Back to resultsDexmedetomidine Supplemented Analgesia in Patients at High-risk of Obstructive Sleep Apnea
Primary Purpose
Obstructive Sleep Apnea, Analgesia, Dexmedetomidine
Status
Completed
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Dexmedetomidine
Placebo
Sponsored by
About this trial
This is an interventional prevention trial for Obstructive Sleep Apnea focused on measuring Obstructive Sleep Apnea, Analgesia, Dexmedetomidine, High-flow nasal cannula, Sleep quality
Eligibility Criteria
Inclusion Criteria:
- Age >=18 years but <=80 years;
- At high-risk of obstructive sleep apnea (a STOP-Bang score ≥3 combined with a serum bicarbonate ≥28 mmol/ L), but does not regularly receive continuous positive airway pressure (CPAP) therapy;
- Scheduled to undergo major noncardiac surgery under general anesthesia, with an expected duration of >=1 hours and planned to use patient-controlled intravenous analgesia (PCIA) after surgery.
Exclusion Criteria:
- Diagnosed as central sleep apnea syndrome;
- Preoperative history of severe central nervous system diseases (epilepsy, parkinsonism, intracranial tumor, craniocerebral trauma) or neuromuscular disorders (myasthenia gravis);
- History of schizophrenia or other mental disorders, or antidepressant or anxiolytic therapy within 3 month before surgery;
- Inability to communicate in the preoperative period because of coma, profound dementia, deafness or language barriers;
- History of drug or alcohol dependence, or sedative or hypnotic therapy within 1 month before surgery;
- Contraindications to HFNC therapy (e.g. mediastinal emphysema, shock, cerebrospinal fluid leakage, nasosinusitis, otitis media, glaucoma);
- Severe tracheal or pulmonary disease (e.g. bullous lung disease, pneumothorax, tracheal fistula);
- Sick sinus syndrome, severe sinus bradycardia (<50 beats per minute), or second-degree or above atrioventricular block without pacemaker；
- Severe hepatic dysfunction (Child-Pugh class C); Severe renal dysfunction (requirement of renal replacement therapy); severe heart dysfunction (preoperative New York Heart Association functional classification ≥3 or left ventricular ejection fraction <30%); ASA classification IV or above; or expected survival <24 hours after surgery;
- Preoperative use of CPAP or HFNC therapy;
- Expected intensive care unit (ICU) admission with tracheal intubation after surgery;
- Refuse to participate in this study;
- Other conditions that are considered unsuitable for study participation.
Sites / Locations
- Dong-Xin Wang
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
Dexmedetomidine group
Placebo group
Arm Description
Patient-controlled analgesia is established with morphine (0.5 mg/ml) and dexmedetomidine (1.25 microgram/ml) in a total volume of 160 ml. The pump is programmed to deliver 2-ml boluses at 6 to 8-minute lockout intervals with a background infusion rate at 1 ml/h. Patient-controlled analgesia is provided for at least 24 hours after surgery.
Patient-controlled analgesia is established with morphine (0.5 mg/ml) in a total volume of 160 ml. The pump is programmed to deliver 2-ml boluses at 6 to 8-minute lockout intervals with a background infusion rate at 1 ml/h. Patient-controlled analgesia is provided for at least 24 hours after surgery.
Outcomes
Primary Outcome Measures
The percentage of non-rapid eye movement stage 2 (N2) sleep.
Calculated according to polysomnographic monitoring results.
Secondary Outcome Measures
Total sleep duration.
Calculated according to polysomnographic monitoring results.
Sleep efficiency.
The ratio between the total sleep time and the total recording time and expressed as percentage. Calculated according to polysomnographic monitoring results.
Duration of non-rapid eye movement stage 1 (N1) sleep.
Calculated according to polysomnographic monitoring results.
Percentage of non-rapid eye movement stage 1 (N1) sleep.
Calculated according to polysomnographic monitoring results.
Duration of non-rapid eye movement stage 2 (N2) sleep.
Calculated according to polysomnographic monitoring results.
Duration of non-rapid eye movement stage 3 (N3) sleep.
Calculated according to polysomnographic monitoring results.
Percentage of non-rapid eye movement stage 3 (N3) sleep.
Calculated according to polysomnographic monitoring results.
