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Salem AE, El-Mawy MG, Al-Kholy AF. Multimodal, non-opioid based analgesia for women presented for laparoscopic hysterectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2031547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Ahmed E. Salem
- Department of Anesthesiology & ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed G. El-Mawy
- Department of Anesthesiology & ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Adel F. Al-Kholy
- Department of Medical Biochemistry, Faculty of Medicine, Benha University, Benha, Egypt
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Mendonça FT, Barreto Filho JH, Hungria MDBCS, Magalhães TC. Efficacy of a single dose of esmolol to prevent extubation-related complications during emergence from anesthesia: a randomized, double-blind, placebo-controlled trial. Braz J Anesthesiol 2021:S0104-0014(21)00340-7. [PMID: 34560115 PMCID: PMC10362437 DOI: 10.1016/j.bjane.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 08/09/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Few trials have examined the efficacy of esmolol to attenuate hemodynamic and respiratory responses during extubation. However, the most appropriate dose of esmolol and an optimal protocol for administering this beta-blocker are uncertain. METHODS Ninety patients ASA physical status I, II, and III (aged 18-60 years) scheduled to procedures with general anesthesia and tracheal extubation were selected. Patients were randomized into esmolol and placebo group to evaluate the efficacy and safety of a single bolus dose of esmolol (2 mg.kg-1) on cardiorespiratory responses during the peri-extubation period. The primary outcome was the rate of tachycardia during extubation. RESULTS The rate of tachycardia was significantly lower in esmolol-treated patients compared to placebo-treated patients (2.2% vs. 48.9%, relative risk (RR): 0.04, 95% confidence interval (95% CI) = 0.01 to 0.32, p = 0.002). The rate of hypertension was also significantly lower in the esmolol group (4.4% vs. 31.1%, RR: 0.14, 95% CI 0.03 to 0.6, p = 0.004). Esmolol-treated patients were associated with higher extubation quality compared to patients who received placebo (p < 0.001), with an approximately two-fold increase in the rate of patients without cough (91.1%) in the esmolol group compared to the placebo group (46.7%). The rate of bucking was approximately 5-fold lower in the esmolol group (8.9% vs. 44.5%, respectively, RR: 0.20 (95% CI, 0.1 to 0.5, p = 0.002, with an NNT of 2.8). CONCLUSION A single bolus dose of esmolol is an effective and safe therapeutic strategy to attenuate cardiorespiratory responses during the peri-extubation period.
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Affiliation(s)
- Fabrício Tavares Mendonça
- Hospital de Base do Distrito Federal, Centro de Ensino e Treinamento em Anestesiologia (CET), Brasília, DF, Brasil; Sociedade Brasileira de Anestesiologia, Título Superior em Anestesiologia (TSA), Rio de Janeiro, RJ, Brasil; Universidade de Brasília, Mestrado em Ciências Médicas, Brasília, DF, Brasil.
| | - Jorge Humberto Barreto Filho
- Hospital de Base do Distrito Federal, Centro de Ensino e Treinamento em Anestesiologia (CET), Brasília, DF, Brasil
| | | | - Thiago Cavalcante Magalhães
- Hospital de Base do Distrito Federal, Centro de Ensino e Treinamento em Anestesiologia (CET), Brasília, DF, Brasil
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Silva Filho SE, Sandes CS, Vieira JE, Cavalcanti IL. Analgesic effect of magnesium sulfate during total intravenous anesthesia: randomized clinical study. Braz J Anesthesiol 2021; 71:550-557. [PMID: 34537125 PMCID: PMC9373246 DOI: 10.1016/j.bjane.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/25/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction and objective : Opioids have usually been used as intraoperative analgesic components, regardless of the many adverse effects they are associated with, such as nausea, vomiting, respiratory depression, and hyperalgesia. Several approaches have been investigated to reduce doses used, and magnesium sulfate has been shown to be a valuable analgesic adjunct. The main objective of the present trial was to evaluate the effectiveness of magnesium sulfate as the chief intraoperative analgesic, and the secondary objectives were to assess propofol consumption, postoperative analgesia, and intraoperative hemodynamic stability. Methods In this prospective, double-blind trial, 50 patients scheduled to undergo post-bariatric abdominoplasty under general intravenous anesthesia were divided into two groups, to receive remifentanil or magnesium sulfate as intraoperative analgesic. Fentanyl 1 µg kg-1 was the rescue analgesic. Results Among the patients in the group receiving Magnesium Sulfate (MSG), 64% did not need supplemental analgesia and none of the patients in the Remifentanil Group (RG) required fentanyl. MSG patients showed propofol consumption 36.6% higher (guided by the Bispectral Index – BIS). MSG patients consumed significantly less ephedrine (mean ± SD) than RG patients, respectively 1.52 ± 4.38 mg and 10 ± 10.39 mg, p < 0.001. Mean values of blood concentrations of magnesium were comparable to values previously described in the literature. Conclusion Magnesium sulfate is a safe and effective option for intraoperative analgesia, when avoiding or decreasing opioid use is required.
