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Zeng K, Long J, Li Y, Hu J. Preventing postoperative cognitive dysfunction using anesthetic drugs in elderly patients undergoing noncardiac surgery: a systematic review and meta-analysis. Int J Surg 2023; 109:21-31. [PMID: 36799783 PMCID: PMC10389238 DOI: 10.1097/js9.0000000000000001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/25/2022] [Indexed: 02/18/2023]
Abstract
Postoperative cognitive dysfunction (POCD) is a common neurological system disorder in surgical patients. The choice of anesthetic can potentially reduce POCD. The authors performed this network meta-analysis to compare different anesthetic drugs in reducing the incidence of POCD for elderly people undergoing noncardiac surgery. We searched MEDLINE, EMBASE, the Cochrane Library, and the Web of Science for randomized controlled trials comparing the different anesthetic drugs for noncardiac surgery in elderly from inception until July, 2022. The protocol was registered on the PROSPERO database (CRD#42020183014). A total of 34 trials involving 4314 patients undergoing noncardiac surgery in elderly were included. The incidence of POCD for each anesthetic drug was placebo (27.7%), dexmedetomidine (12.9%), ketamine (15.2%), propofol (16.8%), fentanyl (23.9%), midazolam (11.3%), sufentanil (6.3%), sevoflurane (24.0%), and desflurane (28.3%). Pairwise and network meta-analysis showed dexmedetomidine was significantly reducing the incidence of POCD when compared with placebo. Network meta-analysis also suggested dexmedetomidine was significantly reducing the incidence of POCD when compared with sevoflurane. Sufentanil and dexmedetomidine ranked the first and second in reducing the incidence of POCD with the surface under the cumulative ranking curve value of 87.4 and 81.5%. Sufentanil and dexmedetomidine had the greatest possibility to reduce the incidence of POCD for elderly people undergoing noncardiac surgery.
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Affiliation(s)
- Kuan Zeng
- Department of Psychiatry, Wuhan Mental Health Center
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology
- Research Center for Psychological and Health Sciences, China University of Geosciences
| | - Jingyi Long
- Department of Psychiatry, Wuhan Mental Health Center
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology
- Research Center for Psychological and Health Sciences, China University of Geosciences
| | - Yi Li
- Department of Psychiatry, Wuhan Mental Health Center
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology
- Research Center for Psychological and Health Sciences, China University of Geosciences
| | - Jichang Hu
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry of China for Neurological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gkliatis E, Makris A, Staikou C. The impact of inhalation anesthetics on early postoperative cognitive function and recovery characteristics in Down syndrome patients: a randomized, double - blind study. BMC Anesthesiol 2021; 21:227. [PMID: 34535086 PMCID: PMC8447517 DOI: 10.1186/s12871-021-01447-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Down syndrome (DS) is associated with intellectual disability. DS patients may be unable to cooperate and often require general anesthesia even for minor surgeries. Rapid recovery significantly contributes to fast-tracking. This prospective randomized, double - blind study investigates the impact of desflurane and sevoflurane on recovery and early postoperative cognitive function of these patients. METHODS Forty-four patients undergoing dental surgery, were randomized to receive desflurane (DES-group) or sevoflurane (SEVO-group) for anesthesia maintenance. The primary outcome was postoperative cognitive function (Prudhoe Cognitive Function Test, PCFT) at 90 min and 4 h postoperatively. Secondary outcome measures were the time between volatile discontinuation and spontaneous breath, eye opening, extubation, orientation and response to commands, time to achieve an Aldrete score ≥ 9 in the Post-anesthesia Care Unit and time to fulfill discharge criteria (Post Anesthetic Discharge Scoring System, PADSS). RESULTS At 90 min, PCFT scores significantly decreased from baseline in both groups. Nevertheless, at 4 h, in DES-group there was no significant change from baseline (p = 0.163), while in SEVO-group the decrease remained significant (p < 0.001). Desflurane was also found superior regarding recovery characteristics, such as time to eye opening (p = 0.021), spatial orientation (p = 0.004), response to commands (p = 0.004). Discharge criteria were met earlier in DES-group (p = 0.018 for Aldrete score / p < 0.001 for PADSS). CONCLUSIONS Desflurane was found superior to sevoflurane in terms of faster recovery and better preserved postoperative cognitive function in DS patients undergoing dental surgery. We suggest that desflurane, as part of a multimodal anesthetic approach, could be a useful agent to enhance early discharge from hospital of ambulatory patients with intellectual disability. TRIAL REGISTRATION Registered with ClinicalTrials.gov ( NCT02971254 , principal investigator: E.G; November 2016).