Duration of rapid eye movement sleep.
Calculated according to polysomnographic monitoring results.
Percentage of rapid eye movement sleep.
Calculated according to polysomnographic monitoring results.
Sleep fragmentation index.
The average number of arousals and awakenings per hour of sleep. Calculated according to polysomnographic monitoring results.
Full Information
NCT ID
NCT04608331
First Posted
October 21, 2020
Last Updated
December 10, 2022
Sponsor
Peking University First Hospital
1. Study Identification
Unique Protocol Identification Number
NCT04608331
Brief Title
Dexmedetomidine Supplemented Analgesia in Patients at High-risk of Obstructive Sleep Apnea
Official Title
Impact of Dexmedetomidine Supplemented Analgesia on Sleep Quality in Patients at High-risk of Obstructive Sleep Apnea After Major Surgery: A Randomized, Double-blind, and Placebo-controlled Pilot Study
Study Type
Interventional
2. Study Status
Record Verification Date
December 2022
Overall Recruitment Status
Completed
Study Start Date
January 29, 2021 (Actual)
Primary Completion Date
August 17, 2022 (Actual)
Study Completion Date
September 20, 2022 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Peking University First Hospital
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Obstructive sleep apnea (OSA) is a common sleep disturbance that can cause intermittent hypoxia, hypercapnia, and sleep structure disorders. The presence of OSA is associated with worse outcomes after surgery including increased incidence of complications. High-flow nasal cannula (HFNC) therapy can improve oxygenation of OSA patients by maintaining a certain positive pressure in the nasopharyngeal cavity. Previous studies showed that, dexmedetomidine supplemented analgesia can improve sleep quality and pain relief. The investigators hypothesize that, for high-risk OSA patients following major non-cardiac surgery with HFNC therapy, dexmedetomidine supplemented analgesia can improve sleep quality. The purpose of this pilot randomized controlled trial is to investigate the impact of dexmedetomidine supplemented analgesia on sleep quality in high-risk OSA patients after major non-cardiac surgery.
Detailed Description
Obstructive sleep apnea (OSA) is a common sleep disturbance that can cause intermittent hypoxia, hypercapnia, and sleep structure disorders; the latter include prolonged sleep latency, shortened sleep duration, frequent wake-up, and disordered circadian rhythm. During the postoperative period, surgical stress, pain and the residual effects of sedatives/analgesics can aggravate the sleep disorder and physiological changes in OSA patients. The resulting consequence is increased incidence of postoperative complications.
High-flow nasal cannula (HFNC) therapy can improve the oxygenation of OSA patients by forming a certain positive pressure in the nasopharyngeal cavity. Previous studies showed that HFNC therapy can reduce respiratory events, improve oxygenation in patients with moderate to severe OSA.
Dexmedetomidine is a highly selective α2-adrenoceptor agonist with sedative, analgesic and anti-anxiety properties. Unlike other sedative agents, dexmedetomidine exerts its sedative effects through an endogenous sleep-promoting pathway, producing a state like non-rapid eye movement sleep without disturbing respiration. Our previous studies shows that dexmedetomidine supplemented analgesia can improve sleep quality and pain relief in patients after surgery.
The investigators hypothesize that, for patients at high-risk of OSA who are recovering from major non-cardiac surgery and receiving HFNC therapy, dexmedetomidine supplemented analgesia can improve sleep quality and postoperative recovery. The purpose of this pilot randomized controlled trial is to investigate the impact of dexmedetomidine supplemented analgesia on the sleep quality in high-risk OSA patients after major non-cardiac surgery.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obstructive Sleep Apnea, Analgesia, Dexmedetomidine, High-flow Nasal Cannula, Sleep Quality
Keywords
Obstructive Sleep Apnea, Analgesia, Dexmedetomidine, High-flow nasal cannula, Sleep quality
7. Study Design
Primary Purpose
Prevention
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
152 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Dexmedetomidine group
Arm Type
Experimental
Arm Description
Patient-controlled analgesia is established with morphine (0.5 mg/ml) and dexmedetomidine (1.25 microgram/ml) in a total volume of 160 ml. The pump is programmed to deliver 2-ml boluses at 6 to 8-minute lockout intervals with a background infusion rate at 1 ml/h. Patient-controlled analgesia is provided for at least 24 hours after surgery.
