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Publications (10 of 24) Show all publications
Bromfalk, Å., Hultin, M., Walldén, J., Myrberg, T. & Engström, Å. (2024). Perioperative staff’s experiences of premedication for children. Journal of Perianesthesia Nursing
Open this publication in new window or tab >>Perioperative staff’s experiences of premedication for children
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2024 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473Article in journal (Refereed) Accepted
National Category
Anesthesiology and Intensive Care Pediatrics
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:umu:diva-224419 (URN)
Available from: 2024-05-16 Created: 2024-05-16 Last updated: 2024-05-17
Bromfalk, Å., Hultin, M., Wallden, J. & Myrberg, T. (2023). Cardiorespiratory response to sedative premedication in preschool children: a randomized controlled trial comparing midazolam, clonidine, and dexmedetomidine. Journal of Perianesthesia Nursing, 38(3), 454-460
Open this publication in new window or tab >>Cardiorespiratory response to sedative premedication in preschool children: a randomized controlled trial comparing midazolam, clonidine, and dexmedetomidine
2023 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 38, no 3, p. 454-460Article in journal (Refereed) Published
Abstract [en]

Purpose: Sedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia.

Design: A single-center randomized controlled trial.

Methods: This is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2–6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg–1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period.

Findings: The final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P<0.001 and P=0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r=-0.570, P<0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min–1, CLO 20.6±2.6 min–1, DEX 20.2±1.7 min–1; P=0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min–1; CLO, 87.4±9.6 min–1; DEX, 87.6±7.9 min–1; P<0.001). The HR was lower immediately after induction (P=0.009) and intraoperatively (P=0.025) in the CLO and DEX groups than in the MID group.

Conclusions: When used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
cardiorespiratory, clonidine, dexmedetomidine, midazolam, pediatric anesthesia, premedication, sedation
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-203567 (URN)10.1016/j.jopan.2022.08.009 (DOI)001001763500001 ()36604221 (PubMedID)2-s2.0-85145714015 (Scopus ID)
Available from: 2023-01-19 Created: 2023-01-19 Last updated: 2024-05-16Bibliographically approved
Gottfridsson, P., Law, L., Aroch, R., Myrberg, T., Hultin, M., Lindqvist, P. & Haney, M. (2023). Left atrial contraction strain during a Valsalva manoeuvre: A study in healthy humans. Clinical Physiology and Functional Imaging, 43(3), 165-169
Open this publication in new window or tab >>Left atrial contraction strain during a Valsalva manoeuvre: A study in healthy humans
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2023 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 43, no 3, p. 165-169Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cardiac mechanics are influenced by loading conditions as well as sympathetic tone. Left atrial (LA) contractile function assessed by two-dimensional (2D) strain has been described in the setting of controlled preload alterations; however, studies show conflicting findings about change or direction of change. We hypothesized that the controlled preload reduction and the sympathetic nervous system activation that occurs during a standardized Valsalva manoeuvre would bring about a change in LA contraction strain.a

METHODS: Healthy young adults of both sexes were recruited. Transthoracic echocardiographic ultrasound images were collected before and during a Valsalva manoeuvre. Standard imaging windows for LA strain assessment were used and the images were copied and stored for later offline analysis. These were assessed for adequate atrial wall visualization in 2D strain assessment. Paired comparisons were carried out using Student's T test.

RESULT: Thirty-eight participants were included and there were 22 complete studies with paired pre- and during Valsalva manoeuvre. LA contraction strain at baseline was 10.5 ± 2.8% (standard deviation) and during the Valsalva manoeuvre 10.6 ± 4.6%, p = 0.86.

CONCLUSION: The Valsalva manoeuvre, a combination of preload reduction and sympathetic nervous system activation, seems not to be associated with a change in LA contraction strain in healthy young individuals. LA contraction strain should be interpreted in the context of both atrial loading conditions and prevailing autonomic nervous system activity.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
contractile function, echocardiography, left atrium, preload, speckle tracking, sympathetic nervous system
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-202113 (URN)10.1111/cpf.12806 (DOI)000902530500001 ()36533722 (PubMedID)2-s2.0-85145300941 (Scopus ID)
Funder
Region Västerbotten
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-09-05Bibliographically approved
Moraitis, A., Myrberg, T., Hultin, M., Nyström, H. & Walldén, J. (2023). Palonosetron as prophylaxis for post-discharge nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial in ambulatory surgery. British Journal of Anaesthesia
Open this publication in new window or tab >>Palonosetron as prophylaxis for post-discharge nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial in ambulatory surgery
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2023 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771Article in journal (Refereed) In press
Abstract [en]

BACKGROUND: Approximately 25% of ambulatory surgery patients experience post-discharge nausea and vomiting (PDNV). We aimed to investigate whether palonosetron, a long-acting anti-emetic, decreases the incidence of PDNV in high-risk patients.

