1, ced-3, but not cep-1. N-acetyl-cysteine attenuated the isoflurane-induced impairment of oogenesis in C. elegans. Mating with male C. elegans did not attenuate the isoflurane-induced changes in oogenesis. These findings suggest that isoflurane may impair oogenesis through abl-1- and ced-3-associated, but not cep-1-associated, germ cell apoptosis and oxidative stress, pending further investigation. These studies will promote more research to determine the potential effects of anesthesia on fecundity.
Collapse
|
5
|
Heo HJ, Kim YY, Lee JH, Lee HG, Baek SM, Kim KM. Comparison of chemical pregnancy rates according to the anesthetic method during ultrasound-guided transvaginal oocyte retrieval for in vitro fertilization: a retrospective study. Anesth Pain Med (Seoul) 2020; 15:49-52. [PMID: 33329789 PMCID: PMC7713849 DOI: 10.17085/apm.2020.15.1.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/08/2019] [Accepted: 07/19/2019] [Indexed: 11/17/2022] Open
Abstract
Background Oocyte retrieval is the most important procedure in in vitro fertilization (IVF). Various anesthetic methods are used to control a patient’s anxiety and pain during IVF; however, there are no recommended anesthetic methods at present. In this study, we retrospectively investigated chemical pregnancy rates according to the anesthetic method used for oocyte retrieval. Methods We reviewed records of patients who underwent oocyte retrieval between January 1, 2012 and December 31, 2017. Patients were divided into the spinal anesthesia (SA) and monitored anesthesia care (MAC) groups. The primary outcome was chemical pregnancy rate after IVF. Results The study included 95 patients. SA was administered in 77 (81%) and MAC in 18 (19%). The overall chemical pregnancy rate was 32.6% (31/95). According to the anesthetic method, the pregnancy rate was 32.5% (25/77) in the SA group and 33.3% (6/18) in the MAC group. There was no statistical difference in the pregnancy rate between the groups (P = 0.575). The procedural time was significantly shorter in the SA group than in the MAC group (P < 0.001). Conclusions Chemical pregnancy rates were not significantly different between the SA and MAC groups. However, the procedure duration was shorter in the SA group than in the MAC group.
Collapse
Affiliation(s)
- Hyun Joo Heo
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Yu Yil Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Ji Hye Lee
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Han Gyeol Lee
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Seung Min Baek
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Ki Man Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| |
Collapse
|
6
|
Anesthesia and analgesia for transvaginal oocyte retrieval. Should we recommend or avoid any anesthetic drug or technique? Curr Opin Anaesthesiol 2019; 32:285-290. [PMID: 31045635 DOI: 10.1097/aco.0000000000000715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The objective of this review is to analyze and summarize the current anesthetic methods used to alleviate pain and discomfort during transvaginal oocyte retrieval procedures (TORP), to try to reach practical recommendations, based on the evidence, which will translate into daily practice, the knowledge on the anesthetic management of patients scheduled for TORP. RECENT FINDINGS There is no strong evidence to recommend the avoidance of any technique or drug for TORP, including nitrous oxide or halogenated agents. Women should be offered any available technique. The evidence available up to date is not convincing enough to recommend avoiding any anesthetic technique in terms of pregnancy and birth rates. SUMMARY TORP is painful for women and different techniques may be used for pain relief in day case surgery. The other important outcome to consider is the pregnancy rate, and any anesthetic technique or drug which would improve this pregnancy rate should be recommended. Conscious sedation and general anesthesia proved to be well tolerated for woman and the oocytes, despite the use of propofol, opioids, benzodiacepines, nitrous oxide, or other drugs. Spinal anesthesia and paracervical block are also acceptable options, and can be combined with conscious sedation. Nevertheless, more studies are needed to find out the ideal drug or technique combination for the woman and the oocyte.
