Department Of Anesthesiology Research Articles

A Baby Boom and New Anesthesiology Department at Phoenix Children's

Facility Spotlight| June 2023 A Baby Boom and New Anesthesiology Department at Phoenix Children's Madeline Talbot Madeline Talbot Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor June 2023, Vol. 87, 29. https://doi.org/10.1097/01.ASM.0000938844.67021.c0 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Madeline Talbot; A Baby Boom and New Anesthesiology Department at Phoenix Children's. ASA Monitor 2023; 87:29 doi: https://doi.org/10.1097/01.ASM.0000938844.67021.c0 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: child, infant, pediatrics Phoenix Children's sits in the heart of Maricopa County, one of the fastest-growing regions of the United States. To meet these demands, Phoenix Children's is in the process of significantly increasing its capacity. A major component of its expansion for the coming influx of pediatric patients is the launch of its first in-house Division of Anesthesiology. Anesthesiologists Narasimhan Jagannathan and Amod Sawardekar discuss the exciting race to establish a new pediatric anesthesiology division to care for the next generation of Arizonans. Drs. Jagannathan and Sawardekar are charged with establishing Phoenix Children's own Division of Anesthesiology. The pediatric anesthesiologist specialists worked together previously at Lurie Children's Hospital in Chicago. Before making the transition to Phoenix, Dr. Jagannathan was the division head for general pediatric anesthesiology, overseeing their clinical and research operations. He has taken on the role of Phoenix Children's Division Chief of Anesthesiology. During his time at Lurie Children's, Dr.... You do not currently have access to this content.

Evaluating the Usability of a 3D-Printed Video Laryngoscope for Tracheal Intubation of a Manikin.

Compared to direct laryngoscopy, videolaryngoscopy (VL) can provide improved laryngeal and glottic view, higher intubation success rates in patients with a known or predicted difficult airway and reduced incidence of laryngeal/airway trauma. However, the cost and availability of these devices handicap its use in resource-restricted facilities. The objective was to design and manufacture a novel VL using additive manufacturing (AM) and evaluate its usability on an intubation manikin by comparing it to one of the most common video laryngoscopes used in clinical practice, the CMAC®, by measuring the time to first pass of the endotracheal tube as the main outcome. A randomised cross-over study was performed with 36 anaesthetists attempting tracheal intubation of a manikin. The novel 3D-printed hyperangulated VL blade was compared to a CMAC® VL (D-blade). Participants had no prior experience or training with the novel device. The participants included consultants, registrars/trainees and medical officers in the Department of Anaesthesiology at the University of the Free State (UFS) in South Africa. The CMAC® had a statistically shorter time to first pass (median 13.8 seconds) compared to the 3D-printed model (median 19.0 seconds) (95% confidence interval [CI] 1.0-6.2; P=0.0013). No failed attempts occurred with either device. Intubation times were faster with the CMAC® than with the novel device. However, with a comparable intubation success rate, 3D printing technology potentially can improve access to video laryngoscopy. Further design improvements, validation of materials and manufacturing processes are required before 3D-printed laryngoscope blades can be used in human subjects.

Development and Implementation of a Clinician-Educator Track for Residents in Anesthesiology.

Clinician-educators in academic settings have often had no formal training in teaching or in giving feedback to trainees. We implemented a Clinician-Educator Track within the Department of Anesthesiology with the initial goal of improving teaching skills through a didactic curriculum and experiential opportunities for a broad audience of faculty, fellows, and residents. We then assessed our program for feasibility and effectiveness. We developed a 1-year curriculum focusing on adult learning theory, evidence-based best teaching practices in different educational settings, and giving feedback. We recorded the number of participants and their attendance at monthly sessions. The year culminated in a voluntary observed teaching session using an objective assessment rubric to structure feedback. Participants in the Clinician-Educator Track then evaluated the program through anonymous online surveys. Qualitative content analysis of the survey comments was performed using inductive coding to generate relevant categories and identify the main themes. There were 19 participants in the first year of the program and 16 in the second year. Attendance at most sessions remained high. Participants appreciated the flexibility and design of scheduled sessions. They very much enjoyed the voluntary observed teaching sessions to practice what they had learned throughout the year. All participants were satisfied with the Clinician-Educator Track, and many participants described changes and improvements in their teaching practices due to the course. The implementation of a novel, anesthesiology-specific Clinician-Educator Track has been feasible and successful, with participants reporting improved teaching skills and overall satisfaction with the program.

Obstetric anesthesia from the beginning to the end: opportunities and challenges.

