Publications of Jean JORIS
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See detailImpact of preoperative treatment with antidepressants and/or anxiolytics on outcomes after colorectal surgery with an enhanced recovery programme: a monocentric retrospective study
HARDY, Pierre-Yves ULiege; Bodson, Aurélie ULiege; de Harenne, Charlotte ULiege et al

in Acta Chirurgica Belgica (2021)

Abstract Background Preoperative use of antidepressants and anxiolytics was reported to increase length of hospital stay (LOS) and worsen surgical outcomes. However, the surgical procedures studied were ... [more ▼]

Abstract Background Preoperative use of antidepressants and anxiolytics was reported to increase length of hospital stay (LOS) and worsen surgical outcomes. However, the surgical procedures studied were seldom performed with an enhanced recovery programme (ERP). This study investigated whether these medications impaired postoperative recovery after colorectal surgery with an ERP. Methods The data of all patients scheduled for colorectal surgery between November 2015 and December 2019 prospectively included in our database were analysed. All the patients were managed with the same ERP. Demographic data, risk factors, incidence of postoperative complications, LOS, and adherence to the ERP were compared between patients with and without preoperative antidepressant and/or anxiolytic treatment. Results Of the 502 patients, 157 (31.3%) were treated with antidepressants and/or anxiolytics. They were older (65.7 vs. 59.5 years, p < 0.001), sicker (higher ASA physical status score, p = 0.001), and underwent surgery more frequently for cancer (73.9 vs. 56.8%, p < 0.001). Overall adherence to ERP (p = 0.99) and adherence to the postoperative items of ERP (p = 0.29), incidence of postoperative complications (35.7 vs. 33.2%, p = 0.61), and LOS (4 [2–7] vs. 4 [2–7], p = 0.99) were similar in the two groups. Conclusions Our findings suggest that preoperative treatment with antidepressants and/or anxiolytics does not worsen outcome after elective colorectal surgery with an ERP, does not impact adherence to ERP, and does not prolong LOS. ERP seems efficacious in patients treated with these medications, who should therefore not be excluded from this programme. [less ▲]

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See detailImpact of Preoperative Anemia on Outcomes of Enhanced Recovery Program After Colorectal Surgery: A Monocentric Retrospective Study
HARDY, Pierre-Yves ULiege; DEGESVES, Maxime ULiege; JORIS, Jean ULiege et al

in World Journal of Surgery (2021)

Abstract Background Anemia is common before major abdominal surgery (35%). It is an independent factor for postoperative complications and longer length of stay (LOS). The aim of this study was to ... [more ▼]

Abstract Background Anemia is common before major abdominal surgery (35%). It is an independent factor for postoperative complications and longer length of stay (LOS). The aim of this study was to evaluate the extent to which preoperative anemia impacts on enhanced recovery programs (ERP) outcomes. Materials and Methods The data for patients scheduled for colorectal surgery between 2015 and 2019, were analyzed (n = 494). All patients were managed with the same ERP. Demographic data, preoperative risk factors, postoperative complications, LOS and adherence to ERP were compared between anemic and non-anemic patients. Anemia was defined by a hemoglobin concentration < 13 g dL-1 in men and < 12 g dL-1 in women. Results and Discussion In total, 173 patients had preoperative anemia. They were older (p<0.001) and more often male (p = 0.02). The following risk factors were significantly more frequent in the anemic group: renal failure (p = 0.04), malnutrition (p<0.001), cardiac arrhythmia (p<0.001), coronaropathy (p = 0.02) and anticoagulant treatment (p<0.001). Despite more risk factors, anemic patients did not experience more postoperative complications (38.2% vs. 31.2%, p = 0.12). Overall adherence to ERP was similar (18 [16–19] vs. 18 [17–19], p = 0.06). LOS was 4 [3–7] and 3 [2–6.25] days in the anemic and the non-anemic groups, respectively (p\0.002). Multivariate analysis showed that anemia did not affect LOS (p = 0.27). Conclusion Our study suggests that preoperative anemia does not detract from the benefits of ERP after elective colorectal surgery. [less ▲]

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See detailComparison of outcome after right colectomy with an enhanced recovery programme in patients with inflammatory bowel disease and patients operated on for other conditions: a monocentric retrospective study
MEUNIER, Anne ULiege; SORCE, Giuseppe ULiege; HARDY, Pierre-Yves ULiege et al

in International Journal of Colorectal Disease (2021)

