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1.
Lancet Glob Health ; 10(10): e1514-e1522, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36113534

RESUMO

BACKGROUND: Use of medical devices represents a unique opportunity to facilitate scale-up of early infant male circumcision (EIMC) across sub-Saharan Africa. The ShangRing, a circumcision device prequalified by WHO, is approved for use in adults and adolescents and requires topical anaesthesia only. We aimed to investigate the safety and efficacy of the ShangRing versus the Mogen clamp for EIMC in infants across eastern sub-Saharan Africa. METHODS: In this multicentre, non-inferiority, open-label, randomised controlled trial, we enrolled healthy male infants (aged <60 days), with a gestational age of at least 37 weeks and a birthweight of at least 2·5 kg, from 11 community and referral centres in Kenya, Tanzania, and Uganda. Infants were randomly assigned (1:1) by a computer-generated text message service to undergo EIMC by either the ShangRing or the Mogen clamp. The primary endpoint was safety, defined as the number and severity of adverse events (AEs), analysed in the intention-to-treat population (all infants who underwent an EIMC procedure) with a non-inferiority margin of 2% for the difference in moderate and severe AEs. This trial is registered with Clinical. TRIALS: gov, NCT03338699, and is complete. FINDINGS: Between Sept 17, 2018, and Dec 20, 2019, a total of 1420 infants were assessed for eligibility, of whom 1378 (97·0%) were enrolled. 689 (50·0%) infants were randomly assigned to undergo EIMC by ShangRing and 689 (50·0%) by Mogen clamp. 43 (6·2%) adverse events were observed in the ShangRing group and 61 (8·9%) in the Mogen clamp group (p=0·078). The most common treatment-related AE was intraoperative pain (Neonatal Infant Pain Scale score ≥5), with 19 (2·8%) events in the ShangRing and 23 (3·3%) in the Mogel clamp group. Rates of moderate and severe AEs were similar between both groups (29 [4·2%] in the ShangRing group vs 30 [4·4%] in the Mogen clamp group; difference -0·1%; one-sided 95% CI upper limit of 1·7%; p=0·89). No treatment-related deaths were reported. INTERPRETATION: Use of the ShangRing device for EIMC showed safety, achieved high caregiver satisfaction, and did not differ from the Mogen clamp in other key measures. The ShangRing could be used by health systems and international organisations to further scale up EIMC across sub-Saharan Africa. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Anestesia , Circuncisão Masculina , Adolescente , Adulto , Circuncisão Masculina/efeitos adversos , Humanos , Lactente , Recém-Nascido , Quênia , Masculino , Dor/etiologia , Uganda
2.
BMC Anesthesiol ; 22(1): 281, 2022 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-36068501

RESUMO

BACKGROUND: A Y-shaped rotatable connector (YRC) for double-lumen tubes (DLT) is invented and compared with the traditional connector (Y-shaped connector, YC). METHODS: Sixty patients with ASA grade I-III, aged ≥ 18 years, who needed to insert a DLT for thoracic surgery were recruited and assigned into the YRC group (n = 30) and the YC group (n = 30) randomly. The primary endpoints included the inhaled air concentration (Fi) and the exhaled air concentration (Et) of sevoflurane before and after the switch between two-lung ventilation and one-lung ventilation at different times, positioning time, and switching time. The secondary endpoints were the internal gas volume of the two connectors, airway pressure, and the sputum suction time. RESULTS: The Et and Fi of the YRC group and the YC group were significantly different (all p < 0.05) at 5s, 10s, and 30s after the patient switched from two-lung ventilation to one-lung ventilation. The positioning time of the YRC group was less than YC group (89.75 ± 14.28 s vs 107.80 ± 14.96 s, p < 0.05), as well as the switching time (3.60 ± 1.20 s vs 9.05 ± 2.53 s, p < 0.05) and the internal gas volume (17.20 ml vs 24.12 ml). There was no difference in airway pressure and the sputum suction time in two groups. CONCLUSION: Compared with YC, YRC was beneficial for maintaining depth of anesthesia, improves efficiency for the switch between one-lung and two-lung ventilation, and shortens the tube positioning time.