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany Correspondence to Vanessa Neef, MD, University Hospital Frankfurt, Goethe University Frankfurt, Germany. E-mail: [email protected]

Preparing Public Health Responses to Mass Shooting Incidents

The Pulse| June 2023 Preparing Public Health Responses to Mass Shooting Incidents Amy Gallagher Amy Gallagher Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor June 2023, Vol. 87, 27–28. https://doi.org/10.1097/01.ASM.0000938840.62254.8a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Amy Gallagher; Preparing Public Health Responses to Mass Shooting Incidents. ASA Monitor 2023; 87:27–28 doi: https://doi.org/10.1097/01.ASM.0000938840.62254.8a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: mass shooting, public health medicine, triage, patient tracking Editor's Note: Gun violence, including mass shootings, is increasingly being referred to as a public health crisis. From 2015 onward, the number of mass shooting events and people injured in these events has increased annually, with a peak of 686 incidents in 2021 (asamonitor.pub/41qQhpE). At the time of publication, there have been almost 200 mass shootings so far in 2023 (asamonitor.pub/3UGMBxG). Behind the scenes of mass shooting incidents (MSIs) in the United States stand many dedicated frontline trauma surgeons, anesthesiologists, emergency medicine physicians, nursing teams, and other health care professionals who are advocating for a public health education strategy to reduce firearm-related violence. Brenda Gentz, MD, Chair of the Department of Anesthesiology at Valleywise Health/District Medical Group in Phoenix, and Stephanie Davidson, DO, FASA, of Sunrise Hospital/Sunrise Children's Hospital/U.S. Anesthesia Partners (USAP) in Las Vegas, recently participated in a first-of-its-kind collaboration on mass shooting incidents... You do not currently have access to this content.

The Effects Between Spinal and General Anesthesia for Pre-Eclamptic Mothers Underwent Caesarean Delivery in a Tertiary Care Hospital- A Comparative Study

Background: Preeclampsia is a multisystem disorder characterized by new onset of hypertension systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and proteinuria >300 mg/24 h arising after 20 weeks of gestation in a previously normotensive woman and associated with significant maternal and neonatal morbidity and mortality worldwide. Women with preeclampsia have an increased rate of cesarean section consequent upon the high incidence of intrauterine growth restriction, fetal distress, and prematurity. The aim of this study was to determine and compare maternal & neonatal outcome among pre-eclamptic women following caesarian delivery under general and spinal anesthesia. Material & Methods: This was a comparative observational study and was conducted in the Department of Anesthesiology of Holy Family red crescent Medical College Hospital, Dhaka, Bangladesh during the period from February,2020 to February,2023. In this study we included 250 preeclamptic women undergoing cesarean delivery. The patients were randomly divided into two groups – GA group (Patients who were given general anesthesia) & SA group (Patients who were given spinal anesthesia). Results: In total 250 patients from both the groups completed the study. In our study we found majority (44.8%) of our patients were aged 28-32 years. The mean age was 27.13 ± 3.76 years. Majority (62.8% ) of our patients were cases of emergency caesarean delivery & 37.2% were elective caesarean delivery classes. Most of the students (41.2%) used magnesium sulfate. Intraoperative systolic BP, diastolic BP was significantly lower in SA group than GA group. We found headache, vomiting, fever and wound gaping, postpartum hemorrhage & lower respiratory tract infection was significantly higher in GA group. On contrary, hypotension & pulmonary edema was higher in SA group. Apgar score at 1st, 5th & 10th minutes was significantly higher in GA group than SA group. In GA group, neonatal mortality at 48 h was 10.4% whereas it was 4.8% in SA group. Conclusion: In our study, we found intra-operative blood pressure and pulse rate was observed significantly higher in GA group than SA. Severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia. Therefore, spinal anesthesia is a safer alternative to general anesthesia among women with severe preeclampsia following caesarean delivery with less postoperative morbidity and mortality.

A Comparative Analysis Between Spinal and General Anesthesia for Orthopedic Surgery