Purpose Enhanced recovery programmes (ERPs) after surgery reduce postoperative complications and hospital stay. Patients with inflammatory bowel disease (IBD) often present risk factors for postoperative ... [more ▼]

Purpose Enhanced recovery programmes (ERPs) after surgery reduce postoperative complications and hospital stay. Patients with inflammatory bowel disease (IBD) often present risk factors for postoperative complications. This accounts for reluctance to include them in ERPs. We compared outcome after right colectomy with an ERP in IBD and non-IBD patients. Methods In our GRACE colorectal surgery database comprising 508 patients, we analysed patients scheduled for right colectomy (n = 160). Adherence to the protocol, postoperative complications and length of hospital stay of IBD patients (n = 45) were compared with those of non-IBD patients (n = 115). Data (mean ± SD, median [IQR], count (%)) were compared by Student’s t, Mann-Whitney U and chi-square tests when appropriate; p < 0.05 taken as statistically significant. Results IBD patients were significantly younger (38.9 ± 13.8 vs. 58.9 ± 18.5 years, p < 0.001) and had lower BMI (23.0 ± 5.0 vs. 25.1 ± 5.0 kg m−2, p < 0.01). Adherence to ERP was similar in the two groups. Resumption of eating on the day of the operation was less well tolerated (73.3% vs. 85.2%, p < 0.05) and postoperative pain (p < 0.001) was greater in IBD patients. The incidence of postoperative complications (13.3% vs. 17.3%) and the length of hospital stay (3 [3–4.5] vs. 3 [2–5] days) were comparable in IBD and non-IBD patients, respectively. Conclusion The management of IBD patients in an ERP is not only feasible but also indicated. These patients benefit as much from ERP as non-IBD patients. [less ▲]

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See detailShort Message Service as a tool to improve Perioperative follow-up of surgical outpatients : a before-after study.
HALLET, Claude ULiege; Lois, Fernande ULiege; Warner, David et al

in Anaesthesia, Critical Care and Pain Medicine (2020), 39(6), 799-805

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See detailLa réhabilitation améliorée après chirurgie colorectale
JORIS, Jean ULiege; HARDY, Pierre-Yves ULiege; SLIM, Karem

in Hépato-Gastro et Oncologie Digestive (2020), 27(7),

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See detailLa réhabilitation améliorée après chirurgie colorectale
HARDY, Pierre-Yves ULiege; MEUNIER, Anne ULiege; COIMBRA MARQUES, Carla ULiege et al

in Revue Médicale de Liège (2020), 75(5-6), 286-291

La réhabilitation améliorée après chirurgie (RAC) colorectale est une prise en charge multidisciplinaire et multimodale, centrée sur le patient. La mise en place de mesures pré-, per- et postopératoires ... [more ▼]

La réhabilitation améliorée après chirurgie (RAC) colorectale est une prise en charge multidisciplinaire et multimodale, centrée sur le patient. La mise en place de mesures pré-, per- et postopératoires réduit la réponse au stress chirurgical, la réaction inflammatoire et leurs conséquences. Ce protocole de soins, basé sur des preuves scientifiques, permet une récupération améliorée et accé- lérée. L’incidence des complications médicales est, secondairement, réduite de 50 %. La réhabilitation améliorée se traduit par une diminution significative de la durée d’hos- pitalisation, une diminution des complications infectieuses et, probablement, par un impact positif sur la survie après chirurgie oncologique. Il n’y a pas de contre-indication à la RAC qui doit donc être proposée à tous les patients devant subir une chirurgie colorectale. Une adaptation du protocole sera néanmoins nécessaire en cas de chirurgie urgente. [less ▲]

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See detailA SINGLE CENTER EXPERIENCE WITH 157 CONTROLED DCD-LIVER TRANSPLANTATIONS
Schielke, Astrid Anita ULiege; Paolucci, Maité ULiege; MEURISSE, Nicolas ULiege et al

in Transplant International (2019, October), 32(S2), 029165

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and ... [more ▼]

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and retransplantation. The authors retrospectively reviewed a single centre experience with controlled DCD-LT in a 15-year period. Patients and Methods: 157 DCD-LT were consecutively performed between 2003 and 2017. All donation and procurement procedures were performed as controlled DCD in the operating theatre. Data are presented as median (ranges). Median donor age was 57 years (16–83). Median DRI was 2.242 (1.322–3.554). Allocation was centre-based. Median recipient MELD score at LT was 15 (6–40). Mean follow-up was 37 months. No patient was lost to follow-up. Results: Median total DCD warm ischemia was 19 min (7–39). Median total ischemia was 313 min (181–586). Patient survivals were 89.8%, 75.5% and 73.1% at 1,3 and 5 years, respectively. Graft survivals were 89%, 73.8% and 69.8% at 1,3 and 5 years, respectively. Biliary complications included mainly anastomotic strictures, that were managed either by endoscopy or hepatico- jejunostomy. Two patients were retransplanted due to intrahepatic ischemic lesions. Conclusion: In this series, DCD LT provides results similar to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. [less ▲]