Collapse
|
7
|
Farzi F, Mehrafza M, Mirmansouri A, Sorouri ZZ, Roushan ZA, Raoufi A, Shalkohi R, Samadnia S, Hosseini A. Hemodynamic parameters and reproductive outcome after intracytoplasmic sperm injection and fresh embryo transfer in patients undergoing oocyte retrieval with general anesthesia using fentanyl, remifentanil or alfentanil - A randomized clinical trial. Taiwan J Obstet Gynecol 2019; 58:536-540. [PMID: 31307747 DOI: 10.1016/j.tjog.2019.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Anesthesia for assisted reproductive technology is very important to provide less stressful and painful environment for patients, with minimal side effects on oocytes. In the present study, we aimed to evaluate hemodynamic parameters, recovery time and intracytoplasmic sperm injection (ICSI) outcome among patients underwent anesthesia with fentanyl, remifentanil or alfentanil. MATERIAL AND METHODS This randomized double-blinded clinical trial was conducted in patients undergoing anesthesia for transvaginal ultrasound guided oocyte retrieval (TUGOR). Patients were randomly allocated to alfentanil (A; 15 μg/kg), fentanyl (F; 1.5 μg/kg) or remifentanil (R; 1.5 μg/kg) groups. RESULTS Three hundred forty patients were assessed for eligibility and randomized for transvaginal oocyte retrieval following general anesthesia and 105 were lost to follow up. No statistically significant differences were noted among groups regarding basic characteristics. Although, time to respond to verbal command was significantly different among groups (A: 1.99 ± 1.64, F: 2.56 ± 1.72, R: 1.78 ± 1.34, P = 0.014). There were no significant differences among groups with respect to the first and second postoperative pain intensity, patient satisfaction, pre-induction and post-induction systolic and diastolic blood pressure (BP). Terminal systolic (A: 101.61 ± 9.15, F: 105.29 ± 12.61, R: 102 ± 12.91, P = 0.01) and diastolic (A: 59.97 ± 9, F: 65.63 ± 9.13, R: 63.69 ± 11.01, P = 0.003) BP was significantly different among groups. The fertilization rate was significantly different among groups (A: 51.6%, F: 54.4%, R: 62.2%, P = 0.018). Implantation rate, biochemical and clinical pregnancy rate was similar among groups. CONCLUSIONS The results of present study demonstrated that all three opioids have the same efficiency, in regards to patient satisfaction and pregnancy outcome. However, Anesthesia with alfentanil compared with fentanyl and remifentanil, seems to be inferior for TUGOR due to higher effect on fertilization rate and less hemodynamic stability. REGISTRATION NUMBER IRCT201410258677N4.
Collapse
Affiliation(s)
- Farnoush Farzi
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Marzieh Mehrafza
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Ali Mirmansouri
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Ziba Zahiri Sorouri
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Zahra Atrkar Roushan
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Azadeh Raoufi
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Reyhane Shalkohi
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Sajedeh Samadnia
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Ahmad Hosseini
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| |
Collapse
|
8
|
Saxena D, Rai R, Dixit A, Bhandari S, Sanwatsarkar S. Effect of Body Mass Index on the Efficacy of Paracervical Block for Ultrasound-Guided Transvaginal Oocyte Retrieval as assessed by Requirement of Rescue Propofol. J Hum Reprod Sci 2018; 11:365-369. [PMID: 30787522 PMCID: PMC6333034 DOI: 10.4103/jhrs.jhrs_86_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background and Aims: Oocyte retrieval is the only vital aspect of in vitro fertilization requiring anesthesia. Previous studies have shown the inconclusive role of paracervical block (PCB) in transvaginal oocyte retrieval (TVOR) under ultrasound guidance. This study was planned to observe the role and efficacy of PCB as measured by the amount of propofol used as rescue in patients undergoing TVOR and grading it on the basis of body mass index (BMI). Methods: This prospective, comparative study, conducted over 1 year, recruited 140 American Society of Anesthesiologists I and II patients and divided into two groups as follows: Group A received PCB with 20 ml of 1% lignocaine and Group B received no PCB. Total propofol consumed, BMI, time taken, oocytes retrieved, postprocedure visual analog scale score, and complications were noted. In both the groups, patients were then divided into underweight, normal, overweight, and obese according to BMI. Statistical analysis was done using Statistical Package Mini Tab Version 17.0. The primary objective was to study the efficacy of PCB as estimated by amount of propofol required during the procedure. The secondary aim was to assess the effect of BMI on the efficacy of PCB. Results: Propofol requirement was found to be significantly more (P < 0.05) in Group B patients (172.14 ± 64.15) in comparison to Group A (132.14 ± 66.11). Amount of propofol required in normal BMI and overweight patients was significantly higher in Group B. No significant difference was observed in underweight, and obese patients in both the groups. Conclusion: PCB reduces the consumption of propofol in normal BMI patients. Underweight and obese population do not benefit from PCB.