Background: Many surgeries can be performed with spinal anesthesia (SA) or general anesthesia (GA). However, there are only limited and confounding data available regarding costs and anesthesia-related times. Hip or knee replacement are common orthopedic surgeries that can be performed using SA or GA without differences regarding mortality or morbidity. Observational studies have suggested that spinal anesthesia may be associated with lower risks of death, delirium and major medical complications and with shorter lengths of stay in the hospital than general anesthesia. The aim of this study was to assess and compare the effects of spinal versus general anesthesia on postoperative outcomes in patients undergoing orthopedic surgery. Material & Methods: This was a comparative observational study and was conducted in the Department of Anesthesiology of Holy Family red crescent Medical College Hospital, Dhaka, Bangladesh during the period from March,2021 to March,2023. In this study we included 200 patients undergoing orthopedic surgery. The patients were randomly divided into two groups – Group A (Patients who were given general anesthesia) & Group B (Patients who were given spinal anesthesia). Results: In total 200 patients from both the groups completed the study. In our study we found majority (44.5%) of our patients were aged 60-69 years and most of our patients were female (56%) compared to male (44%).The mean age of our patients was 61.73 ± 7.92 years. The mean BMI was 31.67±3.24 kg/m.2Among all patients ,48% had mild systemic disease and followed by 31.5% had severe systemic disease. Majority (43.5%) of our patients had hypertension, 31% had diabetes. Vomiting was found 47% in group A on contrary only 23% had vomiting in spinal group. We found the mean anesthesia induction time was significantly higher in spinal group. Anesthesia time was lower in spinal group while PACU time was higher in group B. Time duration of surgery was significantly lower in spinal group. After 24 hours, spinal group showed less pain score than general anesthesia group. Conclusion: In our study, we found that SA is associated with less fixed and variable costs and lower postoperative pain scores during the stay in the PACU. Therefore, SA is a more reasonable alternative to GA in the immediate postoperative period for patients undergoing hip or knee replacement. When compared to general anaesthesia, spinal anaesthesia provides better operating circumstances, better postoperative pain control, and faster postoperative recovery.

Pre-incisional Preventive Precise Multimodal Analgesia May Enhance the Rehabilitation Process of Acute Postoperative Pain Following Total Laparoscopic Hysterectomy: A Randomized Controlled Trial

BACKGROUND: There has been limited research regarding the effect of preventive precise multimodal analgesia (PPMA) on the duration of acute postoperative pain after total laparoscopic hysterectomy (TLH). This randomized controlled trial aimed to evaluate how PPMA affects pain rehabilitation. OBJECTIVES: Our primary objective was to reduce the duration of acute postoperative pain after TLH, including incisional and visceral pain. STUDY DESIGN: A double blind randomized controlled clinical trial. SETTING: Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China. METHODS: Seventy patients undergoing TLH were randomized to Group PPMA or Group Control (Group C) in a 1:1 ratio. Patients in Group PPMA were given PPMA through the pre-incisional administration of parecoxib sodium 40 mg (parecoxib is not approved for use in the US) and oxycodone 0.1 mg/kg as well as local anesthetic infiltration at the incision sites. In Group C, similar doses of parecoxib sodium and oxycodone were injected during uterine removal, and a local anesthetic infiltration procedure was performed immediately before skin closure. The index of consciousness 2 was utilized to titrate the remifentanil dosage in all patients to ensure sufficient analgesia. RESULTS: Compared with the Control, PPMA shortened the durations of incisional and visceral pain at rest (median, interquartile range [IQR]: 0, 0.0– 2.5) vs 2.0, 0.0–48.0 hours, P = 0.045; 24.0, 6.0–24.0 vs 48.0, 24.0–48.0 hours, P < 0.001; and during coughing 1.0, 0.0–3.0 vs 24.0, 0.3–48.0 hours, P = 0.001; 24.0, 24.0–48.0] vs 48.0, 48.0–72.0] hours, P < 0.001). The Visual Analog Scale (VAS) scores for incisional pain within 24 hours and visceral pain within 48 hours in Group PPMA were lower than those in Group C (P < 0.05). PPMA evidently decreased the VAS scores for incisional pain during coughing at 48 hours (P < 0.05). Pre-incisional PPMA significantly reduced postoperative opioid consumption (median, IQR: 3.0 [0.0–3.0] vs 3.0 [0.8–6.0] mg, P = 0.041) and the incidence of postoperative nausea and vomiting (25.0% vs 50.0%, P = 0.039). Postoperative recovery and hospital stay were similar between the 2 groups. LIMITATIONS: This research had some limitations, including that it was a single-center research with a limited sample size. Our study cohort did not represent the overall patient population in the People’s Republic of China; therefore, the external validity of our findings remains limited. Furthermore, the prevalence of chronic pain was not tracked. CONCLUSION: Pre-incisional PPMA may enhance the rehabilitation process of acute postoperative pain after TLH. KEY WORDS: Total laparoscopic hysterectomy, preventive precise multimodal analgesia, incisional pain, visceral pain, rehabilitation process

Eckenhoff, Eakins, and the Inklings of a New Profession

Anesthesiology Reflections from the Wood Library-Museum| July 2023 Eckenhoff, Eakins, and the Inklings of a New Profession Anesthesiology July 2023, Vol. 139, 34. https://doi.org/10.1097/ALN.0000000000004611 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Eckenhoff, Eakins, and the Inklings of a New Profession. Anesthesiology 2023; 139:34 doi: https://doi.org/10.1097/ALN.0000000000004611 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsAnesthesiology Search Advanced Search Jane S. Moon, M.D., Assistant Clinical Professor, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, California. You do not currently have access to this content.