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Affiliation(s)
- Sebastião E Silva Filho
- Hospital Santos Dumont, São José dos Campos, SP, Brazil; Sociedade de Beneficência Portuguesa de Santos - ANGIOCORPORE, Programa de Residência em Anestesiologia, Santos, SP, Brazil.
| | | | - Joaquim E Vieira
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil
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Misganaw A, Sitote M, Jemal S, Melese E, Hune M, Seyoum F, Sema A, Bimrew D. Comparison of intravenous magnesium sulphate and lidocaine for attenuation of cardiovascular response to laryngoscopy and endotracheal intubation in elective surgical patients at Zewditu Memorial Hospital Addis Ababa, Ethiopia. PLoS One 2021; 16:e0252465. [PMID: 34061894 PMCID: PMC8168879 DOI: 10.1371/journal.pone.0252465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Laryngoscopy and endotracheal intubation are essential components of general anesthesia. But it is always associated with side effects called reflex cardiovascular responses. Many methods have been identified to attenuate these responses like intravenous lidocaine, deep inhalational anesthesia, vasodilators, intravenous magnesium sulphate even though therapeutic superiority remains understudied. METHODS An institutional-based cohort study on 112 adult patients aged between 18-60 years was applied. 37 patients in the non-exposed group (Group N), 37 in the lidocaine group (Group L), and 38 in magnesium sulphate (Group M) were included. The hemodynamic parameters like heart rate, systolic, diastolic and mean arterial blood pressure at various time points up to 7 minutes post-intubation were recorded and the effect of both drugs to reduce hemodynamic responses was compared. Parametric data were analyzed using ANOVA and nonparametric data using the Kuruska-Wallis H rank test. P-value < 0.05 considered statistically significant. RESULTS In all three groups, there was a statistically significant rise in heart rate and blood pressure from baseline. There was a statistically significant difference in mean heart rate throughout study minutes among the groups (p<0.001). However, there was no statistically significant difference in mean heart rate between Groups M and L at all post-intubation time intervals. In blood pressure at all three parameters there was statistically significant difference among groups at all-time points except no difference at 7th minutes in DBP. There was significantly lower blood pressure in group M compared to both groups. CONCLUSION In conclusion, prophylactic administration of magnesium sulphate and lidocaine was effective in attenuating hemodynamic responses to the stress effect of laryngoscopy and intubation. But based on our finding prophylaxis of magnesium sulphate is associated with a more favorable hemodynamic response.
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Affiliation(s)
- Abebaw Misganaw
- Department of Anesthesia, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Mulualem Sitote
- School of Anesthesia, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Suliman Jemal
- School of Anesthesia, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyayalem Melese
- School of Anesthesia, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Metages Hune
- Department of Anesthesia, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fetene Seyoum
- Department of Anesthesia, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Alekaw Sema
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Dagim Bimrew
- Department of Anesthesia, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
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Liu KP, Wang BN, Shen YY, Li WX, Li Z, Yao L. [Effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:742-747. [PMID: 31420633 DOI: 10.19723/j.issn.1671-167x.2019.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia. METHODS In the study, 40 patients with American Society of Anesthesiologists (ASA) physical statuses I-II, aged 19-66 years, scheduled for elective thoracic surgeries under general anesthesia requiring orotracheal intubation were allocated to either the double-lumen endobronchial intubation (T group) or double-lumen endobronchial intubation after epidural administration of lidocaine (E group). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy (MDLS), respectively. Invasive blood pressure (BP), heart rate (HR) and bispectral index (BIS) were recorded before and after anesthetic induction, immediately after intubation and 5 minutes after intubation with 1-minute interval and the intubation time also noted. The rate pressure product (RPP) was calculated. RESULTS After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. In comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BPs, HRs and RPP. In comparison with their preinduction values, BPs decreased significantly in E group, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1 min in T group. The HRs of both groups after intubation were significantly higher than their baseline values , and increased in HR and lasted for 1 min and 4 min in E group and T group, respectively. SBP, DBP, MAP, HR and RPP after intubation in T group were significantly higher than those of E group during the observation period. The values of BIS were similar between both the groups. In T group, the incidences of SBP percent increased>30% of the baseline value and RPP more than 22 000 were significantly higher than in E group. None of the patients in group E had SBP more than 130% of the baseline value and RPP more than 22 000. CONCLUSION During double-lumen endobronchial intubation, epidural administration of lidocaine can provide less hemodynamic response and similar arousal response.
