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Coronavirus complaint 2019 makes it more delicate to give parturients with perioperative care( COVID- 19). This study's ideal is to examine postoperative complications and hemodynamic stability in COVID- 19 positive expectant maters who are giving birth while entering spinal anaesthesia. 31 COVID- 19 positive parturients were linked between January and June 2021 as part of this prospective experimental study at a tertiary tutoring sanitarium in Jordan. Each COVID- 19 positive parturient passed anaesthesia in the identical conditions as the control group, while each COVID- 19 negative parturient was matched with a COVID- 19 positive parturient. Of the 31 COVID- 19 cases, 22(71) had normal health overall, while 8(25.7) passed exigency caesarean sections. After 10 twinkles, the COVID- 19 positive group's sensitive degree of spinal block was T8( T6- T10) as opposed to T4( T4- T6) in the COVID- 19 negative group.
DOI: 10.37421/2684-6004.2022.6.157
Peter Ravishon*
Sandel Thomson*
Emma D' James*
Yilkal Tadesse Desta* and Kassaw Moges Abera
Introduction: Stroke is an ischemic/embolic or hemorrhagic cerebrovascular event that can occur at any time. Meanwhile, intravenous or endovascular intra-arterial thrombolysis is the current standard therapy for intracranial intravascular clots, embolic occlusion of a major intracranial vessel occasionally requires microsurgical embolectomy. In particular, when the embolus is a large atherosclerotic plaque or foreign body (such as a balloon or microcoil from endovascular treatment), surgery may be the treatment of choice.
Case history: This is a 70 years old female patient who came with a chief complaint of ‘failure to communicate of 12 hrs duration’ and diagnosed to be recurrent 2˚stroke+old Rt side stroke+type II DM+HTN.
Discussion: Several studies have demonstrated that patients who received general anesthesia for treatment are less likely to have a good outcome than those managed with local anesthesia. This may be due to preintervention risk not included in the stroke severity measures.
Summary: Neuroanaesthesia is a dynamic and rapidly advancing sub-specialty where anesthetic technique can have a real impact on both operative conditions and patient outcomes. Advanced airway skills, multimodal monitoring, and the management of challenging and complex cases are required on a regular basis.
Conclusion: Preintervention risk should always be minimized and blunted to avoid stroke severity and also to avoid irreversible ischemic damages. Additionally, preoperative routine medication with statins and b-blockers should be continued during the perioperative period and also propanol infusion should be considered to replace N2O, Mannitol 0.5 g/kg-1 g/kg, Furosemide 0.3 mg/kg for better lumbar CSF drainage and brain relaxation.
Control of blood pressure is critical for this patient to have successful outcomes and progress and also to avoid the risk of postop hemorrhage. This is mainly because an acute ↑↑ BP →↑↑ transmural pressure across the aneurysmal wall → ruptures of the aneurysm and course body temperature should be maintained normothermic to have good recovery and progress.
Harsimran Kaur, Aruna Jain and Manpreet Singh*
Background and Objectives: Clonidine is a partially selective alpha-2 adrenergic agonist and has extensively been studied intrathecally in regional anaesthesia. With this background, the present study was conducted to compare the clinical efficacy of two different doses of intrathecal clonidine in hyperbaric bupivacaine with hyperbaric bupivacaine alone in terms of duration of post-operative analgesia, quality of surgical anaesthesia, incidence of hypotension and bradycardia in lower limb orthopedics surgeries.
Methods: Total of 150 patients was randomly allocated to 3 groups of 50 patients each. Group I received 2.5 ml of 0.5% hyperbaric bupivacaine+1 ml NS (Normal Saline); Group II received 2.5 ml of 0.5% hyperbaric bupivacaine+0.5 ml clonidine (75 mcg)+0.5 ml NS; group III received 2.5 ml of 0.5% hyperbaric bupivacaine+1 ml clonidine (150 mcg). Intraoperatively, onset of sensory and motor block, highest sensory level achieved, time to reach it, haemodynamic parameters and sedation scoring were noted. Postoperatively haemodynamics, duration of sensory/motor block, sedation and duration of effective analgesia were noted.
Results: Group II patients had effective postoperative analgesia with excellent quality of surgical anaesthesia, effective sedation score and showed significant hypotension. Group III patients had highest incidence of bradycardia.