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See detailSingle center experience in 157 controlled DCD-liver tranplantation
Schielke, Astrid Anita ULiege; Paolucci, M; MEURISSE, Nicolas ULiege et al

Conference (2019, May 16)

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and ... [more ▼]

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and retransplantation. The authors retrospectively reviewed a single centre experience with controlled DCD-LT in a 15-year period. Patients and Methods: 157 DCD-LT were consecutively performed between 2003 and 2017. All donation and procurement procedures were performed as controlled DCD in the operating theatre. Data are presented as median (ranges). Median donor age was 57 years (16-83). Median DRI was 2.242 (1.322-3.554). Allocation was centre-based. Median recipient MELD score at LT was 15 (6-40). Mean follow-up was 37 months. No patient was lost to follow-up. Results: Median total DCD warm ischemia was 19 min (7-39). Median total ischemia was 313 min (181-586). Patient survivals were 89.8%, 75.5% and 73.1% at 1,3 and 5 years, respectively. Graft survivals were 89%, 73.8% and 69.8% at 1,3 and 5 years, respectively. Biliary complications included mainly anastomotic strictures, that were managed either by endoscopy or hepatico- jejunostomy. Two patients were retransplanted due to intrahepatic ischemic lesions. Conclusion: In this series, DCD LT provides results similar to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. [less ▲]

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See detailA single center experience with 157 controlled DCD liver transplantation
Schielke, Astrid Anita ULiege; Paolucci, M; MEURISSE, Nicolas ULiege et al

Conference (2019, March 14)

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and ... [more ▼]

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and retransplantation. The authors retrospectively reviewed a single centre experience with controlled DCD-LT in a 15-year period. Patients and Methods: 157 DCD-LT were consecutively performed between 2003 and 2017. All donation and procurement procedures were performed as controlled DCD in the operating theatre. Data are presented as median (ranges). Median donor age was 57 years (16-83). Median DRI was 2.242 (1.322-3.554). Allocation was centre-based. Median recipient MELD score at LT was 15 (6-40). Mean follow-up was 37 months. No patient was lost to follow-up. Results: Median total DCD warm ischemia was 19 min (7-39). Median total ischemia was 313 min (181-586). Patient survivals were 89.8%, 75.5% and 73.1% at 1,3 and 5 years, respectively. Graft survivals were 89%, 73.8% and 69.8% at 1,3 and 5 years, respectively. Biliary complications included mainly anastomotic strictures, that were managed either by endoscopy or hepatico-jejunostomy. Two patients were retransplanted due to intrahepatic ischemic lesions. Discussion: In this series, DCD LT provides results similar to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. [less ▲]

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See detailHeart donation after circulatory death
LEDOUX, Didier ULiege; MASSION, Paul ULiege; HANS, Grégory ULiege et al

Conference (2019, March 14)

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See detailBilateral subcostal transversus abdominis plane block does not improve the postoperative analgesia provided by multimodal analgesia after laparoscopic cholecystectomy: A randomised placebo-controlled trial.
Houben, Alan ULiege; Moreau, Anne-Sophie; DETRY, Olivier ULiege et al

in European journal of anaesthesiology (2019), 36(10), 772-777

BACKGROUND: Laparoscopic cholecystectomy might be considered minor surgery, but it may result in severe postoperative pain. Subcostal transversus abdominis plane (TAP) block, which produces long-lasting ... [more ▼]