Collapse
Affiliation(s)
- Dipti Saxena
- Department of Anesthesiology, Sri Aurobindo Institute of Medical Sciences, Mohak Hi-Tech Hospital, Indore, Madhya Pradesh, India
| | - Rajeev Rai
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Atul Dixit
- Department of Anesthesiology, Sri Aurobindo Institute of Medical Sciences, Mohak Hi-Tech Hospital, Indore, Madhya Pradesh, India
| | - Shilpa Bhandari
- Department of Reproductive Medicine, Mohak Hi-Tech Hospital, Indore, Madhya Pradesh, India
| | - Sadhana Sanwatsarkar
- Department of Anesthesiology, Sri Aurobindo Institute of Medical Sciences, Mohak Hi-Tech Hospital, Indore, Madhya Pradesh, India
| |
Collapse
|
9
|
Subacute Intracranial Subdural Hematoma 40 Days After Spinal Anesthesia: A Case Report. ARCHIVES OF NEUROSCIENCE 2015. [DOI: 10.5812/archneurosci.25338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
10
|
Anesthesia Related Toxic Effects on In Vitro Fertilization Outcome: Burden of Proof. BIOMED RESEARCH INTERNATIONAL 2015; 2015:475362. [PMID: 26161404 PMCID: PMC4486487 DOI: 10.1155/2015/475362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 11/17/2022]
Abstract
Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the in vitro fertilization (IVF) procedures. There are many studies investigating the influence of anesthesia on IVF success. This review article provides an overview of published data regarding the potential toxic effects of different anesthetic techniques (Loco-regional, general anesthesia (GA), and monitored anesthesia care (MAC)), different anesthetic agents, and alternative medicine approach (principally acupuncture) on the IVF outcome. From our analysis, evidence of serious toxicity in humans is not well established. Trials regarding different anesthetic techniques ended up without clear conclusions. Studies about GA came up with conflicting results. A few trials relate GA with lower pregnancy rates, although some others failed to prove this conclusion. Furthermore, detectable amounts of some anesthetic agents are measurable in the follicular fluid but these findings are not strongly associated with toxicity. MAC and Loco-regional anesthesia appear as safe alternative choices and there is evidence of improved outcome. Whereas acupuncture may provide assistance increasing IVF success according to some trials, some others could not obtain these effects. Questions about the appropriate time of application and the underlying mechanism of action are not answered yet, so further investigation should be done.
Collapse
|
11
|
Amiri F, Ghomeishi A, Aslani SMM, Nesioonpour S, Adarvishi S. Comparison of surgical stress responses during spinal and general anesthesia in curettage surgery. Anesth Pain Med 2014; 4:e20554. [PMID: 25289378 PMCID: PMC4183098 DOI: 10.5812/aapm.20554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/14/2014] [Accepted: 07/02/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Response to the surgical stress is an involuntary response to metabolic, autonomic as well as hormonal changes that leads to heart rate and blood pressure fluctuations. OBJECTIVES This study aimed to investigate the effect of general versus spinal anesthesia on blood sugar level and hemodynamic changes in patients undergoing curettage surgery. PATIENTS AND METHODS In this randomized clinical trial, 50 patients who were candidate for elective curettage surgery were divided into two groups of general (n = 25) and spinal (n = 25) anesthesia. In both groups, blood glucose level was evaluated 10 minutes before, 20 and 60 minutes after initiation of anesthesia. Also, heart rate and mean arterial blood pressure were evaluated at 10 minutes before, 10, 20, 30, 40, 50 and 60 minutes after intiation of anesthesia. RESULTS There was not significantly difference between blood glucose level of both groups during 10 minutes before, 20 and 60 minutes after the intiation of anesthesia. Heart rate changes in the general and spinal groups compared to the baseline level were decreased up to maximum12.5% and 14.5%, respectively. The mean arterial pressure changes in the general and spinal groups compared to the baseline level were decreased up to maximum 5.4% and 8%, respectively. CONCLUSIONS Blood glucose and hemodynamic changes caused by surgical stress were not significantly different between two groups.
Collapse
Affiliation(s)
- Fereshteh Amiri
- Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Ghomeishi
- Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mohammad Mehdi Aslani
- Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sholeh Nesioonpour
- Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sara Adarvishi
- Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding author: Sara Adarvishi, Student Research Committee, Nursing and Midwifery School, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Azadegan Ave., Ahvaz, Iran. Tel: +98-6112220168, Fax: +98-6112220168, E-mail:
| |
Collapse
|
12
|
Mohseni M, Safari S, Alavian SM. Volatile anesthetics in ischemic liver injury: enemy or friend? HEPATITIS MONTHLY 2014; 14:e19880. [PMID: 24976844 PMCID: PMC4071358 DOI: 10.5812/hepatmon.19880] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/01/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Masood Mohseni
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, IR Iran
| | - Saeid Safari
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases Center (MELD), Tehran, IR Iran
| | - Seyed Moayed Alavian
- Middle East Liver Diseases Center (MELD), Tehran, IR Iran
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Seyed Moayed Alavian, Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188945186, Fax: +98-2188945188, E-mail:
| |
Collapse
|