METHODS: In this prospective, randomised, double-blind, placebo-controlled trial, 170 male and female patients undergoing ambulatory surgery under general anaesthesia, with a high predicted risk for PDNV, were randomised to receive either palonosetron 75 μg i.v. (n=84) or normal saline (n=86) before discharge. During the first 3 postoperative days (PODs), we measured outcomes using a patient questionanaire. The primary outcome was the incidence of a complete response (no nausea, vomiting, or use of rescue medication) until POD 2. Secondary outcomes included the incidence of PDNV each day until POD 3.

RESULTS: The incidence of a complete response until POD 2 was 48% (n=32) in the palonosetron group and 36% (n=25) in the placebo group (odds ratio 1.69 [95% confidence interval: 0.85-3.37]; P=0.131). No significant difference in the incidence of PDNV was observed between the two groups on the day of surgery (47% vs 56%; P=0.31). Significant differences in the incidence of PDNV were found on POD 1 (18% vs 34%; P=0.033) and POD 2 (9% vs 27%; P=0.007). No differences were observed on POD 3 (15% vs 13%; P=0.700).

CONCLUSIONS: Compared with placebo, palonosetron did not reduce the overall incidence of PDNV up to POD 2. The lower incidence of PDNV on POD 1 and POD 2 in the palonosetron group requires further investigation.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
5HT-3 antagonist, PDNV, PONV, ambulatory surgery, day-care surgery, palonosetron, post-discharge nausea and vomiting, prophylaxis
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-209021 (URN)10.1016/j.bja.2023.04.034 (DOI)37246062 (PubMedID)2-s2.0-85160219043 (Scopus ID)
Funder
Region VästernorrlandVisare Norr
Available from: 2023-06-02 Created: 2023-06-02 Last updated: 2023-06-07
Bromfalk, Å., Hultin, M., Myrberg, T., Engström, Å. & Walldén, J. (2023). Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine. Pediatric Anaesthesia, 33(11), 962-972
Open this publication in new window or tab >>Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine
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2023 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 33, no 11, p. 962-972Article in journal (Refereed) Published
Abstract [en]

Background: Preoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2–6 years.

Methods: In this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured.

Results: After excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups.

Conclusions: No statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2-agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.

Place, publisher, year, edition, pages
Wiley, 2023
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:umu:diva-212532 (URN)10.1111/pan.14740 (DOI)37528645 (PubMedID)2-s2.0-85166673433 (Scopus ID)
Funder
Region Västerbotten, RV-940554Region Västerbotten, RV-865681Norrbotten County Council, NLL-485451Norrbotten County Council, NLL-486841Norrbotten County Council, RN-785981
Available from: 2023-08-02 Created: 2023-08-02 Last updated: 2024-05-16Bibliographically approved
Gottfridsson, P., A’Roch, R., Lindqvist, P., Law, L., Myrberg, T., Hultin, M., . . . Haney, M. (2022). Left atrial contraction strain and controlled preload alterations, a study in healthy individuals. Cardiovascular Ultrasound, 20(1), Article ID 8.
Open this publication in new window or tab >>Left atrial contraction strain and controlled preload alterations, a study in healthy individuals
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2022 (English)In: Cardiovascular Ultrasound, E-ISSN 1476-7120, Vol. 20, no 1, article id 8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In order to assess left atrial contractile function in disturbed circulatory conditions, it is necessary to have a clear understanding of how it behaves in a normal resting state with changes in loading conditions. However, currently the understanding of this relationship is incomplete. We hypothesize that in healthy individuals, left atrial contraction strain and its peak strain rate are increased or decreased by increasing or decreasing preload, respectively.

METHODS: Controlled maneuvers used to change preload included continuous positive airway pressure by mask (CPAP 20 cmH2O) for preload decrease, and passive leg raise (15 degrees angle) for preload increase. Cardiac ultrasound 4-chamber views of the left atria and left ventricle were acquired at baseline and during maneuver. Acquired images were post processed and analyzed offline. Comparisons were made using paired t-test and means with 95% confidence interval.

