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Echeverri Lombana MDLP, Sanín Hoyos A, Echeverri Mallarino V, García Peña Á, Gomar Sancho C. Spinal anesthesia does not cause left ventricular dysfunction in patients older than 60 years without cardiovascular disease. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:140-147. [PMID: 36842680 DOI: 10.1016/j.redare.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 01/10/2022] [Indexed: 02/28/2023]
Abstract
BACKGROUND Elderly patients are undergoing surgery more frequently than ever. In this population, spinal anesthesia, which is known to cause sympathetic blockade associated with arterial vasodilation, is proposed as an excellent option. However, its effects on left ventricular systolic function have not been studied. OBJECTIVES To evaluate left ventricular systolic function by transthoracic echocardiography in patients older than 60 years, without prior cardiovascular disease, under spinal anesthesia. PATIENTS AND METHODS Prospective observational study with a total of 54 patients older than 60 years without prior cardiovascular disease, in whom, after the completion of subarachnoid anesthesia with hyperbaric 0.5% bupivacaine with sensory block equal to or greater than T10, left ventricular systolic function was measured using MAPSE. In addition, CI-IVC, LVOT-VTI and CO were measured. Values at 5 min after the blockade were compared with those obtained previously. RESULTS A 3.3% decrease in MAPSE and a slight decrease in LVOT-VTI and CO were found, with no statistical or clinical significance. 14.8% of the patients presented MAP equal to or less than 60 mmHg. Comparison of echocardiographic changes between hypotensive and non-hypotensive patients was not statistically significant or clinically relevant. DISCUSSION Our study shows that spinal anesthesia with anesthetic level T10 or higher in patients older than 60 years without cardiovascular disease is a safe technique since it does not significantly alter echocardiographic parameters measuring left ventricular systolic function.
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Affiliation(s)
- M de la P Echeverri Lombana
- Departamento de Anestesiología, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - A Sanín Hoyos
- Departamento de Anestesiología, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - V Echeverri Mallarino
- Departamento de Anestesiología, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Á García Peña
- Departamento de Cardiología, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - C Gomar Sancho
- Universidad de Barcelona y Universidad de Manresa, GRinDoSSeP, Spain
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Esteve CI, Rodríguez GF, Casado MC, Dominguez AC, Jimenez PM, Ripoll RN, Gimenez MA, Sancho CG, Canudas IR, Obrador EQ, Martinez ES, Pereda D, Linares JP. The fate of non-revisited transesophageal findings after cardiopulmonary bypass managed conservatively. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gomar Sancho C, Darias Delbey B. Iliac aneurysm rupture during preconditioning with levosimendan for coronary artery graft, it was levosimendan the most influencing factor? Rev Esp Anestesiol Reanim 2015; 62:52-53. [PMID: 25034938 DOI: 10.1016/j.redar.2014.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/07/2014] [Indexed: 06/03/2023]
Affiliation(s)
- C Gomar Sancho
- Servicio de Anestesiología y reanimación, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
| | - B Darias Delbey
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Canarias, Tenerife, España; Alumno de Máster de la Universidad de Barcelona, Barcelona, España
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Durán Bruce M, Gomar Sancho C, Holguera JC, Muliterno Español E. [Factors involved in the development of vasoplegia after cardiac surgery with extracorporeal circulation. A prospective observational study]. Rev Esp Anestesiol Reanim 2014; 61:246-253. [PMID: 24507583 DOI: 10.1016/j.redar.2013.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 11/19/2013] [Accepted: 11/28/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The incidence and risk factors for vasoplegia in the early postoperative period and at 24h are investigated in patients subjected to cardiopulmonary bypass surgery. Vasoplegia following cardiac surgery with cardiopulmonary bypass is associated with a high morbimortality. The risk factors described emerged from retrospective, non-controlled studies. METHODS Observational prospective study of 188 consecutive patients subjected to cardiac surgery with cardiopulmonary bypass in a single hospital between November 2011 and May 2012. Emergency surgery or complex procedures were excluded. Vasoplegia was assessed during the immediate postoperative period, and at 24h after surgery, and was defined as a mean arterial pressure below 50mmHg, and the need for a noradrenaline perfusion of more than 0.08μg/kg/min, monitored by cardiac output and systemic vascular resistances. The anaesthetic and cardiopulmonary bypass protocols, as well as haemodynamic management, were the same in all patients. RESULTS Almost half (48%) of patients had vasoplegia in the immediate postoperative period, and 34% at 24h. Risk factors for immediate vasoplegia development were preoperative use of angiotensin converting enzyme inhibitor drugs, a mean arterial pressure<50mmHg immediately after beginning cardiopulmonary bypass, duration of aortic clamping as well as the cardiopulmonary bypass, and minimum temperature in cardiopulmonary bypass. Vasoplegia at 24h after surgery was correlated to preoperative angiotensin converting enzyme inhibitor drug treatment and cardiopulmonary bypass duration. CONCLUSION The incidence of vasoplegia after cardiac surgery with cardiopulmonary bypass is high during the first 24 postoperative hours. Preoperative treatment with angiotensin converting enzyme inhibitor and the mean arterial pressure at the beginning of cardiopulmonary bypass are the more easily controllable risk factors. In patients arriving to surgery with those drugs, treatment or prevention of vasoplejia should be planned.