Assuntos
Anestesia , Ventilação Monopulmonar , Procedimentos Cirúrgicos Torácicos , Humanos , Intubação Intratraqueal , Pulmão
3.
Anesth Analg ; 135(4): 697-703, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36108183

RESUMO

ADDENDUM: Please note that in the interim since this paper was accepted for publication, new governmental regulations, pertinent to the topic, have been approved for implementation. The reader is thus directed to this online addendum for additional relevant information: http://links.lww.com/AA/E44.


Assuntos
Anestesia , Anestesiologia , Humanos
6.
BMC Anesthesiol ; 22(1): 294, 2022 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-36114460

RESUMO

BACKGROUND: Opioid anesthetic agents can modulate the impaired immune response in obese patients through mechanisms that involve the expression and release of cytokines. For this reason, anesthetic care for obese patients remains controversial. Therefore, the aim of the study was to compare the effect of opioid-containing anesthesia (OCA) vs opioid-free anesthesia (OFA) using the Cortínez-Sepúlveda model on IL-6, IL-1ß and TNF-α serum levels before and after surgery in obese patients undergoing bypass surgery. METHODS: This randomized cross-sectional study conducted among 40 unrelated obese adults was performed in the Civil Hospital of Guadalajara "Dr. Juan I. Menchaca". Before undergoing laparoscopic Roux-en-Y gastric bypass, patients were randomly assigned to two anesthesia groups: OCA (n = 20) or OFA (n = 20). Fentanyl was the opioid used in the OCA group. The Cortínez-Sepúlveda pharmacokinetic model was used to characterize the disposition of intravenous propofol for the target-controlled infusion technique in obese patients. Body mass was determined to the nearest 0.05 kg using a balance scale (Seca 703; Seca, Hamburg, Germany). Blood samples were taken before and immediately after surgery and cytokine concentrations were determined by ELISA. Pain was assessed using a numerical pain rating scale. Adverse effects were collected within the first 24 h after surgery. RESULTS: A total of 6 men and 34 women were included (37.9 ± 10.6 years). Pre-surgery IL-6 and TNF-α serum levels were not detected in study subjects. However, IL-1ß levels significantly decreased after surgery (49.58 pg/mL (18.50-112.20)-before surgery vs 13 pg/mL (5.43-22)-after surgery, p = 0.019). IL-6 concentrations were significantly higher in subjects who received OCA (with fentanyl) compared to subjects with OFA (224.5 pg/mL (186.3-262.8) vs 99.5 pg/mL (60.8-138.2), respectively, p < 0.001; adjusted by age, gender, and BMI). In addition, the use of opioids confers an increased risk for higher IL-6 levels in obese patients (OR = 2.95, 95% CI: 1.2-7.2, p = 0.010). A linear regression model showed that the operative time (in hours) of bypass surgery and anesthetic technique were positively correlated with IL-6 levels. CONCLUSION: Anesthesia with opioids correlated positively with IL-6 serum levels in obese patients undergoing bypass surgery. This finding could have clinical relevance when an appropriate anesthetic management plan is selected for bariatric surgical patients. TRIAL REGISTRATION: The study was retrospectively registered at ClinicalTrials.gov Identification Number: NCT04854252, date 22/04/2021.


Assuntos
Anestesia , Derivação Gástrica , Propofol , Adulto , Analgésicos Opioides/uso terapêutico , Estudos Transversais , Citocinas , Feminino , Fentanila/uso terapêutico , Derivação Gástrica/métodos , Humanos , Interleucina-6 , Masculino , Obesidade/cirurgia , Dor/tratamento farmacológico , Fator de Necrose Tumoral alfa
7.
Contrast Media Mol Imaging ; 2022: 9633527, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36105451

RESUMO

In order to solve the problem of CT reconstruction imaging, this paper presents a study on the clinical application of preanesthesia in patients with tracheal stenosis. Patients with tracheal stenosis and multislice spiral CT virtual endoscopy (CTVE) were diagnosed, and their application effects were analyzed. Methods. 60 patients with tracheal stenosis were selected for clinical observation. The patients were given tracheal stenosis examination and multislice spiral CT virtual endoscopy. The examination results of the two groups were compared and analyzed by statistical methods. Results. There was no significant difference in the detection rate, sensitivity, accuracy, and specificity between the two groups (P > 0.05). Conclusion. Multislice spiral CT virtual endoscopy combined with a fiberoptic bronchoscope for clinical diagnosis of tracheal stenosis can complement each other. Combined use can effectively improve the detection consistency, and is safe and reliable. It can be used as an effective means for the diagnosis of tracheal stenosis.