Conclusion: This study concluded that 75 mcg clonidine is an effective adjuvant to 0.5% hyperbaric bupivacaine when used intrathecally in lower limb orthopaedic surgeries. Incidence of hypotension and bradycardia is lesser in 75 mcg than 150 mcg clonidine.
Manpreet Singh, Dheeraj Kapoor, Lakesh Kumar Anand and Jasveer Singh
Temperature monitoring is an important modality of monitoring and is included in minimum monitoring standards. LMA Gastro Airway has wide diameter gastric channel that allows entrance of endoscope during endoscopy. We have added an innovative thought to the functioning of this airway where gastric tube and temperature probe are passed through the gastric channel during the surgical procedure. This will provide core body temperature throughout the duration of surgery in operation theatre and during endoscopic procedure under general anaesthesia. When smaller diameter endoscope is entered through gastric channel, temperature probe can also be introduced in that tube to measure temperature continuously.
Raman Naresh kumar
Perineural dexamethasone appears to prolong the duration of analgesia after brachial plexus block when combined with local anaesthetics. Several studies have compared intravenous with perineural dexamethasone in upper extremity surgeries, however there is concern regarding potential neural toxicity of perineural dexamethasone; Therefore we aimed to find out whether intravenous dexamethasone compared to perineural dexamethasone had similar or superior effects in prolonging the duration of nerve block, as adjuvant to local anaesthetic brachial plexus block.
This randomized, prospective observational study was conducted on 222 patients,in govt.medical college hospital, thiruvananthapuram, posted for upperlimb forearm surgeries under supraclavicular brachial plexus block with duration of analgesia as the primary outcome. The Study period was from December 2016 to June 2018 (1.5 years) after getting clearance from Institutional Ethics Committee and study duration was 1 ½ years. Analysis was done using Excel 2007 worksheet and SPSS 16 statistical software Qualitative data were expressed in proportion and percentage. Quantitative data expressed as mean and SD. Bivariable analysis was done using students t-test and chi-square test. The supraclavicular block lasted significantly longer in patients who received intravenous dexamethasone compared with perineural dexamethasone (p=0.001).With respect to secondary outcomes, there was a reduction in total post operative morphine equivalent administration in perineural dexamethasone compared with intravenous dexamethasone (p = 0.002).We have concluded that 8 mg of intravenous dexamethasone extended the duration of analgesia and reduced pain scores. We suggest that intravenous dexamethasone be preferred, as its use is licensed and the possibility of neurotoxicty is avoided.
Sanebela Olivia
Roles and Responsibility
Nagwa Mohammed Doha, Hatem Amin Attalla, Mohamed Shawky Abdullah, Ahmed Mokhtar Elkersh, Walaa Samy Mokhtar and Sadik Abdel Maseeh Sadik
Background: Mechanical ventilating was an essential life supporting method for crucially ill cases. The weaning outcomes influences the morbidities and mortalities of cases when their main disorder advances.
Aim and objectives: To evaluate the predictive value of heart, lung and diaphragmatic US in the process of weaning in mechanically ventilated patients over 48 hours.
Methods: This is a prospective observational single group research which was performed at Menoufia University hospitals between (May 2019 and May 2020). The study included 62 mechanically ventilated patients over 48 hours fulfilling weaning criteria underwent one Hour Spontaneous Breathing Trail (SBT). Before extubating, data collection comprised US evaluation of LVEF, LVDF was assessed using Left Atrial Area (LAA), early diastolic transmitral flowing velocity wave (E), late diastolic transmitral flow velocity wave (A), early diastolic mitral annulus velocity E′ (average septal and lateral E′), E/A, E de-acceleration time, E/E′, lungs losing of ventilation scoring and diaphragmatic movements./
Results: A high significant relation was found among weaning and LVEF, E’, E/E’ and LAA (p< 0.001) and statistically significant relation between weaning and E/A.Using aeration score it was shown that above 15.5, it can predict failure of weaning with Area Under Curve (AUC) of 0.781. Using diaphragmatic dysfunction, it was shown that if there were full diaphragmatic dysfunction, it can predict failure of weaning with AUC of 0.639.
Conclusion: The US characteristics of heart, lung, and diaphragm providing serious information around cardio-pulmonary and diaphragmatic job throughout SBT. Unsuccessful weaning was more predominant if markers of left ventricular diastolic dysfunctions, increased Lung aeration score and diaphragmatic dysfunction were present.