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Affiliation(s)
- Emmanouil Gkliatis
- Department of Anesthesiology, Asklepieion Hospital of Voula, Vas. Pavlou 1, 16673, Athens, Greece
| | - Alexandros Makris
- Department of Anesthesiology, Asklepieion Hospital of Voula, Vas. Pavlou 1, 16673, Athens, Greece.
| | - Chryssoula Staikou
- Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece, Athens, Greece
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Saha M, Saxena KN, Wadhwa B. Comparative study of recovery of airway reflexes and cognitive function following sevoflurane versus desflurane anaesthesia. Indian J Anaesth 2021; 65:282-288. [PMID: 34103741 PMCID: PMC8174598 DOI: 10.4103/ija.ija_1219_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/15/2020] [Accepted: 02/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims Sevoflurane and desflurane have almost similar blood-gas solubility but recent studies suggest that desflurane compared to sevoflurane leads to faster recovery of airway reflexes, but the recovery of cognitive function varies significantly. We conducted this study to compare the times of recovery from anaesthesia following desflurane versus sevoflurane anaesthesia. Methods This randomised double-blinded study was conducted on 60 patients of American Society of Anesthesiologists (ASA) classification I-II, age between 18 and 60 years with body mass index (BMI) ≤30 kg/m2 who underwent elective cholecystectomy. A standard general anaesthesia protocol was followed with either sevoflurane (group A = 30 patients) or desflurane (group B = 30 patients) along with bispectral index and neuromuscular monitoring. Following extubation, tests for recovery of airway reflexes and cognitive function were conducted and various time intervals were noted. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) standard software version 17. Results The mean time from first verbal response to first passing the swallowing test was comparable in both the groups (5.50 ± 3.45 vs. 4.10 ± 3.42 min, P value = 0.120). Patients receiving desflurane showed faster response to verbal commands (5.93 ± 4.13 vs. 8.20 ± 3.39 min, P value = 0.024), passed the swallowing test earlier (10.03 ± 4.97 vs. 13.70 ± 3.48 min, P value = 0.009) and Short orientation memory concentration test (SOMCT) earlier (9.83 ± 4.51 vs. 14.10 ± 4.31 min, P value ≤0.001) compared to sevoflurane. Conclusion In patients undergoing laparoscopic cholecystectomy under controlled conditions, earlier recovery is seen with desflurane compared to sevoflurane.