Assuntos
Anestesia , Estenose Traqueal , Humanos , Tomografia Computadorizada Espiral/métodos , Estenose Traqueal/diagnóstico por imagem , Estenose Traqueal/cirurgia
8.
Cas Lek Cesk ; 161(3-4): 139-143, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36100453

RESUMO

Over the last 5 years, around 75 heart transplantations a year have been performed in the Czech Republic. According to these data and longer survival of these patients, it is obvious that non-cardiac surgical procedures in this particular group of patients are not rare. In the patients after heart transplantation, there is a significantly higher risk of undergoing elective and emergency surgical procedures due to various reasons. Appropriate anaesthesia and perioperative care are fundamentally affected by the knowledge of pathophysiological and pharmacological differences of transplanted heart. An equally important aspect is a lifetime immunosuppressive therapy in these patients.


Assuntos
Anestesia , Transplante de Coração , Anestesia/efeitos adversos , República Tcheca , Transplante de Coração/efeitos adversos , Humanos , Assistência Perioperatória
9.
Eur J Anaesthesiol ; 39(10): 848-849, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36101916
10.
Artigo em Alemão | MEDLINE | ID: mdl-36049737

RESUMO

Safe and appropriate pharmacotherapy in children requires knowledge of age-group-specific features regarding pharmacology and drug dosing. In addition, aspects of medication safety must be considered. This review highlights basic principles and discusses key facts; further research in paediatric databases is recommended (www.kinderformularium.de).


Assuntos
Anestesia , Criança , Humanos
11.
J Med Case Rep ; 16(1): 333, 2022 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-36057618

RESUMO

BACKGROUND: Over 1.4 million US adults identify as transgender when gender identity differs from the sex assigned at birth [1]. Although transgender patients face adverse health outcomes, they remain an understudied population [2]. A 2017 study surveyed 411 practicing clinicians and found that 80% had been involved in treating a transgender patient, but 80.6% had never received training on transgender care [3]. The purpose of this report is to describe prolonged desaturation in one case of a transgender patient who wore a chest binder intraoperatively owing to a lack of preoperative recognition. CASE PRESENTATION: A 19-year-old transgender male of African-American descent with anxiety and class 3 obesity presented for an esophagogastroduodenoscopy to evaluate a 2-year history of upper abdominal pain unresponsive to proton pump inhibitor therapy, with a plan for monitored anesthesia care. His medications included sertraline, pantoprazole, zolpidem, ergocalciferol, leuprolide, and testosterone cypionate. Preoperatively, the patient was instructed to remove all clothing and to don a patient gown while in the bathroom. The attending anesthesiologist then conducted the interview and examination in the preoperative holding area. The patient was induced with 250 mg of propofol, and reassuring respirations were noted by capnography. Respirations and oxygen saturation remained stable upon insertion of the endoscope. Four minutes later, the patient's oxygen saturation rapidly decreased to 50% and end-tidal capnography was lost. The endoscope was removed, and the patient was given 200 mg of propofol and 20 mg succinylcholine. His oxygen saturation recovered to 80% and 100% after 2 and 5 minutes, respectively, of ventilation with 100% inspired oxygen. No further oxygen desaturation was noted throughout the procedure, and the patient was closely monitored for signs of respiratory difficulty during an uneventful postoperative course. After full emergence, it was revealed that the patient had been wearing a chest binder throughout the operative procedure. The patient was counseled on the necessity to communicate the presence of this accessory prior to all future procedures. CONCLUSION: In the clinical narrative, a healthy patient was observed to have prolonged oxygen desaturation after induction of anesthesia. Laryngospasm was suspected clinically owing to the sudden absence of end-tidal carbon dioxide. Prolonged oxygen desaturation despite appropriate interventions suggests the contribution of additional factors. We speculate that the presence of a chest binder intraoperatively predisposed the patient to more rapid oxygen desaturation less responsive to typical therapy. A chest binder would introduce mechanical restriction to the patient's breathing owing to its inherent design to compress. Although the patient was asked to remove all clothing, specific instructions were not provided regarding the removal of a chest binder. The presence of chest binding was also absent in the electronic health record, despite the documented presence of the patient's preferred gender, hormonal therapy regimen, and medical history. Ultimately, this case reflects the gap between practitioner knowledge and hospital guidelines and the practices of transgender patients. In reviewing existing literature and the potential for atelectasis with external compression, we would consider that patients refrain from chest binding for 12-24 hours before surgical procedures, resume no sooner than 24 hours after ambulation, and participate in diagnostic incentive spirometry pre- and postoperatively.