Kushee-Nidhi Kumar*, Ambreen Alam, Anna Ng Pellegrino, Vikas Yellapu
Purpose: The aim of the study is to evaluate the effectiveness of lavender aromatherapy on patients undergoing outpatient surgery to reduce anxiety scores, improve patient’s vital signs, and reduce the use of anti-anxiety medications.
Methods: Vital signs and anxiety scores were documented before and after 30 minutes of lavender aromatherapy in perioperative area. Patients’ interest in anti-anxiety medication before surgery, and patient experience with the aromatherapy was also assessed.
Findings: 75% of patients reported a decrease in their anxiety score number and 57% reported a decrease in anxiety range 30 minutes after the start of aromatherapy. 39% of patients saw a reduction in the Mean Arterial Pressure (MAP) by 10 units or more and 31% saw a reduction in heart rate by 10 units or more after aromatherapy use (p values<<0.05). 22% of patients did not require an anxiolytic medication prior to entering the OR (Operating Room). 55% of patients returned surveys back with mainly positive feedback about the project.
Conclusions: Lavender aromatherapy proves to be an effective method in reducing anxiety scores, improving patient’s vital signs, and reducing use of anti-anxiety medications among patients undergoing outpatient surgery.
Ambuj Giri
Traumatic brain injury is a major public health concern not only in our country but everywhere else. It is an emerging research priority which needs to be extensively studied keeping in mind its huge burden on public health. But in our country there is lack of scientific research and education in field of trauma. It affects a large proportion of individual. Road traffic accidents contributes to the major burden of Traumatic brain injury. The definition of TBI is an‘alteration in brain function, or other evidence of brain pathology, caused by an external force’. However, this unitary epidemiological definition encompasses a complex disease process with diverse injury subtypes that may overlap. There is an increasing drive to differentiate these subtypes to allow precision-medicine approaches to management
Kapil Anand, Brian Mayeda, Brad Penenberg and Alex Macario
Background: As the number of total joint arthroplasty (TJA) cases continues to grow operating room (OR) suites can evaluate parallel processing strategies to reduce the length of time the patient is in the OR as a mechanism to increase throughput of cases. The goals of this study were to 1) assess the safety and success rate of performing spinal anesthesia in the hospital preoperative area and 2) measure the OR times for patients after the first case of the day undergoing total hip (THA) or knee arthroplasty (TKA) in an inpatient setting.
Methods: A retrospective review of electronic medical records (EMR) was performed on all patients after the first case of the day who underwent unilateral THA or TKA via spinal anesthesia by three orthopedic surgeons between January 2017 and December 2018. Spinal anesthesia was performed based on anesthesiologist preference either in the OR or in the preoperative holding area. Measured OR times included time from patient entry into the OR to: incision, surgery closure end, OR exit, and discharge from the Post Anesthesia Care Unit (PACU). Spinal anesthesia failure (inability to perform surgery without conversion to general anesthesia), high spinals requiring airway management, hypotension or bradycardia needing treatment in the holding area, and cardiac arrest were the primary clinical adverse events abstracted from the EMR.
Results: Twenty-five % (n=398) of a total of 1594 TJAs (720 THAs and 874 TKAs, 924 females and 572 males) received spinal anesthesia by 8 anesthesiologists in the preoperative holding area, with the remaining 1,196 patients receiving the spinal anesthetic in the OR. These 398 TJA patients had a mean and standard deviation (SD) of 70.7 (10.3) years of age, body mass index of 30.4 (6.7), American Society of Anesthesiologists (ASA) Physical Status of 2.3 (0.5) with 269 ASA 2 patients and 129 ASA 3 patients, with 36% males, and 42% undergoing THA. 100% of patients successfully had the spinal anesthetic with isobaric bupivacaine 0.5% (no additives) placed in the preoperative area, with no high spinals, and the time in minutes from entering the OR to: incision equaled mean (SD) of 42 (16), to surgery closure end 140 (21), OR exit 155 (20), and PACU discharge 297 (90). Complications included emesis (n=2), and persistent hypotension (n=4).
Conclusions: All 398 TJA patients had a spinal anesthetic successfully placed in the preoperative area with a minimal number of complications which provides evidence that anesthesiologists can choose patients in which spinal anesthesia is feasible and can be performed safely in the preoperative holding area.