BACKGROUND: Laparoscopic cholecystectomy might be considered minor surgery, but it may result in severe postoperative pain. Subcostal transversus abdominis plane (TAP) block, which produces long-lasting supra-umbilical parietal analgesia, might improve analgesia after laparoscopic cholecystectomy. OBJECTIVE: We investigated whether subcostal TAP block would reduce opioid consumption and pain after laparoscopic cholecystectomy in patients provided with multimodal analgesia. DESIGN: A randomised, placebo-controlled, double-blind study. SETTING: The study was conducted at a university teaching hospital from December 2017 to June 2018. PATIENTS: Sixty patients scheduled for laparoscopic cholecystectomy were included. Anaesthesia and postoperative analgesia (etoricoxib, paracetamol, ketamine and dexamethasone) were standardised. INTERVENTION: After induction of anaesthesia, patients were allocated into two groups: ultrasound-guided bilateral subcostal TAP block with 20 ml of levobupivacaine 0.375% and epinephrine 5 mug ml or 0.9% saline with epinephrine 5 mug ml. MAIN OUTCOME MEASURES: Opioid consumption in the recovery room and during the first 24 h after surgery were recorded. Postoperative somatic and visceral pain scores, fatigue and nausea were measured. Intra-operative end-tidal concentrations of sevoflurane (FETSEVO) were also recorded. RESULTS: Twenty-four hour postoperative opioid consumption were similar in both groups: 21.2 mg (95% CI 15.3 to 27.1) vs. 25.2 (95% CI 15.1 to 35.5) oral morphine equivalent in the levobupivacaine and 0.9% saline groups, respectively; P = 0.48. No significant between-group differences were observed with regards to parietal (P = 0.56) and visceral (P = 0.50) pain scores, fatigue and nausea. FETSEVO was slightly lower in the levobupivacaine group (P < 0.01). CONCLUSION: Subcostal TAP block does not improve the analgesia provided by multimodal analgesia after laparoscopic cholecystectomy. It allows for a small reduction in intra-operative sevoflurane requirements. TRIAL REGISTRATION: NCT0339153. [less ▲]

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See detailA SINGLE CENTER EXPERIENCE WITH 157 CONTROLED DCD-LIVER TRANSPLANTATIONS
Schielke, Astrid Anita ULiege; Paolucci, Maite; MEURISSE, Nicolas ULiege et al

Conference (2018, November 29)

But du travail: Rapporter une expérience monocentrique de 14 ans de transplantation hépatique (TH) à partir de donneurs en mort circulatoire de type III (DMC III) de Maastricht. Méthodes : 157 TH DMC III ... [more ▼]

But du travail: Rapporter une expérience monocentrique de 14 ans de transplantation hépatique (TH) à partir de donneurs en mort circulatoire de type III (DMC III) de Maastricht. Méthodes : 157 TH DMC III ont été réalisées entre 2003 et 2017. Tous les prélèvements ont été réalisés sur des DMC III dont les soins ont été interrompus en salle d’opération. Aucune perfusion normothermique n’a été utilisée dans cette série. Les données sont présentées en médiane et extrêmes. L’âge des donneurs étaient de 57 ans (16-84). L’âge des receveurs était de 60 ans (21-74), avec un score MELD de 15 (6-40). Le suivi était de 37 mois (6-180). Résultats : L’ischémie chaude totale de prélèvement (de l’arrêt du support respiratoire à la perfusion aortique) était de 19 min (7-39). L’ischémie froide était de 237 min (105-576). Le pic d’ASAT était de 978 U/L (67-21.510). La survie des patients et de greffons étaient de 89,8%, 75,5% and 73,1 % et 89%, 73,8% and 69,8%, à 1, 3 et 5 ans, respectivement. La plupart des complications biliaires ont été des sténoses anastomotiques traitées par voie endoscopique, et 2 patients ont été re-transplantés pour des lésions ischémiques intra-hépatiques diffuses. La majorité des décès étaient dus à des causes néoplasiques (récidive de carcinome hépatocellulaire ou tumeur de novo). Conclusions : cette expérience nous encourage à continuer l’utilisation des DMC III pour la TH. Une ischémie froide courte et une sélection des patients avec des MELD peu élevé peut en partie expliquer ces bons résultats. [less ▲]

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See detailLiver transplantation in Jehovah’s Witnesses: a single center-experience
VANDERMEULEN, Morgan ULiege; MEURISSE, Nicolas ULiege; DAMAS, Pierre ULiege et al

Conference (2018, March 15)

For religious reasons most of the Jehovah's witnesses (JW) refuse infusions of any blood product, including autologous or homologous pre-donated blood, platelets, fresh frozen plasma. However, they may ... [more ▼]

For religious reasons most of the Jehovah's witnesses (JW) refuse infusions of any blood product, including autologous or homologous pre-donated blood, platelets, fresh frozen plasma. However, they may accept solid organ transplantation. The authors report their experience of liver transplantation (LT) in JW over a 20-year period. [less ▲]

