47,009 results match your criteria Sedation


Asymptomatic benzocaine spray-induced methaemoglobinaemia in preoperative sedation for oesophagogastroduodenoscopy.

BMJ Case Rep 2022 Jun 27;15(6). Epub 2022 Jun 27.

Emergency/Internal Medicine, Luzmila Hospital, Amman, Jordan.

Methaemoglobinaemia is defined as elevated methaemoglobin in the blood which is characterised by conversion of some of the reduced ferrous iron elements [Fe2+] to the oxidised ferric [Fe3+] form which does not have capacity to bind and transport oxygen resulting in functional anaemia. Causes can be genetic mutations or acquired by medications such as dapsone, nitrates or benzocaine. Benzocaine is currently being used as a topical anaesthetic agent before certain procedures. Read More

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Mechanical Ventilation during ECMO: Lessons from Clinical Trials and Future Prospects.

Semin Respir Crit Care Med 2022 Jun 27. Epub 2022 Jun 27.

Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.

Acute Respiratory Distress Syndrome (ARDS) accounts for 10% of ICU admissions and affects 3 million patients each year. Despite decades of research, it is still associated with one of the highest mortality rates in the critically ill. Advances in supportive care, innovations in technologies and insights from recent clinical trials have contributed to improved outcomes and a renewed interest in the scope and use of Extracorporeal life support (ECLS) as a treatment for severe ARDS, including high flow veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) and low flow Extracorporeal Carbon Dioxide Removal (ECCO2R). Read More

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Liberation from Mechanical Ventilation: Established and New Insights.

Semin Respir Crit Care Med 2022 Jun 27. Epub 2022 Jun 27.

The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

A substantial proportion of critically ill patients require ventilator support with the majority requiring invasive mechanical ventilation. Timely and safe liberation from invasive mechanical ventilation is a critical aspect of patient care in the intensive care unit (ICU) and is a top research priority for patients and clinicians. In this article, we discuss how to (1) identify candidates for liberation from mechanical ventilation, (2) conduct spontaneous breathing trials (SBTs), and (3) optimize patients for liberation from mechanical ventilation. Read More

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Microcirculatory tissue perfusion during general anaesthesia and noncardiac surgery: An observational study using incident dark field imaging with automated video analysis.

Eur J Anaesthesiol 2022 Jul 16;39(7):582-590. Epub 2022 Jun 16.

From the Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (MF, THS, KK, BS), Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (JM, CI), Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Romagna, Rimini, Italy (JM), Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (LK), Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Groningen, the Netherlands (HDdB), Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (TWLS), Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland (MH) and Outcomes Research Consortium, Cleveland, Ohio, USA (BS).

Background: Handheld vital microscopy allows direct observation of red blood cells within the sublingual microcirculation. Automated analysis allows quantifying microcirculatory tissue perfusion variables - including tissue red blood cell perfusion (tRBCp), a functional variable integrating microcirculatory convection and diffusion capacities.

Objective: We aimed to describe baseline microcirculatory tissue perfusion in patients presenting for elective noncardiac surgery and test that microcirculatory tissue perfusion is preserved during elective general anaesthesia for noncardiac surgery. Read More

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Factors Associated with Difficulty Maintaining Insufflation of the Colon During Endoscopy.

Dig Dis Sci 2022 Jun 27. Epub 2022 Jun 27.

Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

Background: Insufflation of the colon allows for adequate visualization of the mucosal tissue and advancement of the endoscope during colonoscopy. Most colonoscopies are performed with sedation to mitigate discomfort and enhance the colonoscopy experience for both the patient and the endoscopist.

Aim: We aimed to evaluate factors associated with difficulty maintaining insufflation. Read More

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Systematic review and meta-analysis comparing the efficacy of dexmedetomidine to midazolam as premedication and a sedative agent in pediatric patients undergoing dental procedures.

Oral Maxillofac Surg 2022 Jun 27. Epub 2022 Jun 27.

Department of Oral and Maxillofacial Surgery, Dr. H.S.R.S.M. Dental College, Hingoli, Maharashtra, India.

Introduction: Pediatric dental surgeries are associated with the emotions of fear, anxiety, and other behavioral disturbances of children that need to be managed. Sedation using drugs like dexmedetomidine (DEX) and midazolam (MID) is a common pharmacological behavior managing technique. We conducted this meta-analysis to evaluate the efficacy of both these drugs in current literature. Read More

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ABCDE and ABCDEF care bundles: A systematic review of the implementation process in intensive care units.

Medicine (Baltimore) 2022 Jun 24;101(25):e29499. Epub 2022 Jun 24.

Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil.