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Affiliation(s)
- K P Liu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China.,Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - B N Wang
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - Y Y Shen
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - W X Li
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Z Li
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - L Yao
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
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Cavalcanti IL, de Lima FLT, da Silva MJS, da Cruz Filho RA, Braga ELC, Verçosa N. Use Profile of Magnesium Sulfate in Anesthesia in Brazil. Front Pharmacol 2019; 10:429. [PMID: 31105568 PMCID: PMC6499034 DOI: 10.3389/fphar.2019.00429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/04/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives: The use of magnesium sulfate in the perioperative period has several benefits, including analgesia, inhibition of the release of catecholamines and prevention of vasospasm. The aim of this survey was to provide an overview of the use of magnesium sulfate in anesthesia. Method: This was a prospective descriptive cross-sectional study. An online questionnaire was sent to 9,869 Brazilian anesthesiologists and trainees. The questionnaire comprised closed questions mainly regarding the frequency, clinical effects, adverse events, and doses of magnesium sulfate used in anesthesia. Results: Of the 954 doctors who responded to the survey, 337 (35.32%) reported using magnesium sulfate in anesthesia. The most commonly cited clinical effects for the use of magnesium sulfate in anesthesia were (n/%): postoperative analgesia (245/72.70%), reduction of anesthetic consumption (240/71.21%) and prevention and treatment of preeclampsia and seizures in eclampsia (220/65.28%). The most frequently reported adverse events were hypotension (187/55.48%), residual neuromuscular blockade (133/39.46%), hypermagnesemia (30/8.90%), and intravenous injection pain (26/7.71%). The intravenous doses of magnesium sulfate used in most general anesthesia inductions were between 30 and 40 mg.kg−1. Conclusions: Magnesium sulfate is an important adjuvant drug in the practice of anesthesia, with several clinical effects and a low incidence of adverse events when used at recommended doses.
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Affiliation(s)
- Ismar Lima Cavalcanti
- Department of General and Specialized Surgery, Anesthesiology, Fluminense Federal University, Niterói, Brazil.,Coordination for Education, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | | | | | | | - Estêvão Luiz Carvalho Braga
- Department of General and Specialized Surgery, Anesthesiology, Fluminense Federal University, Niterói, Brazil
| | - Nubia Verçosa
- Department of Surgery, Anesthesiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Megalla SA, Abdou KA, Mohamed AI. Bispectral index guided attenuation of hemodynamic and arousal response to endotracheal intubation using magnesium sulfate and fentanyl. Randomized, controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1080/11101849.2019.1595346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Sohair A. Megalla
- Department of Anesthesiology &ICU, Minia Faculty of Medicine, El Minia University, El Minia, Egypt
| | - Khaled A. Abdou
- Department of Anesthesiology &ICU, Minia Faculty of Medicine, El Minia University, El Minia, Egypt
| | - Ahmed I. Mohamed
- Department of Anesthesiology &ICU, Minia Faculty of Medicine, El Minia University, El Minia, Egypt
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Rahimi M, Farhanchi A, Taheri M, Samadi S. The Effects of Acupuncture on Hemodynamic Changes During Endotracheal Intubation for General Anesthesia. Med Acupunct 2019; 31:123-129. [PMID: 31031879 DOI: 10.1089/acu.2018.1330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The goal of this research was to investigate the efficacy of perioperative manual acupuncture in the LV 3 and LI 4 points for lessening hemodynamic changes during endotracheal intubation in patients who were receiving anesthesia. Materials and Methods: This double-blinded randomized controlled study enrolled patients who were undergoing endotracheal intubation, in 2015-2016, during general anesthesia in the general surgery department of the Imam Khomeini Hospital complex, in the Tehran University of Medical Sciences, Iran. The patients were randomly allocated into 2 groups with 30 patients in each group. In the treatment group, acupuncture needles were placed at LV 3 and LI 4, whereas, in the control group, the needles were placed 1 cm lateral to these points. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and heart rate (HR) before and after placing the acupuncture needles, after induction, immediately, 1 minute, and 3 minutes after intubation were measured and recorded prospectively. Results: The patients had a mean age of 44.45 ± 12.72 years and included 35 (58.3%) males. Before acupuncture, demographic data, mean blood pressure (BP), and mean HR of the patients were not significantly different in the treatment and control groups. The mean SBP, DBP, MAP, and HR of all patients changed over time significantly (P < 0.001 for all). In the treatment group, mean SBP, DBP, and MAP changes immediately after the needles were placed were significantly less than those in the control group (P = 0.033, 0.024, and 0.024, respectively). Conclusions: Although acupuncture could have a very-short-term effect that reduces BP during endotracheal intubation, hemodynamic changes might not be prevented during endotracheal intubation.