RESULTS: There were 38 participants, complete results were obtained from 23 in the CPAP maneuver and 27 in the passive leg raise maneuver. For the CPAP group, left atrial contraction strain was 11.6% (10.1 to 13.1) at baseline and 12.8% (11.0 to 14.6) during the maneuver (p = 0.16). Left atrial contraction peak strain rate was - 1.7 s- 1 (- 1.8 to - 1.5) at baseline and - 1.8 s- 1 (- 2.0 to - 1.6) during the maneuver (p = 0.29). For the passive leg raise-group, left atrial contraction strain was 10.1% (9.0 to 11.2) at baseline and 10.8% (9.4 to 12.3) during the maneuver (p = 0.28). Left atrial contraction peak strain rate was - 1.5 s- 1 (- 1.6 to - 1.4) at baseline and - 1.6 s- 1 (- 1.8 to - 1.5) during the maneuver (p = 0.29). Left atrial area, an indicator of preload, increased significantly during passive leg raise and decreased during CPAP.

CONCLUSION: In healthy individuals, left atrial contraction strain and its peak strain rate seem to be preload-independent.

TRIAL REGISTRATION: The study was 2018-02-19 registered at clinicaltrials.gov ( NCT03436030 ).

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Contractile function, Echocardiography, Left atrium, Preload, Speckle tracking
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-193748 (URN)10.1186/s12947-022-00278-1 (DOI)000776052500001 ()35354482 (PubMedID)2-s2.0-85127286852 (Scopus ID)
Note

Errata: Gottfridsson, P., A’Roch, R., Lindqvist, P. et al. Correction to: Left atrial contraction strain and controlled preload alterations, a study in healthy individuals. Cardiovasc Ultrasound 20, 12 (2022). DOI: 10.1186/s12947-022-00281-6

Available from: 2022-04-12 Created: 2022-04-12 Last updated: 2024-01-17Bibliographically approved
Stenberg, Y., Rhodin, Y., Lindberg, A., Aroch, R., Hultin, M., Wallden, J. & Myrberg, T. (2022). Pre-operative point-of-care assessment of left ventricular diastolic dysfunction, an observational study. BMC Anesthesiology, 22(1), Article ID 96.
Open this publication in new window or tab >>Pre-operative point-of-care assessment of left ventricular diastolic dysfunction, an observational study
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2022 (English)In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 22, no 1, article id 96Article in journal (Refereed) Published
Abstract [en]

Background: Left ventricular (LV) diastolic dysfunction is an acknowledged peri-operative risk factor that should be identified before surgery. This study aimed to evaluate a simplified echocardiographic method using e’ and E/e’ for identification and grading of diastolic dysfunction pre-operatively.

Methods: Ninety six ambulatory surgical patients were consecutively included to this prospective observational study. Pre-operative transthoracic echocardiography was conducted prior to surgery, and diagnosis of LV diastolic dysfunction was established by comprehensive and simplified assessment, and the results were compared. The accuracy of e’-velocities in order to discriminate patients with diastolic dysfunction was established by calculating accuracy, efficiency, positive (PPV) and negative predictive (NPV) values, and area under the receiver operating characteristic curve (AUROC).

Results: Comprehensive assessment established diastolic dysfunction in 77% (74/96) of patients. Of these, 22/74 was categorized as mild dysfunction, 43/74 as moderate dysfunction and 9/74 as severe dysfunction. Using the simplified method with e’ and E/e’, diastolic dysfunction was established in 70.8% (68/96) of patients. Of these, 8/68 was categorized as mild dysfunction, 36/68 as moderate dysfunction and 24/68 as severe dysfunction. To discriminate diastolic dysfunction of any grade, e’-velocities (mean < 9 cm s− 1) had an AUROC of 0.901 (95%CI 0.840–0.962), with a PPV of 55.2%, a NPV of 90.9% and a test efficiency of 0.78.

Conclusions: The results of this study indicate that a simplified approach with tissue Doppler e’-velocities may be used to rule out patients with diastolic dysfunction pre-operatively, but together with E/e’ ratio the severity of diastolic dysfunction may be overestimated.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Diastole, Left ventricular dysfunction, Point-of-care ultrasound, Prospective studies, Risk assessment, Tissue Doppler, Transthoracic echocardiography
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-194280 (URN)10.1186/s12871-022-01642-4 (DOI)000778706100003 ()35382761 (PubMedID)2-s2.0-85127625909 (Scopus ID)
Funder
Norrbotten County Council, NLL-733291
Available from: 2022-04-29 Created: 2022-04-29 Last updated: 2022-04-29Bibliographically approved
Myrberg, T., Lindberg, A., Eriksson, B., Hedman, L., Stridsman, C., Lundbäck, B., . . . Backman, H. (2022). Restrictive spirometry versus restrictive lung function using the GLI reference values. Clinical Physiology and Functional Imaging, 42(3), 181-189
Open this publication in new window or tab >>Restrictive spirometry versus restrictive lung function using the GLI reference values
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2022 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 42, no 3, p. 181-189Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Restrictive lung function may indicate various underlying diseases. The aim of this study was to evaluate the accuracy of different restrictive spirometry patterns (RSPs) to identify restrictive lung function (total lung capacity [TLC] < lower limit of normal [LLN]) according to reference values by the Global Lung Function Initiative (GLI) in a wide age-ranged, general population sample.