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Affiliation(s)
- Mousumi Saha
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Kirti N Saxena
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Bharti Wadhwa
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
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Boggett S, Ou-Young J, Heiberg J, De Steiger R, Richardson M, Williams Z, Royse C. A randomized trial of desflurane or sevoflurane on postoperative quality of recovery after knee arthroscopy. PLoS One 2019; 14:e0220733. [PMID: 31381593 PMCID: PMC6681958 DOI: 10.1371/journal.pone.0220733] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/19/2019] [Indexed: 12/04/2022] Open
Abstract
Background Studies have described different recovery profiles of sevoflurane and desflurane typically early after surgery. Methods We conducted a randomized superiority trial to determine whether Overall Recovery 3 days after knee arthroscopy would be superior with desflurane. Adult participants undergoing knee arthroscopic surgery with general anesthesia were randomized to either desflurane or sevoflurane general anesthesia. Intraoperative and postoperative drugs and analgesics were administered at the discretion of the anesthesiologist. Postoperative quality of recovery was assessed using the “Postoperative Quality of Recovery Scale”. The primary outcome was Overall Recovery 3 days after surgery and secondary outcomes were individual recovery domains at 15 minutes, 40 minutes, 1 day, 3 days, 1 month, and 3 months. Patients and researchers were blinded. Results 300 patients were randomized to sevoflurane or desflurane (age 51.7±14.1 vs. 47.3±13.5 years; duration of anesthesia 24.9±11.1 vs. 23.3±8.3 minutes). The proportion achieving baseline or better scores in all domains increased over the follow-up period in both groups but was not different at day 3 (sevoflurane 43% vs. desflurane 37%, p = 0.314). Similarly, rates of recovery increased over time in the five subdomains, with no differences between groups for physiological, p = 0.222; nociceptive, p = 0.391; emotive, p = 0.30; Activities-of-daily-living, p = 0.593; and cognitive recovery, p = 0.877. Conclusion No significant difference in the quality of recovery scale could be shown using sevoflurane or desflurane general anesthesia after knee arthroscopy in adult participants.
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Affiliation(s)
- Stuart Boggett
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jared Ou-Young
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Johan Heiberg
- Dept. of Cardiothoracic & Vascular Surgery, Aarhus University, Aarhaus, Denmark
| | - Richard De Steiger
- Epworth Healthcare Campus, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Richardson
- Epworth Healthcare Campus, The University of Melbourne, Melbourne, Victoria, Australia
| | - Zelda Williams
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Colin Royse
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
- Outcomes Research Consortium, Cleveland Clinic, Ohio, United States of America
- * E-mail:
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Emergence times and airway reactions during general anaesthesia with remifentanil and a laryngeal mask airway: A multicentre randomised controlled trial. Eur J Anaesthesiol 2019; 35:588-597. [PMID: 29916859 PMCID: PMC6072370 DOI: 10.1097/eja.0000000000000852] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Avoidance of airway complications and rapid emergence from anaesthesia are indispensable for the use of a laryngeal mask airway (LMA). Evidence from adequately powered randomised studies with a low risk of bias for the optimal anaesthetic in this context is limited. OBJECTIVE We tested the hypothesis that when using remifentanil-based intra-operative analgesia, desflurane would be the most suitable anaesthetic: with noninferiority in the occurrence of upper airway complications and superiority in emergence times compared with sevoflurane or propofol. DESIGN A randomised, multicentre, partially double-blinded, three-arm, parallel-group study. SETTING Two university and two regional German hospitals, from February to October 2015. PATIENTS A total of 352 patients (age 18 to 75 years, ASA physical status I to III, BMI less than 35 kg m−2 and fluent in German) were enrolled in this study. All surgery was elective with a duration of 0.5 to 2 h, and general anaesthesia with a LMA was feasible. INTERVENTION The patients were randomised to receive desflurane, sevoflurane or propofol anaesthesia. MAIN OUTCOME MEASURES This study was powered for the primary outcome ‘time to state date of birth’ and the secondary outcome ‘intra-operative cough’. Time to emergence from anaesthesia and the incidence of upper airway complications were assessed on the day of surgery. RESULTS The primary outcome was analysed for 343 patients: desflurane (n=114), sevoflurane (n=111) and propofol (n=118). The desflurane group had the fastest emergence. The mean (± SD) times to state the date of birth following desflurane, sevoflurane and propofol were 8.1 ± 3.6, 10.1 ± 4.0 and 9.8 ± 5.1 min, respectively (P < 0.01). There was no difference in upper airway complications (cough and laryngospasm) across the groups, but these complications were less frequent than in previous studies. CONCLUSION When using a remifentanil infusion for intra-operative analgesia in association with a LMA, desflurane was associated with a significantly faster emergence and noninferiority in the incidence of intra-operative cough than either sevoflurane or Propofol. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02322502; EudraCT identifier: 2014-003810-96.