Assuntos
Anestesia , Propofol , Pessoas Transgênero , Adulto , Feminino , Identidade de Gênero , Humanos , Recém-Nascido , Masculino , Oxigênio , Adulto Jovem
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 418-421, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36086567

RESUMO

Electrodermal activity (EDA), which tracks sweat gland activity as a proxy for sympathetic activation, has the potential to be a biomarker of physiological and psychological changes in the clinic. To show this, in this study, we demonstrate that the tonic component of EDA responds consistently and robustly during induction of anesthesia in the operating room in 8 subjects during surgery. This response is seen bilaterally. The response shows a significant increase in EDA in anticipation of induction and then a gradual decrease in response to the administration of medication, which agrees with both the expected psychological effects of stress and anxiety and the physiological effects of anesthetic medication on sweat glands. The results also show a slightly faster response to drug in the arm directly receiving the medication intravenously compared to the opposite, though the magnitude of the effect evens out over time. Clinical Relevance- EDA can serve as a robust non-invasive biomarker in the clinic to track both psychologically and physiologically induced autonomic changes.


Assuntos
Anestesia , Resposta Galvânica da Pele , Ansiedade , Sistema Nervoso Autônomo , Biomarcadores , Humanos
13.
Br J Hosp Med (Lond) ; 83(8): 1-3, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-36066302

RESUMO

This article discusses the place of routine use of depth of anaesthesia monitoring in patients receiving volatile anaesthesia. Benefits include reducing the probability of accidental awareness or excessive depth of anaesthesia, and creating training opportunities to improve familiarity with its use, but these must be weighed against the costs, as it may not be advantageous from a cost-benefit perspective.


Assuntos
Anestesia , Anestesiologia , Anestesia Geral/efeitos adversos , Análise Custo-Benefício , Monitoramento de Medicamentos , Humanos
14.
AACN Adv Crit Care ; 33(3): 253-261, 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36067265

RESUMO

BACKGROUND: Clinical assessments of depth of sedation are insufficient for patients undergoing neuromuscular blockade during treatment of acute respiratory distress syndrome (ARDS). This quality initiative was aimed to augment objective assessment and improve sedation during therapeutic paralysis using the bispectral index (BIS). METHODS: This quality improvement intervention provided education and subsequent implementation of a BIS monitoring and sedation/analgesia bundle in a large, urban, safety-net intensive care unit. After the intervention, a retrospective review of the first 70 admissions with ARDS assessed use and documented sedation changes in response to BIS. RESULTS: Therapeutic neuromuscular blockade was initiated for 58 of 70 patients (82.8%) with ARDS, of whom 43 (74%) had BIS monitoring and 29.3% had bundled BIS sedation-titration orders. Explicit documentation of sedation titration in response to BIS values occurred in 27 (62.8%) of those with BIS recordings. CONCLUSIONS: BIS sedation/analgesia bundled order sets are underused, but education and access to BIS monitoring led to high use of monitoring alone and subsequent sedation changes.