METHODS: A general population sample (n = 607, age 23-72 years, smokers 18.8%) with proper dynamic spirometry and TLC measurements, was included. Accuracy of two main categories of RSP to identify TLC < LLN were evaluated: traditional RSPs (definition 1: FVC < 80% of predicted and FEV1 /FVC ≥ 0.7 and definition 2: FVC < LLN and FEV1 /FVC ≥ LLN) and RSPs defined by Youden's method (definition 3: FVC < 85.5% of predicted and FEV1 /FVC ≥ LLN and definition 4: FVC Z-score < -1.0 and FEV1 /FVC ≥ LLN).

RESULTS: The prevalence of restrictive lung function (TLC < LLN) was 5.3%. The most accurate cut-offs for FVC to identify TLC < LLN were 85.5% for FVC% of predicted, and -1.0 for FVC Z-score. The traditional RSP definitions 1 and 2 had higher specificity (95.0% and 96.9%) but substantially lower sensitivity compared to RSP definitions 3 and 4.

CONCLUSION: Based on the GLI reference values, the RSP definition FVC < LLN and FEV1 /FVC ≥ LLN yielded the highest specificity and may appropriately be used to rule out restrictive lung function. The RSP definition with the most favourable trade-off between sensitivity and specificity, FVC < 85.5% of predicted and FEV1 /FVC ≥ LLN, may serve as an alternative with higher sensitivity for screening.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
epidemiology, respiratory function tests, restrictive lung function, restrictive spirometry pattern, spirometry, total lung capacity
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-192841 (URN)10.1111/cpf.12745 (DOI)000761753200001 ()35225428 (PubMedID)2-s2.0-85125413535 (Scopus ID)
Available from: 2022-03-02 Created: 2022-03-02 Last updated: 2023-09-05Bibliographically approved
Johansson-Jänkänpää, E., Hultin, M., Myrberg, T. & Wallden, J. (2021). Early post-operative nausea and vomiting: A retrospective observational study of 2030 patients. Acta Anaesthesiologica Scandinavica, 65(9), 1229-1239
Open this publication in new window or tab >>Early post-operative nausea and vomiting: A retrospective observational study of 2030 patients
2021 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 65, no 9, p. 1229-1239Article in journal (Refereed) Published
Abstract [en]

Background: The overall risk of post-operative nausea and vomiting (PONV) after general anaesthesia is reportedly 20%–40%. The first episode of PONV may occur early in the post-anaesthesia care unit (PACU) or later at the ward or after discharge at home in an ambulatory setting. This study aimed to investigate and describe the risk of early PONV in a PACU, and we hypothesised that patients and perioperative factors were associated with early PONV.

Methods: This single-centre retrospective observational study was conducted in a Swedish county hospital from January to June 2017 and included adult patients who underwent surgical procedures under general anaesthesia. Perioperative data were obtained by reviewing the local registry for surgical procedures, medical records and anaesthesia and post-operative charts. Early PONV was defined as PONV occurring up to 4 hours post-operatively at the PACU. Any notification in the medical records, perioperative charts or the registry regarding nausea, vomiting or PONV treatment was regarded as PONV. Univariate and multivariate analyses were performed for factors associated with early PONV.

Results: A total of 2030 patients were included in the study, of which 9.6% (n = 194) experienced early PONV. Factors associated with a high risk of early PONV were suboptimal PONV prophylaxis, need for opioids, female sex, body mass index >35 kg m−2 and major surgery and anaesthesia time ≥60 minutes.

Conclusion: We found that every 10th patient under general anaesthesia experienced early PONV. Suboptimal PONV prophylaxis and previously acknowledged risk factors for PONV were associated with early PONV.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
observational study, post-anaesthesia care unit, post-operative nausea and vomiting
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-185907 (URN)10.1111/aas.13936 (DOI)000669405100001 ()34086350 (PubMedID)2-s2.0-85109093353 (Scopus ID)
Available from: 2021-07-12 Created: 2021-07-12 Last updated: 2023-03-24Bibliographically approved
Myrberg, T. (2021). In Response [Letter to the editor]. Anesthesia and Analgesia, 132(5), E75-E76
Open this publication in new window or tab >>In Response
2021 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 132, no 5, p. E75-E76Article in journal, Letter (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-183020 (URN)10.1213/ANE.0000000000005426 (DOI)000639311200011 ()2-s2.0-85104227751 (Scopus ID)
Available from: 2021-05-12 Created: 2021-05-12 Last updated: 2023-09-05Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8802-2321

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