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Affiliation(s)
- Mojgan Rahimi
- Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Farhanchi
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahboobeh Taheri
- Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Samadi
- Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran
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Tan W, Li S, Liu X, Gao X, Huang W, Guo J, Wang Z. Prophylactic Intravenous Lidocaine at Different Doses for Fentanyl-Induced Cough (FIC): A Meta-Analysis. Sci Rep 2018; 8:9946. [PMID: 29967371 PMCID: PMC6028622 DOI: 10.1038/s41598-018-27457-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/25/2018] [Indexed: 12/23/2022] Open
Abstract
To evaluate whether different doses of intravenous lidocaine are effective at preventing fentanyl-induced cough (FIC), we searched PubMed, Scopus, Cochrane Library, EMBASE and Web of Science, according to predefined criteria, for all articles published until June 2017. A meta-analysis and subgroup analysis were performed by combining the reported incidence of FIC. The odds ratio (OR) was used as a summary statistic. Eleven articles were included, with 965 patients in the lidocaine group and 745 patients in the control group. A pooled analysis indicated that the overall incidence of FIC was significantly different between the lidocaine group and the control group (OR, 0.27; 95% confidence interval (CI), 0.21-0.35; P < 0.05), as well as between the adult and paediatric subgroups. Sensitivity analysis showed that the results were stable. Subgroup analyses showed that compared to a placebo, both low (0.5-1.0 mg/kg) and high doses of lidocaine (1.5-2.0 mg/kg) were effective at reducing FIC incidence. There was no significant difference between low or high doses of lidocaine. Fentanyl doses added no significant heterogeneity as shown by meta-regression. The findings of this meta-analysis indicate that prophylactic intravenous lidocaine is effective at preventing FIC in both adults and children.
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Affiliation(s)
- Wulin Tan
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Si Li
- The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xiaochen Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xiang Gao
- Department of Pharmacy, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wenqi Huang
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Junying Guo
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
| | - Zhongxing Wang
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
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Gnanapragasam R, Gomaa A, Patil V. Evaluation of the efficacy of lidocaine and magnesium sulphate in reducing the hemodynamic effects caused after intubation/laryngoscopy. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29037764 PMCID: PMC9391708 DOI: 10.1016/j.bjane.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ateka Gomaa
- Barts and the London School of Medicine and Dentistry, Londres, Inglaterra
| | - Vinod Patil
- Barking, Havering and Redbridge University Hospitals NHS Trust, Londres, Inglaterra
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Mendonça FT, Guimarães GMN. Resposta à carta ao Editor. Braz J Anesthesiol 2017; 67:667-669. [DOI: 10.1016/j.bjan.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/26/2017] [Accepted: 07/28/2017] [Indexed: 11/28/2022] Open
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Gnanapragasam R, Gomaa A, Patil V. [Evaluation of the efficacy of lidocaine and magnesium sulphate in reducing the hemodynamic effects caused after intubation/laryngoscopy]. Rev Bras Anestesiol 2017; 68:212-213. [PMID: 29037764 DOI: 10.1016/j.bjan.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Ateka Gomaa
- Barts and the London School of Medicine and Dentistry, Londres, Inglaterra
| | - Vinod Patil
- Barking, Havering and Redbridge University Hospitals NHS Trust, Londres, Inglaterra
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