Sanjay Jaiswal
Covid has led to innovations and strategies, primarily to manage patients with hypoxia and respiratory failure. Although devastating, the pandemic brought the best out of the medical fraternity in terms of patient care and research. Undoubtedly, invasive ventilation is the last resort in patients with progressive dyspnea not manageable with non-invasive methods; still, non-invasive ventilation methods are becoming popular and have proven their worth. CPAP and Bipap played a vital role during the first and second pandemic waves, with HFNC gradually becoming popular with the intensivists and ICU physicians because of its unique advantages(1).
Manpreet Singh
Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by radiological diffuse bilateral lung infiltration, decreased respiratory compliance and severe hypoxemia. The major goal in ARDS is correction of life threatening hypoxemia and concurrent improvement of respiratory mechanics. Mechanical ventilation is invariably required in this subset of patients with aim of providing optimum oxygenation and at the same time strategies to prevent ventilator-induced lung injury (VILI). While lung protective strategies remain the main stay of treatment, early prone ventilation plays a crucial role to improve ventilation perfusion mismatch.
Prone ventilation with or without neuromuscular blocking agents (NMBAs) are distinctly indicated in severe refractory ARDS to achieve better expansion of the dorsal lung regions with consequent improvement in oxygenation. However, prone positioning requires advance competence level for attending critical care physicians and nursing staff due to the inherent risk associated with positioning. We report the successful management of an adult mechanically ventilated patient having scrub typhus induced severe refractory ARDS, undergoing early prone ventilation in conjunction with recommended ventilation strategies
Trishagni Talukdar, Ahmad Zahid
Uterine leiomyomas, commonly called fibroids are benign tumours of uterine myometrium composed of smooth muscle with variable amount of connective tissue. It is the commonest tumour of the female pelvic organ. 1. As it is vascular tumour, many a times Myomectomy leads severe intraoperative blood loss. It is estimated that the average volume of blood loss during abdominal myomectomy ranges between 200 – 400 ml, 2,3,4 with blood loss greater than 1000 ml considered as major blood loss.5 Vasopressin is a synthetic analogue of the anti-diuretic hormone, has a V1 receptor agonistic action thereby causes vasoconstriction . Intramyometrial injection of vasopressin helps to reduce significant intraoperative blood loss. However, it is not devoid of side effects and sometimes might cause very serious complications like arrhythmias, bradycardia, pulmonary oedema, and cardiac arrest. Here we are presenting a case report of sudden severe bradycardia caused by intramyoma diluted vasopressin injection and discussion on management of such patients.
Lady Christine Ong Sio, Alexander Bautista
This paints a picture of a woman just about ready to bring a new life into the world. Yet such a wonderful childbirth experience can bring one memories of pain, fear, and joy all packaged into one. Childbirth is an experience that is both exciting and painful for every woman. This is a review of the development of obstetric anesthesia and puts in perspective the history of obstetric anesthesia in both the western and eastern medicine, and how each has contributed to the other.
In western medicine, the introduction of modern anesthesia in obstetrical practice has been credited to Sir James Y. Simpson who used ether in childbirth on January 19th of 1847. A few more attempts led him to chloroform which was found to be stronger and better than ether. (Heaton, 1946) By the turn of the 20th century, ether and chloroform were ubiquitous in childbirth on both sides of the Atlantic Ocean. (Caton, 2004) Despite this medical breakthrough, however, the British criticized that ether and chloroform not only increased the risk of hemorrhage and infection but had detrimental effects on the newborn. (Edwards & Jackson, 2017) Some would argue that the pain of childbirth was inseparable from the function of the uterus, and to suppress that pain would inhibit labor. (Gibson, 2017) Still, others would argue that to relieve pain during childbirth was to counter the biblical teaching that women would suffer in childbirth after Eve’s sin and that anesthesia would open the door to unnecessary procedures without the patient’s consent. (Gibson, 2017) Figure 1 shows a timeline on the development of obstetric anesthesia in the western part of the globe.
Sanebela Olivia
Organizing Committee invites all the participants from all over the world to attend “6th International Conference on Anesthesia” during September 22-23, 2021 in Zurich, Switzerland on the theme “Gaining a broader practical understanding of global approaches used in Anesthesia” which includes prompt Keynote presentations, Oral talks, Poster presentations and Exhibitions.