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Kinjo S, Lim E, Magsaysay MV, Sands LP, Leung JM. Volatile anaesthetics and postoperative delirium in older surgical patients-A secondary analysis of prospective cohort studies. Acta Anaesthesiol Scand 2019; 63:18-26. [PMID: 30051465 DOI: 10.1111/aas.13227] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Volatile Anaesthetics (VAs) may be associated with postoperative delirium (POD). However, to date, the effects of VAs on POD are not completely understood. The objective of this study was to investigate the incidence of POD in different VA groups. METHODS A secondary analysis was conducted using a database created from prospective cohort studies in patients who underwent elective major noncardiac surgery. Patients who received general anaesthesia with desflurane, isoflurane, or sevoflurane were included in the study. POD occurring on either of the first two postoperative days was measured using the Confusion Assessment Method. RESULTS Five hundred and thirty-two patients were included in this study, with a mean age of 73.5 ± 6.0 years (range, 65-96 years). The overall incidence of POD on either postoperative day 1 or 2 was 41%. A higher incidence of POD was noted in the desflurane group compared with the isoflurane group (Odds Ratio = 3.35, 95% CI = 1.54-7.28). The incidence of POD between the sevoflurane and isoflurane or desflurane group was not statistically significant. CONCLUSION Each VA may have different effects on postoperative cognition. Further studies using a prospective randomized approach will be necessary to discern whether anaesthetic type or management affects the occurrence of postoperative delirium.
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Affiliation(s)
- Sakura Kinjo
- Department of Anesthesia and Perioperative Care; University of California, San Francisco; San Francisco California
| | - Eunjung Lim
- Biostatistics Core Facility; Department of Complementary & Integrative Medicine; John A Burns School of Medicine; University of Hawaii; Honolulu Hawaii
| | - Maria Victoria Magsaysay
- Department of Anesthesia and Perioperative Care; University of California, San Francisco; San Francisco California
| | - Laura P. Sands
- Human Development Center for Gerontology; Virginia Polytechnic Institute and State University; Blacksburg Indiana
| | - Jacqueline M. Leung
- Department of Anesthesia and Perioperative Care; University of California, San Francisco; San Francisco California
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Zhang DX, Jiang S, Yu LN, Zhang FJ, Zhuang Q, Yan M. The effect of sevoflurane on the cognitive function of rats and its association with the inhibition of synaptic transmission. Int J Clin Exp Med 2015; 8:20853-20860. [PMID: 26885010 PMCID: PMC4723855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/27/2015] [Indexed: 06/05/2023]
Abstract
To observe the effects of different concentrations of sevoflurane on synaptotagmin 1 (Syt1) expression, synaptic long term depression (LTD), and paired pulse depression (PPD) in the rat hippocampus as well as to investigate the association between these effects and the cognitive function of rats. A total of 24 male Sprague-Dawley (SD) rats were selected and randomly divided into 3 groups: the control group (group A), which inhaled air; group B, which inhaled 0.65 minimum alveolar concentration (MAC) sevoflurane for 2 h; and group C, which inhaled 1.30 MAC sevoflurane for 2 h. The subsequent experiments were performed after one day. (1) Y maze tests were performed, and the expression of Syt1 in hippocampal tissues was detected using western blot. (2) The changes in LTD and PPD in rat hippocampal slices were examined using electrophysiological techniques. Compared to the control group, the cognitive function was decreased and Syt1 expression in the hippocampus was significantly decreased in rats in the 1.30 MAC sevoflurane inhalation group. After 60 min of low frequency stimulation, the amplitudes of population spike (PS) potentials in rat hippocampal slices were significantly decreased. After induction of PPD, the P2/P1 ratio was significantly increased. No indicators in the 0.65 MAC sevoflurane inhalation group showed any significant changes. Inhalation of high concentrations of sevoflurane significantly reduced Syt1 protein levels in the rat hippocampus, significantly inhibited the release of presynaptic neurotransmitters, and reduced the efficiency of synaptic transmission, thus causing memory impairment.