COMPARISON OF PRE-EMPTIVE PARACETAMOL AND PARACETAMOL-DICLOFENACCOMBINATION FOR POSTOPERATIVE PAIN AFTER SURGERIES UNDER GENERAL ANESTHESIA - A SINGLE-BLINDED RANDOMIZED CONTROL STUDY

Background: Postoperative pain control is a critical component of patient care. Effective pain control can improve patient comfort and reduces the risk of complications. Multimodal analgesia is one of the approaches used for postoperative pain control. The idea of combining analgesics is to reduce the side effects of each drug yet effectively deal with postoperative pain. The present study aimed to compare the time for the first analgesia request and compare the total amount of analgesic consumption in the two groups in the postoperative period in the first 24 hrs. Methods: The present study was a single-blinded randomized control study, done in the Department of Anesthesiology, MRMC, and Basaveshwar Teaching and General Hospital, Kalaburgi, Karnataka State. Patients undergoing surgeries under General Anaesthesia with ASA I/II categories were randomly allocated to two groups. Group A n=25 patients with Tab. Paracetamol oral(2gm). Group B n=25 patients with Tab. Paracetamol oral(1gm). + Inj Diclofenac 75mg IM. Postoperative NRS and first demand for rescue analgesia and total consumption of analgesic in two groups were compared. Results: The mean values of NRS scores were found to be lesser in group B as compared to group A indicating better pain control in group B as compared to group A. The time for 1st analgesia request was seen in 60% of group A in 2nd hour and 32% in 1st hour. Time for 1st analgesia request was seen in 60% of patients in group B in the 3rd hour and 20% in the 2nd hour. The overall consumption of analgesics at the end of 24 hours was greater in Group A as compared to Group B. Conclusion: Pre-emptive analgesia with inj. diclofenac is more effective when compared to a tab. paracetamol group alone in post-operative analgesia following elective surgeries. It can further improve the quality of multimodal analgesia during the post-operative period and can reduce the hospital stay and financial burden on the patient. Both paracetamol and diclofenac drugs are safe to provide analgesia in the postoperative period without any major significant side effects.

A Comparative Study of Intravenous Magnesium Sulphate Versus Intrathecal Magnesium Sulphate in 0.5% Hyperbaric Bupivacaine Spinal Anaesthesia for Elective Infraumbilical Surgery

BACKGROUND
 In this study, we wanted to compare the characteristics of subarachnoid block when intrathecal versus intravenous magnesium sulphate was used with 0.5 % hyperbaric bupivacaine spinal anaesthesia in elective infraumbilical surgery.
 METHODS
 This was a hospital based prospective randomized clinical parallel arm study double-blinded (patient and observer blinded) single hospital study conducted among 100 patients who presented with elective infraumbilical surgery under spinal anaesthesia to the Department of Anesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati, from 1st June 2021 to 31st May 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.
 RESULTS
 The onset of sensory block, and comparison of duration of analgesia with respect to time to first analgesic request was found to be statistically significant. While comparing, duration of analgesia was significantly prolonged in the intravenous group. Magnesium administered intravenously or intrathecally was not linked to any harmful side effects.
 CONCLUSIONS
 Infraumbilical procedures that use intravenous magnesium sulphate as an adjuvant to 0.5% hyperbaric bupivacaine spinal anaesthetic extend the time that post-operative analgesia lasts. Intrathecal co-administration of Magnesium sulphate with 0.5% hyperbaric bupicavaine delays the onset of sensory block compared to intravenous MgSO4.

Interprofessional Collaboration Between Nurses and Physicians in the Perioperative Period

PurposeTo explore nurses' and physicians’ experiences of the six dimensions of interprofessional (IP) collaboration when using Goal-Directed Therapy (GDT), and to examine how existing protocols on GDT facilitate the six dimensions of IP collaboration. DesignA qualitative design using individual semi-structured interviews and participant observations. MethodsA secondary analysis of data from participant observation and semi-structured interviews with nurses (n= 23) and physicians (n=12) in three departments of anesthesiology. Observations and interviews were carried out from December 2016 to June 2017. A deductive, qualitative content analysis using the Inter-Professional Activity Classification as a categorization matrix was used to explore interprofessional collaboration as a barrier to implementation. This analysis was supplemented by a text analysis of two protocols. FindingsFour dimensions were identified to influence IP collaboration: commitment, roles and responsibilities, interdependence, and integration of work practices. Negative factors included hierarchical boundaries, traditional nurse-physician relationship, unclear responsibility, and lack of shared knowledge. Positive factors included physician involvement of nurses in decisions and bedside education. The text-analysis showed a lack of clear directions of specific action and responsibility. ConclusionsCommitment and roles and responsibilities were dominant aspects of interprofessional collaboration in this context, causing problems for enhanced collaboration. Lack of clear guidance in the protocols might detract nurses’ feelings of responsibility.