Anesthesia 2021 which aims to gather the most elegant societies and industries along with the renowned and honorable persons form top universities across the globe. Anesthesia 2021 on behalf of its organizing Committee welcomes all the Anesthesia and Anesthesiology researchers, industrialists, doctors, young scientists as well as student and corporate delegates to participate and to have a great experience
Sanebela Olivia
Above all else I express genuine thankfulness to all authors and reviewers of the Journal of Clinical Anesthesiology: Open Access (JCAO) in the interest of the whole publication board and the publisher. It was with the negligible co-activity, excitement, and soul of the authors and reviewers we could make JCAO a fantastic achievement. Authors have been a genuine inspiration and key in setting up JCAO among one of the best journal for publication in the subject of Anesthesiology and Pharmacovigilance. I express gratitude toward them all in considering and trusting JCAO as the stage for publishing their significant work. I additionally thank all authors for their caring co-activity stretched out during the different phases of processing of the articles in JCAO.
Ashebir Nigussie Yirgu and Moges Daba Bikila
Abstract
Background: Caesarean delivery is one of the most commonly performed surgical procedures all over the world. The choice of anesthesia for cesarean section is regional and general anesthesia. Some of the factors influencing the choice of anesthesia type for cesarean section are the degree of urgency, maternal and fetal condition, and willingness of the mother, the experience of the anesthetists, and availability of all anesthesia equipment. Hence, the aim of this study was to identify factors influencing types of anesthesia selection for cesarean section.
Methods: A prospective cross-sectional study design was conducted on factors influencing the choice of anesthesia type for mothers who underwent cesarean section in Jimma specialized hospital from April to June, 2018. All mothers who underwent cesarean section were included. Regular supervision and follow-up were made. Descriptive statistics were used to identify factors influencing types of anesthesia. Data was entered and analysis was done using SPSS version 25.
Luiz Eduardo Imbelloni
Local anesthetics are drugs that produce temporary and localized blockage of nerve conduction. Depending on the place of administration and the dose used, they can lead to interruption of sensitivity, autonomous innervation and motricity, and must associate properties that, in addition to efficacy, ensure safety.
Most pharmaceutical drugs are released in racemic form. The study of the chirality of substances is an important field in the pharmaceutical industry and agrochemicals. Several review articles on chirality have been published, but none of them address the presence of an enantiomeric excess. In Brazil, an enantiomeric excess local anesthetic containing 75% of the S-enantiomer and 25% of the R-enantiomer was investigated, and later approved for use in regional anesthesia.
Rickey Miller Jr
Abdominal surgeries produce the highest number of Surgical Site Infections (SSI) than any other surgical procedures. Pathology specimens from these procedures (either fluid or tissue) have been analyzed for bacterial isolates in diagnostic labs using various plating and culture methods for years. While these methods have been effective, newer technology and tests based on whole genome sequencing have shortened the time for microbial identification. Six different molecular diagnostic platforms: quantitative Reverse Transcription-PCR (RT-qPCR) Laboratory-Developed Test (LDT), a COBAS SARS-CoV-2 high-throughput system, three direct RT-qPCR kits, and Reverse Transcription loop-mediated isothermal AMPlification (RT-LAMP) plus rapid antigen tests were evaluated for their diagnostic capacity to detect SARS-CoV-2 RNA by 103 SARS-CoV-2 positive patient samples were tested with these 7 methods and viral RNA being detected between 50.5% - 81.6% of samples on molecular platforms. Antigens were detected only 11.7% of samples when tested by rapid antigen test. Despite varying sensitivities on the different platforms, each platform was verified as a reliable detection tool for the virus with rapid antigen testing being a less reliable option for detecting coronavirus RNA. Increased precision and sensitivity from molecular testing platforms provide more accuracy and efficiency when looking for pathogenic bacteria causing surgical site infections in recovering patients. Early detection of bacterial isolates in surgical incisions post-surgery is imperative to the recovery of patients after a procedure. This project will investigate which molecular genomic platform is better at detecting pathogenic bacteria after abdominal surgery.
Sanebela Olivia
ME Conferences is pleased to announce the upcoming “14th International Conference on Anesthesiology and Critical Care” scheduledduring August 12, 2021. Critical Care 2021 will be an online event focused on the core understanding and major developments in the ever-expanding field of anesthesiology by fascinating experts on a global scale.