Assuntos
Anestesia , Bloqueio Neuromuscular , Síndrome do Desconforto Respiratório , Sedação Consciente , Humanos , Hipnóticos e Sedativos/uso terapêutico , Unidades de Terapia Intensiva , Monitorização Fisiológica , Dor , Paralisia , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/tratamento farmacológico
15.
Rev Med Inst Mex Seguro Soc ; 60(5): 584-590, 2022 Aug 31.
Artigo em Espanhol | MEDLINE | ID: mdl-36049082

RESUMO

Background: Hyperthyroidism is the increase in the synthesis and secretion of thyroid hormones. It is rare but serious in children and constitutes approximately 5% of all cases; 15% manifests before 10 years of age. The peak of presentation and the majority of cases (80%) are diagnosed around 10-15 years of age. Adolescence is usually the stage with the highest incidence and it is more frequent in women (5:1). Acute thyrotoxic crisis or thyroid storm is rare and only occurs in a poorly controlled hyperthyroid patient or in a hyperthyroid patient undergoing emergency surgery. It is manifested by fever, extreme tachycardia, tachyarrhythmia with atrial fibrillation, vomiting, diarrhea, agitation and mental confusion. Clinical case: 17-year-old adolescent with Graves' disease with uncontrolled clinical manifestations that did not respond to medical treatment and was scheduled for radical thyroidectomy. 35 points were obtained on the Burch and Wartofsky Scale. It was managed with general anesthesia, reducing stimuli for airway and regional control to reduce surgical stimuli. Adjuvant medications such as magnesium sulfate for intraoperative stability were used. Conclusion: Multimodal anesthesia managed to avoid thyroid storm, postoperative pain, as well as other complications.


Introducción: el hipertiroidismo es el incremento en la síntesis y secreción de hormonas tiroideas. Es raro pero grave en la edad pediátrica y constituye aproximadamente el 5% de todos los casos; el 15% se presenta antes de los 10 años. El pico de presentación y la mayoría de los casos (80%) se diagnostican hacia los 10-15 años. La adolescencia es la etapa de mayor incidencia y más frecuente en mujeres (5:1). La crisis tirotóxica aguda o tormenta tiroidea es rara y solo se presenta en un hipertiroideo mal controlado o en un paciente hipertiroideo intervenido de urgencia. Se manifiesta con fiebre, taquicardia extrema, taquiarritmia con fibrilación auricular, vómito, diarrea, agitación y confusión mental. Caso clínico: adolescente de 17 años con enfermedad de Graves con manifestaciones clínicas descontroladas, la cual no respondió a tratamiento médico y se programó para tiroidectomia radical. Se obtuvieron 35 puntos en la Escala de Burch y Wartofsky. Se manejó con anestesia general y fueron disminuyendo los estímulos para control de vía aérea y regional a fin de disminuir los estímulos quirúrgicos. Se usaron medicamentos adyuvantes como sulfato de magnesio para la estabilidad transoperatoria. Conclusión: la anestesia multimodal logró evitar la tormenta tiroidea, el dolor postoperatorio, así como otras complicaciones.


Assuntos
Anestesia , Doença de Graves , Crise Tireóidea , Tireotoxicose , Adolescente , Criança , Feminino , Doença de Graves/complicações , Doença de Graves/diagnóstico , Doença de Graves/cirurgia , Humanos , Crise Tireóidea/complicações , Crise Tireóidea/diagnóstico , Tireoidectomia/efeitos adversos , Tireotoxicose/complicações , Tireotoxicose/diagnóstico
17.
Rev Esc Enferm USP ; 56: e20210471, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36122360

RESUMO

OBJECTIVE: To evaluate the effect of implementing a Patient safety checklist: nursing in anesthetic procedure on the perception of safety climate and team climate of nurses and anesthesiologists from an operating room. METHOD: Quasi-experimental study held in the operating room of a hospital in Brazil with a sample of nurses and anesthesiologists. The outcome was evaluated through the instruments "Safety Attitudes Questionnaire/Operating Room Version" and "Team Climate Inventory", applied before and after the implementation of a Patient safety checklist: nursing in anesthetic procedure by nurses. The mixed effects linear regression model was used to analyse the effect of the implementation. RESULTS: Altogether, 19 (30.2%) nurses and 44 (69.8%) anesthesiologists participated in the study, implementing the Patient safety checklist: nursing in anesthetic procedure in 282 anesthesias. The Safety Attitudes Questionnaire/Operating Room Version score changed from 62.5 to 69.2, with modification among anesthesiologists in the domain "Perception of management" (p = 0.02). Between both professionals, the Team Climate Inventory score increased after the intervention (p = 0.01). CONCLUSION: The implementation of the Patient safety checklist: nursing in anesthetic procedure changed the perception score of safety and teamwork climate, improving communication and collaborative work.