Background: The ABCDE (Awakening and Breathing Coordination of daily sedation and ventilator removal trials, Delirium monitoring and management, and Early mobility and exercise) and ABCDEF (Assessment, prevent and manage pain, Both spontaneous awakening and spontaneous breathing trials, Choice of analgesia and sedation, assess, prevent and manage Delirium, Early mobility and exercise, Family engagement) care bundles consist of small sets of evidence-based interventions and are part of the science behind Intensive Care Unit (ICU) liberation. This review sought to analyse the process of implementation of ABCDE and ABCDEF care bundles in ICUs, identifying barriers, facilitators and changes in perception and attitudes of healthcare professionals; and to estimate care bundle effectiveness and safety.

Methods: We selected qualitative and quantitative studies addressing the implementation of ABCDE and ABCDEF bundles in the ICU, identified on MEDLINE, Embase, CINAHL, The Cochrane Library, Web of Science, Epistemonikos, PsycINFO, Virtual Health Library and Open Grey, without restriction on language or date of publication, up to June 2018. Read More

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Microcirculatory tissue perfusion during general anaesthesia and noncardiac surgery: An observational study using incident dark field imaging with automated video analysis.

Eur J Anaesthesiol 2022 Jun 13. Epub 2022 Jun 13.

From the Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (MF, THS, KK, BS), Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (JM, CI), Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Romagna, Rimini, Italy (JM), Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (LK), Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Groningen, the Netherlands (HDdB), Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (TWLS), Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland (MH) and Outcomes Research Consortium, Cleveland, Ohio, USA (BS).

Background: Handheld vital microscopy allows direct observation of red blood cells within the sublingual microcirculation. Automated analysis allows quantifying microcirculatory tissue perfusion variables - including tissue red blood cell perfusion (tRBCp), a functional variable integrating microcirculatory convection and diffusion capacities.

Objective: We aimed to describe baseline microcirculatory tissue perfusion in patients presenting for elective noncardiac surgery and test that microcirculatory tissue perfusion is preserved during elective general anaesthesia for noncardiac surgery. Read More

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Impact of COVID-19 pandemic on cardiac rhythm management services: views from the United Kingdom.

Heart Rhythm O2 2022 Jun 15. Epub 2022 Jun 15.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom.

Background: Effects of the COVID-19 pandemic on cardiac rhythm management(CRM) services remain poorly quantified.

Objective: To describe the impact of COVID-19 on specialist CRM centres in the United Kingdom(UK).

Methods: Two-centre study involving the Liverpool Heart and Chest Hospital NHS Foundation Trust and Royal Papworth Hospital NHS Foundation Trust. Read More

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Factors Associated With Deep Sedation Practice in Mechanically Ventilated Patients: A Analysis of a Cross-Sectional Survey Combined With a Questionnaire for Physicians on Sedation Practices.

Front Med (Lausanne) 2022 9;9:839637. Epub 2022 Jun 9.

Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.

Purpose: The study aimed to explore factors associated with deep sedation practice in intensive care units (ICUs).

Materials And Methods: A analysis was conducted for a cross-sectional survey on sedation practices in mechanically ventilated (MV) patients, combined with a questionnaire for physicians regarding their preferences for light sedation (P-pls Score) in 92 Chinese ICUs.

Results: There were 457 and 127 eligible MV patients in the light and deep sedation groups respectively. Read More

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Developments in procedural sedation for adults.

Authors:
J R Sneyd

BJA Educ 2022 Jul 20;22(7):258-264. Epub 2022 Apr 20.

University of Plymouth, Plymouth, UK.

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Meta-analysis comparing the efficiency of high-flow nasal cannula versus low-flow nasal cannula in patients undergoing endoscopic retrograde cholangiopancreatography.

Proc (Bayl Univ Med Cent) 2022 20;35(4):485-491. Epub 2022 Apr 20.

McLaren Health Care, Flint, Michigan.

Endoscopic retrograde cholangiopancreatography (ERCP) identifies and treats pancreatic and biliary diseases. We conducted a systematic review and meta-analysis examining relevant papers in five databases to examine the frequency of hypoxia throughout the surgery and the lowest oxygen saturation level in patients under sedation. Our meta-analysis included three randomized controlled trials with 390 participants, 196 in the high-flow oxygen (HFNC) group and 194 in the low-flow oxygen (LFNC) group. Read More

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Pharmacotherapy for Spine-Related Pain in Older Adults.

Drugs Aging 2022 Jun 27. Epub 2022 Jun 27.

Department of Neurology, Boston University School of Medicine, Boston Medical Center, 85 E. Concord St, 1122, Boston, MA, 02118, USA.