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Affiliation(s)
- M Durán Bruce
- Servicio de Anestesiología, Hospital San Borja Arriarán, Santiago de Chile, Chile.
| | - C Gomar Sancho
- Servicio de Anestesiología, Hospital Clínic, Barcelona, España
| | - J C Holguera
- Servicio de Anestesiología, Clínica Teknon, Barcelona, España
| | - E Muliterno Español
- Servicio de Anestesiología, Hospital Universitario Josep Trueta, Girona, España
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Gomar Sancho C. [Continuous paravertebral block for analgesia in minimally invasive cardiac surgery]. Rev Esp Anestesiol Reanim 2013; 60:237. [PMID: 23453238 DOI: 10.1016/j.redar.2012.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/04/2012] [Indexed: 06/01/2023]
Affiliation(s)
- C Gomar Sancho
- Servicio de Anestesiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
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Navarro Ripoll R, Matute Jiménez MP, Berge Ramos R, Gomar Sancho C. [Correction of persistent, undiagnosed ductus arteriosus during endovascular repair of aortic coarctation]. Rev Esp Anestesiol Reanim 2010; 57:610. [PMID: 21155348 DOI: 10.1016/s0034-9356(10)70295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- R Navarro Ripoll
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona.
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Carrero Cardenal EJ, Bueno Rodríguez A, Fontanals Dotras J, Tercero Machín FJ, Gomar Sancho C. [First-year medical residents' self-assessment of skill in basic life support and automatic external defibrillation]. Rev Esp Anestesiol Reanim 2010; 57:201-208. [PMID: 20499797 DOI: 10.1016/s0034-9356(10)70205-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine first-year medical residents' perception of their competence in basic life support (BLS) and the use of automatic external defibrillation (AED). MATERIAL AND METHODS Course in BLS and AED accredited by the European Resuscitation Council with pre- and post-course self-assessment. The post-training questionnaire was administered immediately after the course and 8 months later. The data recorded covered (a) prior training and experience, (b) self-assessment of BLS and AED skills (9 items, scored 1-5), (c) the skill considered most difficult, and (d) satisfaction (13 items, scored 0-10). RESULTS The questionnaire was initially completed by 71 residents; 31 also responded 8 months later. Self-assessment scores improved immediately after the course (P = .0001). Scores had fallen 8 months later (P = .0001) but were still significantly higher than pre-course perception of skill (P = .017). More than 95% of the residents considered themselves to be competent after the course and more than 80% felt competent 8 months later, with the exception of skills in bag-mask ventilation (74.2%) and removal of a foreign body (61.3%). The skill considered most difficult was bag-mask ventilation. Mean (SD) BLS and AED scores for real-life situations were 8.48 (1.33) and 9.19 (0.94), respectively, after the course and 7.32 (1.4) and 7.29 (1.32) at 8 months (P = .0001). Overall satisfaction was high. CONCLUSIONS The residents perceived themselves as competent to give BLS and AED immediately after the course and 8 months after training, although fewer felt as competent at the second assessment. Bag-mask ventilation was considered the most difficult skill.