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See detailLiver transplantation in Jehovah's witnesses
VANDERMEULEN, Morgan ULiege; MEURISSE, Nicolas ULiege; DAMAS, Pierre ULiege et al

in Acta Gastro-Enterologica Belgica (2018, January), 81(1), 30

Introduction: Liver transplantation (LT) is a major surgical procedure with large dissections and sutures of large vessels in patients with high portal hypertension and low levels of platelets and ... [more ▼]

Introduction: Liver transplantation (LT) is a major surgical procedure with large dissections and sutures of large vessels in patients with high portal hypertension and low levels of platelets and coagulation factors. In consequence, LT often requires large amounts of blood products. For religious reasons, most Jehovah's witnesses (JW) refuse infusions of any blood product, including autologous or homologous pre-donated blood, platelets, fresh frozen plasma, coagulation factor concentrates, or human albumin. However, they may accept solid organ transplantation, including LT. Aim: The authors developed experience in abdominal and oncological surgery in JW and present here their results with LT in JW patients. Methods: Over a 20-year period, 22 LT (16 DBD, 2DCD, and 4 LRLT with JW living donors) were performed in 21 JW patients and were analyzed retrospectively. All patients received perioperative iron supplementation and erythropoietin. Two patients had percutaneous spleen embolization to increase platelet level. Anti-fibrinolytic (aprotinin or tranexamic acid) was administrated during LT and meticulous surgical hemostasis was achieved, helped by argon beam coagulation. Continuous circuit cell salvage and reinfusion whereby scavenged blood was maintained in continuity with the patient's circulation, was used in all patients. Veno-venous bypass was avoided during LT to minimize the coagulation disorders. Results: There were 10 male and 11 female patients whose mean age was 48 years (ranges: 6-70). Indications for LT were HCV with (3) or without (1) HCC, PBC (2), PSC (1), HBV (2), autoimmune hepatitis (1), antitrypsin deficiency (1), sarcoidosis (2), amyloidosis (3), polycystic liver disease (1), alcoholic cirrhosis with HCC (1), cryptogenic (3), hepatic artery thrombosis (1). At transplant, mean pre-operative hematocrit was 41% (ranges: 22-50), mean platelet level was 140x103/mm3 (ranges: 33-355), and mean INR was 1.25 (ranges: 0.84- 2.18).One LRLT recipient died at day 11 from aspergillosis and anemia, and another DBD recipient at day 28 due to complications after hepatic artery thrombosis. One patient finally accepted to be transfused for severe anemia. The mean hospital stay was 31 days (10-137). Kaplan-Maier patient survival was 85%, 72%, 72% at 5, 10 and 15 years, respectively Conclusions: According to the authors' experience, LT may be successful in selected and prepared JW patients who should not be a priori excluded from this life saving procedure. The indications for LT in JW were quite different from the common indications for LT, with a low rate of alcoholic cirrhosis. The experience with this particular group of patients helped the team to reduce transfusion needs in the non-JW patients. [less ▲]

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See detailIntravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study
Forster, C.; VANHAUDENHUYSE, Audrey ULiege; GAST, Pierrette ULiege et al

in British Journal of Anaesthesia (2018), 121(5), 1059-1064

Background: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery ... [more ▼]

Background: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery. We tested the hypothesis that i.v. lidocaine reduces propofol requirements during colonoscopy and improves post-colonoscopy recovery. Methods: Forty patients undergoing colonoscopy were included in this randomised placebo-controlled study. After titration of propofol to produce unconsciousness, patients were given i.v. lidocaine (1.5 mg kg−1 then 4 mg kg−1 h−1) or the same volume of saline. Sedation was standardised and combined propofol and ketamine. The primary endpoint was propofol requirements. Secondary endpoints were: number of oxygen desaturation episodes, endoscopists’ working conditions, discharge time to the recovery room, post-colonoscopy pain, fatigue. Results: Lidocaine infusion resulted in a significant reduction in propofol requirements: 58 (47) vs 121 (109) mg (P=0.02). Doses of ketamine were similar in the two groups: 19 (2) vs 20 (3) mg in the lidocaine and saline groups, respectively. Number of episodes of oxygen desaturation, endoscopists’ comfort, and times for discharge to the recovery room were similar in both groups. Post-colonoscopy pain (P<0.01) and fatigue (P=0.03) were significantly lower in the lidocaine group. Conclusions: Intravenous infusion of lidocaine resulted in a 50% reduction in propofol dose requirements during colonoscopy. Immediate post-colonoscopy pain and fatigue were also improved by lidocaine. Clinical trial registration: NCT 02784860. © 2018 British Journal of Anaesthesia [less ▲]

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