As the population ages, spine-related pain is increasingly common in older adults. While medications play an important role in pain management, their use has limitations in geriatric patients due to reduced liver and renal function, comorbid medical problems, and polypharmacy. This review will assess the evidence basis for medications used for spine-related pain in older adults, with a focus on drug metabolism and adverse drug reactions. Read More

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ARDS clinical practice guideline 2021.

Respir Investig 2022 Jun 23. Epub 2022 Jun 23.

Department of Anesthesiology, Osaka Women's and Children's Hospital, Osaka, Japan.

Background: The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021.

Methods: The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. Read More

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Use of a single dose of 70mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3132 cases.

Rev Esp Anestesiol Reanim (Engl Ed) 2022 Jun 23. Epub 2022 Jun 23.

Hospital Universitario de Leganés, Facultad de Medicina, Universidad Alfonso X el Sabio, Leganés, Madrid, Spain.

Objective: To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI).

Material And Methods: Prospective study conducted from January 2000 to January 2020 in which 3132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Read More

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The evolution of performing a kidney biopsy: a single center experience comparing native and transplant kidney biopsies performed by interventional radiologists and nephrologists.

BMC Nephrol 2022 Jun 25;23(1):226. Epub 2022 Jun 25.

Yale School of Medicine, Section of Nephrology, New Haven, CT, USA.

Background: Kidney biopsy is the most vital tool guiding a nephrologist in diagnosis and treatment of kidney disease. Over the last few years, we have seen an increasing number of kidney biopsies being performed by interventional radiologists. The goal of our study was to compare the adequacy and complication rates between kidney biopsies performed by interventional radiology versus nephrology. Read More

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Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation.

Ann Emerg Med 2022 Jun 22. Epub 2022 Jun 22.

Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.

Study Objective: Laryngospasm is a rare but potentially life-threatening complication of sedation. The objective of this study was to perform a predictor analysis of biologically plausible predictors and the interventions and outcomes associated with laryngospasm.

Methods: Secondary analysis of prospectively collected data from consecutively sedated patients, less than or equal to 22 years of age, at multiple locations at 64 member institutions of the Pediatric Sedation Research Consortium. Read More

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Sedation and HIV medication.

Authors:
K Bhatia C Moshkun

Br Dent J 2022 Jun;232(12):841-842

By email, Manchester, UK.

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Manchester University NHS Foundation Trust v WV [2022] EWCOP 9 : The Court of Protection: On balancing risks; best interests and kidney transplantation.

Authors:
Neera Bhatia

J Bioeth Inq 2022 Jun 24. Epub 2022 Jun 24.

School of Law, Deakin University, Melbourne, Victoria, 3125, Australia.

At first glance, this case might give the impression that a resolution would have been straightforward. A 17-year-old young man with moderate to severe learning disabilities and other conditions discussed below required a kidney transplant-the Court of Protection was tasked with determining whether this was in his best interests. However, the case of WV was in fact far more technical and required nuanced discussion and expert medical evidence from a range of specialists to objectively balance the needs of WV and the risks to WV, and to ultimately determine his fate of life or death based on receiving a kidney transplant. Read More

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Intravenous Ganaxolone for the Treatment of Refractory Status Epilepticus: Results from an Open-Label, Dose-Finding, Phase 2 Trial.

Epilepsia 2022 Jun 24. Epub 2022 Jun 24.

Marinus Pharmaceuticals, Radnor, PA.

Objective: Patients with refractory status epilepticus (RSE) have failed treatment with benzodiazepines and ≥1 second-line intravenous (IV) anti-seizure medication (ASM). Guidelines recommend IV anesthesia when second-line ASMs have failed, but potential harms can outweigh benefits. Novel treatments are needed to stop and durably control RSE without escalation to IV anesthetics. Read More

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Neuroimaging for Pediatric Non-First-Time Seizures in the Emergency Department.

Neurol Clin Pract 2022 Jun;12(3):e7-e13

Section of Neurology (EM, SR, ES, JJ, JM, RM, MS), Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora; Section of Emergency Medicine Department of Pediatrics (RDM, JL), University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora; and Division of Neurology (CAP), Department of Pediatrics, Children's Hospital of Philadelphia, PA.

Background And Objectives: Neuroimaging is often part of the workup for a pediatric patient presenting with a seizure to an emergency department (ED). We aim to evaluate when neuroimaging in the ED for children with a non-first-time seizure, or nonindex seizure (NIS), is associated with an acute change in management (ACM).

Methods: This is a retrospective cohort study of all pediatric patients presenting to an ED from 2008 to 2018 with a NIS, excluding repeat febrile seizures, who underwent neuroimaging. Read More

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Modified Thermal Balloon Endometrial Ablation for Treatment of Heavy Menstrual Bleeding.

Gynecol Minim Invasive Ther 2022 Apr-Jun;11(2):100-104. Epub 2022 May 4.