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Affiliation(s)
- E J Carrero Cardenal
- Servicio de Anestesiologia, Reanimación y Terapéutica del Dolor, Hospital Clinic, Universidad de Barcelona.
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Gomar Sancho C, Montero Matamala A, Puig Riera de Conias M, Sabaté Pes A, Fábregas Juliá N, Valero Castell R, Dalmau Llitjos A, Rull Bartomeu M, García Guasch R, Fita Rodríguez G, Rovira Canudas I, Gallart Gallego L, Samsó Sabé E, Villalonga Vadell R, Vilanova Cardena F, Koo Gómez M, Roigé Solé J, de Nadal Clanchet M, Añez Simón C, Villalonga Morales A, Roldán Osuna J, Díaz Meco FX. [A proposal for competencies in anethesiology, intensive recovery care, and pain therapy: the consensus of university faculty members in Catalonia regarding expectations for medical school graduates]. ACTA ACUST UNITED AC 2009; 56:436-44. [PMID: 19856690 DOI: 10.1016/s0034-9356(09)70424-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C Gomar Sancho
- Servicio de Anestesiología y Reanimación, Hospital Clínico y Provincial, Universidad de Barcelona, Barcelona.
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Plaza Moral AM, de Fernández Lopez Hierro C, Pons Casaovas M, Gomar Sancho C. [Toxic maternal dose of bupivacaine during fetoscopic treatment of twin-to-twin transfusion syndrome]. Rev Esp Anestesiol Reanim 2006; 53:671-3. [PMID: 17302087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Llau Pitarch JV, De Andrés Ibáñez J, Gomar Sancho C, Gómez Luque Z, Hidalgo Martínez F, Torres Morera LM. [Hemostasis-altering drugs and techniques for regional anesthesia and analgesia: safety recommendations]. Rev Esp Anestesiol Reanim 2005; 52:248-50. [PMID: 15901035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Pérez Martínez J, Arguis Giménez MJ, Fernández Candil JL, Martínez Fernández G, Sinche Yupanqui M, Moreno Cuartas LA, Galard Hernández JJ, Gomar Sancho C. [Intrathecal methadone for cancer pain after vulvectomy]. Rev Esp Anestesiol Reanim 2004; 51:559-60. [PMID: 15620170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Martínez Fernández G, Plaza Moral A, Miró Descarga P, Arguís Gimeno MJ, Gomar Sancho C. [Acute dystonia due to haloperidol during labor]. Rev Esp Anestesiol Reanim 2004; 51:229-31. [PMID: 15168934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Llau Pitarch JV, De Andrés Ibáñez J, Gomar Sancho C, Gómez Luque A, Hidalgo Martínez F, Torres Morera LM. [Hemostasis-altering drugs and regional anesthetic techniques: safety guidelines]. Rev Esp Anestesiol Reanim 2004; 51:137-42. [PMID: 15200185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
New developments--in the form of emerging clinical settings for regional anesthesia as well as problems arising with the concomitant use of regional techniques and hemostasis-altering drugs--require the ongoing revision of safety guidelines. The annual meeting of ESRA held in Spain in 2003 saw the discussion and clarification of a variety of issues of current concern, including conclusions reached on the estimated risk of spinal hematoma when published safety guidelines are followed or not, precautions to take in epidural anesthesia during cardiac surgery, guidelines for using fondaparinux for thromboprophylaxis, the circumstances under which neuroaxial techniques can be used safely in patients under the effects of platelet aggregation inhibitors such as thienopyridine, and the application of epidural anesthesia in parturients with eclampsia who have received platelet aggregation inhibitors. Conclusions drawn at the meeting enrich and clarify certain important safety issues related to local and regional anesthesia in patients receiving antiplatelet drugs and/or anticoagulants.