Assuntos
Anestesia , Lista de Checagem , Atitude do Pessoal de Saúde , Humanos , Salas Cirúrgicas/métodos , Segurança do Paciente
18.
BMC Anesthesiol ; 22(1): 279, 2022 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-36056321

RESUMO

BACKGROUND: Pediatric anesthesia care in the Magnetic Resonance Imaging is a challenge for clinicians. The recent debate about the role of anesthetic agent on neural development, encouraged an evaluation of their actual activity in this environment. In this active call survey, the authors sought to delineate the Italian situation regarding national centers, staff involved, monitoring tools available and sedation techniques. METHODS: A complete sample of all national centers performing almost a pediatric discharge in the 2014 was obtained from Health Ministry registers. All Institutions were contacted for a prospective phone investigation and a three-section survey was fill out with the Physician in charge. A descriptive and exploratory analyzes about the organization setting of the Centers were performed. RESULTS: Among 876 Institution screened, only 106 (37%) met minimal criteria for inclusion. Children are managed by anesthesiologists in the 95% of cases, while neonates in the 54%. A dedicated nurse is present in 74% of centers. While a pulse oximetry is present in 100% of centers, the rate of prevalence of other monitoring is lower. A specific MRI-compatible ventilator is available in the 95% of Centers, but many tools are not equally homogenously distributed. Pharmacological approach is preferred in pediatric age (98%), but its use for newborns is reduced to 43%. CONCLUSIONS: We found significant heterogeneity in the daily clinical practice of sedation in MRI. Our results could be a starting point to evaluate the further evolution of approach to children and neonates in magnetic resonance setting. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04775641.


Assuntos
Anestesia , Imageamento por Ressonância Magnética , Criança , Humanos , Recém-Nascido , Estudos Prospectivos
20.
Artigo em Alemão | MEDLINE | ID: mdl-36049740

RESUMO

Perioperative complications are more frequent in younger children, especially under the age of 3 years and in infants. The anatomy and physiology of children cause more respiratory adverse events compared to adult patients. Respiratory adverse events account for 60% of all anesthetic complications. Main risk factors for respiratory adverse events are upper respiratory tract infections. Keeping the airway management as noninvasive as possible helps prevent major complications.Perioperative hypotension can compromise cerebral oxygenation, especially when hypocapnia and anemia are present. Congenital heart disease leads to a higher cardiovascular adverse event rate and should be diagnosed preoperatively whenever possible.Venous and arterial cannulation is more challenging in children and complications are more frequent even for experienced practitioners. Ultrasound is an essential tool for peripheral venous access as well as for central venous catheterization.Medication errors are more common in pediatric than in adult patients. Charts and electronic calculation of dosing can increase safety of prescriptions. Standardized storage of medications at all workplaces, avoiding look-alike medications in the same compartment and storing high-risk medications separately help prevent substitution errors.Emergence delirium and postoperative nausea and vomiting (PONV) are the most frequent postoperative adverse events. For diagnosing emergence delirium, the PAED scale is a helpful tool. Prevention of emergence delirium by pharmacological and general measures plays a key role for patient outcome. Routine prophylaxis of PONV above the age of 3 years is recommended.Frequency and severity of perioperative adverse events in pediatric anesthesia can be reduced by using algorithms and defined processes to allow for structured actions. Efficient communication and organization are mainstays for utilizing all medical options to reduce the risk of complications.


Assuntos
Anestesia , Delírio do Despertar , Adulto , Anestesia/efeitos adversos , Período de Recuperação da Anestesia , Criança , Pré-Escolar , Humanos , Lactente , Complicações Pós-Operatórias , Náusea e Vômito Pós-Operatórios , Fatores de Risco
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