In Response.

Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, [email protected] Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, Outcomes Research Consortium, Cleveland, Ohio Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Accepted for publication July 26, 2022. Conflicts of Interest: B.S. has received honoraria for consulting, honoraria for giving lectures, and refunds of travel expenses from Edwards Lifesciences (Irvine, CA). B.S. has received honoraria for consulting, institutional restricted research grants, honoraria for giving lectures, and refunds of travel expenses from Pulsion Medical Systems (Feldkirchen, Germany). B.S. has received institutional restricted research grants, honoraria for giving lectures, and refunds of travel expenses from CNSystems Medizintechnik (Graz, Austria). B.S. has received institutional restricted research grants from Retia Medical (Valhalla, NY). B.S. has received honoraria for giving lectures from Philips Medizin Systeme Böblingen (Böblingen, Germany). B.S. has received honoraria for consulting, institutional restricted research grants, and refunds of travel expenses from Tensys Medical (San Diego, CA).

In Response.

Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, [email protected] Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Health System/Ryder Trauma Center, Miami, Florida Accepted for publication June 24, 2022. Funding: R.D. received research funding from Haemonetics Corporation.

The use of immersive audiovisual distraction with virtual reality during pain procedures: a randomized controlled trial.

Journal Article Accepted manuscript The Use of Immersive Audiovisual Distraction with Virtual Reality During Pain Procedures: A Randomized Controlled Trial Get access Naileshni Singh, MD, Naileshni Singh, MD Associate Professor, University of California, Davis, Department of Anesthesiology and Pain Medicine Corresponding author. Naileshni Singh, MD, Associate Professor, University of California, Davis, Department of Anesthesiology and Pain Medicine, Phone: 916 734 6824, Fax: 916 734 6827, Email: naisingh@ucdavis.edu Search for other works by this author on: Oxford Academic PubMed Google Scholar Michael J Jung, M.D., M.B.A, Michael J Jung, M.D., M.B.A Assistant Clinical Professor, Department of Anesthesiology and Pain Medicine, University of California, Davis Search for other works by this author on: Oxford Academic PubMed Google Scholar Fatima Yusuf, B. S, Fatima Yusuf, B. S Medical Student, California Health Sciences University Search for other works by this author on: Oxford Academic PubMed Google Scholar Almas Khan, Almas Khan Student Research Assistant, University of California, Davis, Department of Anesthesiology and Pain Medicine Search for other works by this author on: Oxford Academic PubMed Google Scholar Tiffany Su, MD, Tiffany Su, MD Pain Management Physician, Chronic Pain Wellness Center, Phoenix VA Health Care System Search for other works by this author on: Oxford Academic PubMed Google Scholar Allison Glinka-Przybysz, MD MPH, Allison Glinka-Przybysz, MD MPH Assistant Professor, University of Wisconsin-Madison, Department of Orthopedics and Rehabilitation Search for other works by this author on: Oxford Academic PubMed Google Scholar Sandra L Taylor, PhD Sandra L Taylor, PhD Department of Public Health Sciences, University of California, Davis, School of Medicine Search for other works by this author on: Oxford Academic PubMed Google Scholar Pain Medicine, pnad066, https://doi.org/10.1093/pm/pnad066 Published: 19 May 2023 Article history Received: 28 February 2023 Revision received: 02 May 2023 Accepted: 11 May 2023 Published: 19 May 2023

In Response.

Department of Anesthesiology and Intensive Care, University Hospital of Leipzig, Leipzig, Germany, [email protected]

On the Importance of Transparency About the Internal Operation of Medical Devices.

Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, [email protected]

In Response.

Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China, [email protected] Department of Anesthesiology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China

In Response.

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, [email protected]

Is the Latency Between Symptom Onset and Diagnosis a Confounder in Understanding the Potential Relationship Between Intraoperative Blood Pressure and Long-Term Neurodevelopmental and Neuropsychiatric Disorders in Children?

Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada, Vancouver General Hospital, Jim Pattison Pavilion North, [email protected] Funding: Stock options as a consultant for Anesthesia Labs Inc.