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Affiliation(s)
- Deng-Xin Zhang
- Department of Anesthesiology, The Second Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou 310009, P. R. China
- Department of Anesthesiology, The Affiliated Hospital of Jiangnan University (Wuxi 4th People’s Hospital)Wuxi 214000, P. R. China
| | - Shan Jiang
- Lianyungang Branch of Traditional Chinese Medicine, Jiangsu Union Technical InstituteLianyungang 222007, P. R. China
| | - Li-Na Yu
- Department of Anesthesiology, The Second Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou 310009, P. R. China
| | - Feng-Jiang Zhang
- Department of Anesthesiology, The Second Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou 310009, P. R. China
| | - Qing Zhuang
- Department of Anesthesiology, The Affiliated Hospital of Jiangnan University (Wuxi 4th People’s Hospital)Wuxi 214000, P. R. China
| | - Min Yan
- Department of Anesthesiology, The Second Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou 310009, P. R. China
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Lee KH, Kim JY, Kim JW, Park JS, Lee KW, Jeon SY. Influence of Ketamine on Early Postoperative Cognitive Function After Orthopedic Surgery in Elderly Patients. Anesth Pain Med 2015; 5:e28844. [PMID: 26587403 PMCID: PMC4644306 DOI: 10.5812/aapm.28844] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/11/2015] [Accepted: 06/06/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Postoperative cognitive dysfunction (POCD) is a serious and frequent complication after surgery, especially in elderly patients. Ketamine is an N-methyl D-aspartic acid receptor antagonist with demonstrated neuroprotective effects. An intravenous bolus of a sub-anesthetic dose (0.5 mg/kg) of ketamine can reduce postoperative delirium (POD) and POCD after cardiac surgery. But, the influence of ketamine on early POCD after non-cardiac surgery is unclear. Objectives: The current study aimed to evaluate the influence of ketamine on early postoperative cognitive function after orthopedic surgery in elderly patients. Patients and Methods: Fifty six elderly patients (> 60-years-old), scheduled for elective orthopedic surgery during general anesthesia (duration of anesthesia > two hours) were enrolled. Patients received intravenous bolus, a total of 3 mL mixed with 0.9% normal saline and 0.5 mg/kg ketamine (K group) or 3 mL of 0.9% normal saline (N group). Three neurocognitive function tests (mini-mental status examination, trail-making test, digit substitution test), and c-reactive protein (CRP) concentration were determined before surgery and on postoperative day one (POD 1) and postoperative day six (POD 6). Results: The two groups had similar demographic characteristics except for the gender. Surgical and anesthetic data were not significantly different. A statistically significant difference was observed in comparison of trail-making test score. Trail-making test score increased more in the N group (52.5 points) than the K group (13 points) at POD 1 (P = 0.047) compared with baseline scores. There were no significant differences in the mini-mental status examination, digit substitution test and CRP concentration at POD 1 and POD 6 between the two groups. POCD (the two Z-scores in more than two tests or the combined Z-score was 1.96 or more) was present in one patient (4%) in the K group at POD 6 (P = 0.98). Conclusions: The incidence of POCD was not significantly influenced by a bolus dose of ketamine (0.5 mg/kg) after orthopedic surgery in elderly patients. There were no negative effects of ketamine on early POCD.
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Affiliation(s)
- Ki Hwa Lee
- Department of Anesthesia and Pain Medicine, Haeundae Paik Hospital, Inje University, Busan, South Korea
| | - Ji Yeon Kim
- Department of Anesthesia and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Jeong Won Kim
- Department of Anesthesia and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Jang Su Park
- Department of Anesthesia and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
- Corresponding author: Jang Su Park, Department of Anesthesia and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea. Tel: +81-319107114, Fax: +51-7970499, E-mail:
| | - Kyu Won Lee
- Department of Anesthesia and Pain Medicine, Haeundae Paik Hospital, Inje University, Busan, South Korea
| | - Sang Yoon Jeon
- Department of Anesthesia and Pain Medicine, Halla Hospital, Jeju, South Korea
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