Arm Title
Placebo group
Arm Type
Placebo Comparator
Arm Description
Patient-controlled analgesia is established with morphine (0.5 mg/ml) in a total volume of 160 ml. The pump is programmed to deliver 2-ml boluses at 6 to 8-minute lockout intervals with a background infusion rate at 1 ml/h. Patient-controlled analgesia is provided for at least 24 hours after surgery.
Intervention Type
Drug
Intervention Name(s)
Dexmedetomidine
Other Intervention Name(s)
Dexmedetomidine hydrochloride
Intervention Description
Patient-controlled analgesia is provided for at least 24 hours but no more than 48 hours. The pump is established with morphine (0.5 mg/ml) and dexmedetomidine (1.25 microgram/ml), in a total volume of 160 ml normal saline, and programmed to deliver 2-ml boluses at 6 to 8-minute lockout intervals with a background infusion rate of 1 ml/h.
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Normal saline
Intervention Description
Patient-controlled analgesia is provided for at least 24 hours but no more than 48 hours. The pump is established with morphine (0.5 mg/ml), in a total volume of 160 ml normal saline, and programmed to deliver 2-ml boluses at 6 to 8-minute lockout intervals with a background infusion rate of 1 ml/h.
Primary Outcome Measure Information:
Title
The percentage of non-rapid eye movement stage 2 (N2) sleep.
Description
Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Secondary Outcome Measure Information:
Title
Total sleep duration.
Description
Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Title
Sleep efficiency.
Description
The ratio between the total sleep time and the total recording time and expressed as percentage. Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Title
Duration of non-rapid eye movement stage 1 (N1) sleep.
Description
Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Title
Percentage of non-rapid eye movement stage 1 (N1) sleep.
Description
Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Title
Duration of non-rapid eye movement stage 2 (N2) sleep.
Description
Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Title
Duration of non-rapid eye movement stage 3 (N3) sleep.
Description
Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Title
Percentage of non-rapid eye movement stage 3 (N3) sleep.
Description
Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Title
Duration of rapid eye movement sleep.
Description
Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Title
Percentage of rapid eye movement sleep.
Description
Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Title
Sleep fragmentation index.
Description
The average number of arousals and awakenings per hour of sleep. Calculated according to polysomnographic monitoring results.
Time Frame
During the night of surgery (from 9 pm on the day of surgery to 6 am on the first day after surgery)
Other Pre-specified Outcome Measures:
Title
Sedation level
Description
Sedation level is assessed with the Richmond Agitation Sedation Scale (RASS), with scores ranging from -5 (unarousable) to +4 (combative) and 0 indicates alert and calm.
Time Frame
Up to 5 days after surgery.
Title
Cumulative morphine consumption
Description
Cumulative morphine consumption
Time Frame
Up to 5 days after surgery.
Title
Pain intensity
Description
Pain intensity is assessed twice daily (8-10 am and 18-20 pm) with the numeric rating scale, an 11-point scale where 0=no pain and 10=the worst pain.
Time Frame
Up to 5 days after surgery.
Title
Subjective sleep quality during the first 5 days after surgery.
Description
Subjective sleep quality is assessed daily (8-10 am) with the Richards-Campbell Sleep Questionnaire; which assesses subjective sleep quality in 5 aspects, each scale ranges from 0 to 100, with higher score indicating better function.
Time Frame
Up to the fifth day after surgery.
Title
Incidence of delirium during the first 5 days after surgery.
Description
Delirium is assessed twice daily (8-10 am and 18-20 pm) with the 3D-Confusion Assessment Method for non-intubated patients or the Confusion Assessment Methods for the Intensive Care Unit for intubated patients.
Time Frame
Up to the fifth day after surgery.
Title
Length of stay in hospital after surgery
Description
Length of stay in hospital after surgery
Time Frame
Up to 30 days after surgery
Title
Incidence of postoperative complications within 30 days
Description
Postoperative complications are generally defined as newly occurred medical conditions that are deemed harmful and required therapeutic intervention within 30 days after surgery.