Department of Obstetrics and Gynecology, College of Medicine, Mosul University, Mosul, Iraq.

Objectives: The objective of this study was to determine the efficacy of modified thermal balloon ablation using Foley's catheter in the treatment of heavy menstrual bleeding (HMB).

Materials And Methods: Twelve patients with HMB aged 35-55 years underwent modified thermal balloon ablation using Foley's catheter. Patients were selected after complete clinical evaluation and investigations. Read More

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Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS.

J Clin Med 2022 Jun 17;11(12). Epub 2022 Jun 17.

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany.

The sedation management of patients with severe COVID-19 is challenging. Processed electroencephalography (pEEG) has already been used for sedation management before COVID-19 in critical care, but its applicability in COVID-19 has not yet been investigated. We performed this prospective observational study to evaluate whether the patient sedation index (PSI) obtained via pEEG may adequately reflect sedation in ventilated COVID-19 patients. Read More

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Expert Multinational Consensus Statement for Total Intravenous Anaesthesia (TIVA) Using the Delphi Method.

J Clin Med 2022 Jun 17;11(12). Epub 2022 Jun 17.

Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZD, UK.

The use of total intravenous anaesthesia (TIVA) has been well established as an anaesthetic technique over the last few decades. Significant variation in practice exists however, and volatile agents are still commonly used. This study aims to determine the motivations and barriers for using TIVA over the use of volatile agents by analysing the opinion of several international anaesthetists with specific expertise or interests. Read More

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Dental Treatment under General Anesthesia in Patients with Special Needs Provided by Private and Public Healthcare Services-A Retrospective, Comparative Study.

Healthcare (Basel) 2022 Jun 20;10(6). Epub 2022 Jun 20.

Graduate Program in Dentistry, Health Institute of Nova Friburgo, Fluminense Federal University, Friburgo 20950-000, RJ, Brazil.

In special care dentistry, general anesthesia (GA) is considered as an alternative option to facilitate treatment for uncooperative patients with special needs (PSN) who require invasive dental interventions.

Objective: to evaluate the profile of dental treatment procedures performed and the characteristics of PSN who underwent dental treatment under GA, provided by private and public healthcare providers.

Methods: A retrospective, observational study involving a sample of 100 PSN treated in hospital and specialist secondary care settings. Read More

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Comparing the Effect of Dexmedetomidine and Midazolam in Patients with Brain Injury.

Brain Sci 2022 Jun 8;12(6). Epub 2022 Jun 8.

Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China.

Background: Studies have shown that dexmedetomidine improves neurological function. Whether dexmedetomidine reduces mortality or improves quantitative electroencephalography (qEEG) among patients post-craniotomy remains unclear.

Methods: This single-center randomized study was conducted prospectively from 1 January 2019 to 31 December 2020. Read More

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Using EmPalPed-An Educational Toolkit on Essential Messages in Palliative Care and Pain Management in Children-As a Strategy to Promote Pediatric Palliative Care.

Children (Basel) 2022 Jun 6;9(6). Epub 2022 Jun 6.

Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS #260, Memphis, TN 38105, USA.

Background: Most children needing palliative care (PC) live in low- and middle-income countries. In Colombia, pediatric palliative care (PPC) knowledge among healthcare professionals (HCPs) is lacking as PPC is not included in the educational curricula of healthcare programs. Therefore, specific training that improves knowledge of HCPs and access to PC for children and their families is needed. Read More

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Pediatric Procedural Sedation and Analgesia (PROSA) in the Leuven University Hospitals: An Audit on Efficacy and Safety.

Children (Basel) 2022 May 25;9(6). Epub 2022 May 25.

Department of Pediatrics, University Hospitals UZ Leuven, 3000 Leuven, Belgium.

The hospital can be a stressful environment for a child. To address the increase in demands for pediatric procedural sedation, the PROSA team initiative was started in the Leuven University Hospitals in 2014. In this study, we assessed the efficacy and safety of this project since its initiation. Read More

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Clinical features, electroencephalogram, and biomarkers in pediatric sepsis-associated encephalopathy.

Sci Rep 2022 Jun 23;12(1):10673. Epub 2022 Jun 23.

Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil.

To date, no specific diagnostic criteria for sepsis-associated encephalopathy (SAE) have been established. We studied 33 pediatric patients with sepsis prospectively and evaluated the level of consciousness, the presence of delirium, electroencephalographic (EEG) findings, and plasma levels of neuron-specific enolase and S100-calcium-binding protein-B. A presumptive diagnosis of SAE was primarily considered in the presence of a decreased level of consciousness and/or delirium (clinical criteria), but specific EEG abnormalities were also considered (EEG criteria). Read More

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