The theme of Critical Care 202 “New Innovative Opportunities to Allow Patient Engagement” targets at proclaiming information and sharing fresh ideas among the professionals, industrialists, researchers, and students from the exploration area of anesthesia, intensive care medicine, critical emergency medicine, and pain medicine.
Hala Kaptan and Nagwa Mohamed Doha
Post-operative pain management in pediatric patients is essential, development of safe and effective techniques is very important. (1)
Historically, pain management in children has been poor, but in the last decades many advances have been made. (2)
The transversus abdominis plane block (TAP block) have been tried successfully in adults for post-operative pain, its role in children remains unclear. (3)
TAP block was first described by Rafi in 2001(4). It is a compartmental block, it pr0vides analgesia to parietal peritoneum, skin and muscles of anterior abdominal wall(5) .
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Drugs distribute in the body after absorption, in part to reach target tissues and in part to be disposed of in tissues where they have no clinically relevant effects. Drug metabolism and/or elimination usually end therapeutically relevant effects. The spleen's traditionally attributed role in these fundamental pharmacokinetic processes was clearly marginal. However, due to its high blood flow and microcirculation characteristics, this organ is expected to be significantly exposed to large, new generation drugs that cannot penetrate other tissues with tight endothelial barriers.
The spleen is barely mentioned in pharmacology textbooks and among its physiological roles, such as immunological surveillance, removal of aged blood cells, hematopoiesis and blood volume regulation, neither drug disposition nor involvement in pharmacological drug action are ever mentioned. The spleen received little attention in pharmacology due to a lack of evidence that it could play a significant role in the disposition of "classical" drugs. However, just as when a new character appears in a novel and our perspective on the story changes dramatically, our perspective on the relationship between drugs and the spleen is changing as a result of the development of "new-generation" drugs.
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The attending anesthesiologists have always had difficulty administering anaesthesia during obstetric and non-obstetric surgery. Although statistics from the industrialised world are scarce, data from underdeveloped countries show that 1-2% of all obstetric patients undergo emergency non-obstetric surgery at least once in their lifetime. A pregnant woman may need to be hospitalised due to a number of disorders and their complications, which may necessitate surgical intervention. Pregnancy-related surgical situations, such as ovarian cyst torsion, appendicitis, strangulated hernias, traumatic injuries, etc., demand prompt attention. Although the risk of surgery is similar to that of the general population, managing anaesthesia during this time is quite difficult.
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Healthcare-associated infections are a significant source of morbidity and mortality in paediatric patients. Anesthesiologists specialise in the prevention of infections. Practicing good hand hygiene and keeping the anaesthetic workspace clean help to lower infection incidence in surgical patients. Standard protocols exist for the insertion and handling of central lines, arterial lines, and regional operations, which should be strictly adhered to in order to prevent infection issues. Infections at the surgical site can be prevented by regulating temperature and giving medications on schedule. Education, a change in culture, employee involvement, and efficient change management are necessary for the implementation of infection control strategies.
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Anesthesiologists generally give further anodynes and anesthetics to consolidate anaesthesia or, as an volition, use presto- acting muscle relaxants to achieve deep neuromuscular leaguer. It indicates that the case's motor function has not entirely recovered from surgery when there's residual muscular relaxation. Residual muscular relaxation can affect in hypoxia, respiratory depression, and airway blockage. The neuromuscular leaguer brought on by rocuronium or vecuronium is reversed because the commerce between muscle relaxants and nicotinic cholinergic receptors at the neuromuscular junction is disturbed. Neuromuscular relaxants are used to reduce the convulsive motor exertion, which is necessary in cases with osteoporosis or spinal injuries to avoid bone fractures and physical detriment during the seizure. Although succinylcholine has a number of negative side goods, including increased internal gastric pressure, myalgia, hyperkalemia, and a implicit link to nasty hyperthermia; it's the most effective and extensively used neuromuscular relaxant due to its short duration of action and quick recovery. Indeed after taking sugammadex, the peril of rush shouldn't be taken smoothly, especially in cases with severe renal impairment causes extended elimination of rocuronium and sugammadex.
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Journal of Clinical Anesthesiology: Open Access received 7 citations as per Google Scholar report