Time Frame
Up to 30 days after surgery
Title
All-cause 30-day mortality
Description
All-cause 30-day mortality
Time Frame
Up to 30 days after surgery
Title
Quality of life in 30-day survivors
Description
Quality of life is assessed with World Health Organization Quality of Life brief version (WHOQOL-BREF), a 24-item questionnaire that provides assessments of the quality of life in physical, psychological, social relationship, and environmental domains. For each domain, the score ranges from 0 to 100, with higher score indicating better function.
Time Frame
At 30 days after surgery
Title
Cognitive function in 30-day survivors
Description
Cognitive function of 30-day survivors is assessed with the modified Telephone Interview for Cognitive Status (TICSm), a 12-item questionnaire that provides an assessment of global cognitive function by verbal communication via telephone. The score ranges from 0 to 48, with higher score indicating better function.
Time Frame
At 30 days after surgery
Title
The overall subjective sleep quality in 30-day survivors
Description
Assessed with the Pittsburgh Sleep Quality Index, which estimates overall subjective sleep quality in the past 30 days. Overall score ranges from 0 to 21, with higher score indicating better sleep.
Time Frame
At 30 days after surgery
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age >=18 years but <=80 years;
At high-risk of obstructive sleep apnea (a STOP-Bang score ≥3 combined with a serum bicarbonate ≥28 mmol/ L), but does not regularly receive continuous positive airway pressure (CPAP) therapy;
Scheduled to undergo major noncardiac surgery under general anesthesia, with an expected duration of >=1 hours and planned to use patient-controlled intravenous analgesia (PCIA) after surgery.
Exclusion Criteria:
Diagnosed as central sleep apnea syndrome;
Preoperative history of severe central nervous system diseases (epilepsy, parkinsonism, intracranial tumor, craniocerebral trauma) or neuromuscular disorders (myasthenia gravis);
History of schizophrenia or other mental disorders, or antidepressant or anxiolytic therapy within 3 month before surgery;
Inability to communicate in the preoperative period because of coma, profound dementia, deafness or language barriers;
History of drug or alcohol dependence, or sedative or hypnotic therapy within 1 month before surgery;
Contraindications to HFNC therapy (e.g. mediastinal emphysema, shock, cerebrospinal fluid leakage, nasosinusitis, otitis media, glaucoma);
Severe tracheal or pulmonary disease (e.g. bullous lung disease, pneumothorax, tracheal fistula);
Sick sinus syndrome, severe sinus bradycardia (<50 beats per minute), or second-degree or above atrioventricular block without pacemaker；
Severe hepatic dysfunction (Child-Pugh class C); Severe renal dysfunction (requirement of renal replacement therapy); severe heart dysfunction (preoperative New York Heart Association functional classification ≥3 or left ventricular ejection fraction <30%); ASA classification IV or above; or expected survival <24 hours after surgery;
Preoperative use of CPAP or HFNC therapy;
Expected intensive care unit (ICU) admission with tracheal intubation after surgery;
Refuse to participate in this study;
Other conditions that are considered unsuitable for study participation.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dong-Xin Wang, MD, PhD
Organizational Affiliation
Peking University First Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Dong-Xin Wang
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100034
Country
China
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
20086074
Citation
Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010 Jan;90(1):47-112. doi: 10.1152/physrev.00043.2008. Erratum In: Physiol Rev.2010 Apr;90(2):797-8.
Results Reference
background
PubMed Identifier
31300334
Citation
Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pepin JL, Peppard PE, Sinha S, Tufik S, Valentine K, Malhotra A. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019 Aug;7(8):687-698. doi: 10.1016/S2213-2600(19)30198-5. Epub 2019 Jul 9.
Results Reference
background
PubMed Identifier
23589584
Citation
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013 May 1;177(9):1006-14. doi: 10.1093/aje/kws342. Epub 2013 Apr 14.
Results Reference
background
PubMed Identifier
19690624
Citation
Lee W, Nagubadi S, Kryger MH, Mokhlesi B. Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective. Expert Rev Respir Med. 2008 Jun 1;2(3):349-364. doi: 10.1586/17476348.2.3.349.
Results Reference
background
PubMed Identifier
28162150
Citation
Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017 Mar 15;13(3):479-504. doi: 10.5664/jcsm.6506.
Results Reference
background
PubMed Identifier
19293703
Citation
Brown KA. Intermittent hypoxia and the practice of anesthesia. Anesthesiology. 2009 Apr;110(4):922-7. doi: 10.1097/ALN.0b013e31819c480a.