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Affiliation(s)
- J V Llau Pitarch
- Servicio de Anestesiología, Hospital Clínico Universitario, Valencia
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Plaza Moral A, Fernández López de Hierro C, Carrero Cardenal E, Mañero Rey J, Gomar Sancho C. [Ambulatory peridural analgesia in obstetrics: toward a consensus document on the "Walking Epidural"]. Rev Esp Anestesiol Reanim 2003; 50:212-3. [PMID: 12825312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Tornero Tornero JC, Gomar Sancho C. [Efficacy of clonidine combined with ropivacaine in brachial plexus block]. Rev Esp Anestesiol Reanim 2003; 50:58-9; author reply 59. [PMID: 12701271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Tornero Tornero JC, Gomar Sancho C. [Placing central lines in patients with implantable (port-a-cath) systems]. Rev Esp Anestesiol Reanim 2002; 49:561-2. [PMID: 12677981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Planas Liébanas E, López Montserrat JC, Gomar Sancho C. [Breakage of the distal portion of a double-caliber 25-29 GA Polymedic needle during intradural anesthesia for cesarean section]. Rev Esp Anestesiol Reanim 2002; 49:277-8. [PMID: 12216512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Gomar Sancho C. [The doctoral dissertation, whom does it benefit and what is it used for?]. Rev Esp Anestesiol Reanim 2002; 49:121-3. [PMID: 12136452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Fernández López Del Hierro C, Gomar Sancho C. [Nurse-midwife competence in providing regional analgesia during labor]. Rev Esp Anestesiol Reanim 2001; 48:293-4. [PMID: 11446947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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García-Fages LC, Gomar Sancho C, Villalonga A, Pacheco García M, Nalda MA. [Comparative study of radial and cubital arterial catheterization]. Rev Esp Anestesiol Reanim 1991; 38:268-70. [PMID: 1771290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this prospective study we evaluated catheterization of the cubital artery as an alternative to cannulation of the radial artery. Seventy six surgical patients were randomly allocated into two groups of 38 patients according to the intention to catheterize the cubital or the radial artery. The incidence of failure and the technical difficulties were significantly higher in cubital than in radial arterial catheterization (p less than 0.001 and p less than 0.05, respectively) and they were related to the cubital pulse palpation. There were no significant differences in the time elapsed to achieve the catheterization, time of stability of the catheter, nor in the incidence of complications. The qualification of the technician, the arterial blood pressure and the anatomic characteristics of the forearm did not influence the results. We conclude that whenever the cubital arterial pulse is appropriately perceived, catheterization of this artery is a good alternative to radial catheterization.
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Affiliation(s)
- L C García-Fages
- Servicio de Anestesiología-Reanimación. Hospital Clínic i Provincial Barcelona
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Villalonga Morales A, Gomar Sancho C, Nalda Felipe MA. [Cephalic migration of methadone administered by the spinal route]. Rev Esp Anestesiol Reanim 1989; 36:60. [PMID: 2710985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Gomar Sancho C. [Anesthesia and postoperative hepatic changes]. Med Clin (Barc) 1988; 90:579-82. [PMID: 3398624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Anglada Casas MT, Gomar Sancho C. [Reversal of benzodiazepine depression with aminophylline]. Rev Esp Anestesiol Reanim 1984; 31:175. [PMID: 6536074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Fábregas Juliá N, Gomar Sancho C, Nalda Felipe MA. [Attitude of the anesthesiologist-resuscitator confronted with a patient addicted to heroin]. Rev Esp Anestesiol Reanim 1984; 31:153-63. [PMID: 6100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Doria Martínez de Salinas A, Gomar Sancho C, Nalda Felipe MA. [Study of RO 21-3981 (Midazolam) as an anesthetic induction agent]. Rev Esp Anestesiol Reanim 1981; 28:329-33. [PMID: 7330381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Gomar Sancho C, Dori Martínez de Salinas AM, Nalda Felipe MA. [Study of midazolam in anaesthetic premedication (author's transl)]. Rev Esp Anestesiol Reanim 1981; 28:278-81. [PMID: 6120538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Castillo Monsegur J, Gomar Sancho C, Nalda Felipe MA. [Bronchospasm and fixed pigmented erythema in a patient with allergic diathesis]. Rev Esp Anestesiol Reanim 1979; 26:404-8. [PMID: 504763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gomar Sancho C, Nalda Felipe MA, Fita Rodríguez G. [Clinical pharmacology of sodium nitroprusside]. Rev Esp Anestesiol Reanim 1979; 27:13-25. [PMID: 424643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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