Results Reference
background
PubMed Identifier
27476705
Citation
Fassbender P, Herbstreit F, Eikermann M, Teschler H, Peters J. Obstructive Sleep Apnea-a Perioperative Risk Factor. Dtsch Arztebl Int. 2016 Jul 11;113(27-28):463-9. doi: 10.3238/arztebl.2016.0463. Erratum In: Dtsch Arztebl Int. 2016 Aug;113(31-32):524.
Results Reference
background
PubMed Identifier
21868464
Citation
Kaw R, Pasupuleti V, Walker E, Ramaswamy A, Foldvary-Schafer N. Postoperative complications in patients with obstructive sleep apnea. Chest. 2012 Feb;141(2):436-441. doi: 10.1378/chest.11-0283. Epub 2011 Aug 25.
Results Reference
background
PubMed Identifier
18339794
Citation
Hwang D, Shakir N, Limann B, Sison C, Kalra S, Shulman L, Souza Ade C, Greenberg H. Association of sleep-disordered breathing with postoperative complications. Chest. 2008 May;133(5):1128-34. doi: 10.1378/chest.07-1488. Epub 2008 Mar 13.
Results Reference
background
PubMed Identifier
19774431
Citation
Liao P, Yegneswaran B, Vairavanathan S, Zilberman P, Chung F. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anaesth. 2009 Nov;56(11):819-28. doi: 10.1007/s12630-009-9190-y.
Results Reference
background
PubMed Identifier
15947324
Citation
Aloia MS, Stanchina M, Arnedt JT, Malhotra A, Millman RP. Treatment adherence and outcomes in flexible vs standard continuous positive airway pressure therapy. Chest. 2005 Jun;127(6):2085-93. doi: 10.1378/chest.127.6.2085.
Results Reference
background
PubMed Identifier
29558988
Citation
Helviz Y, Einav S. A Systematic Review of the High-flow Nasal Cannula for Adult Patients. Crit Care. 2018 Mar 20;22(1):71. doi: 10.1186/s13054-018-1990-4.
Results Reference
background
PubMed Identifier
17363769
Citation
McGinley BM, Patil SP, Kirkness JP, Smith PL, Schwartz AR, Schneider H. A nasal cannula can be used to treat obstructive sleep apnea. Am J Respir Crit Care Med. 2007 Jul 15;176(2):194-200. doi: 10.1164/rccm.200609-1336OC. Epub 2007 Mar 15.
Results Reference
background
PubMed Identifier
28105598
Citation
Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clin Pharmacokinet. 2017 Aug;56(8):893-913. doi: 10.1007/s40262-017-0507-7.
Results Reference
background
PubMed Identifier
27542303
Citation
Su X, Meng ZT, Wu XH, Cui F, Li HL, Wang DX, Zhu X, Zhu SN, Maze M, Ma D. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial. Lancet. 2016 Oct 15;388(10054):1893-1902. doi: 10.1016/S0140-6736(16)30580-3. Epub 2016 Aug 16.
Results Reference
background
PubMed Identifier
29742525
Citation
Zhang DF, Su X, Meng ZT, Li HL, Wang DX, Xue-Ying Li, Maze M, Ma D. Impact of Dexmedetomidine on Long-term Outcomes After Noncardiac Surgery in Elderly: 3-Year Follow-up of a Randomized Controlled Trial. Ann Surg. 2019 Aug;270(2):356-363. doi: 10.1097/SLA.0000000000002801.
Results Reference
background
PubMed Identifier
26378880
Citation
Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea. Chest. 2016 Mar;149(3):631-8. doi: 10.1378/chest.15-0903. Epub 2016 Jan 12.
Results Reference
background
PubMed Identifier
15273542
Citation
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae.
Results Reference
background
PubMed Identifier
26289837
Citation
Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, Tsubosa Y, Satoh T, Yokomizo A, Fukuda H, Sasako M. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016 Jun;46(6):668-85. doi: 10.1007/s00595-015-1236-x. Epub 2015 Aug 20.
Results Reference
background
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Dexmedetomidine Supplemented Analgesia in Patients at High-risk of Obstructive Sleep Apnea
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