Regional Anesthesia and Spontaneous Breathing in AnoRectalMalformation (ARM) repair procedure

Regional Anesthesia and Spontaneous Breathing in AnoRectalMalformation (ARM) repair procedure | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Regional Anesthesia and Spontaneous Breathing in AnoRectalMalformation (ARM) repair procedure Eufrasia Frattarelli, Paola Presutti, Luigi Tritapepe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5121809/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Many neonatal procedures can be performed under regional anesthesia (RA). We describe a case of anorectal malformation (ARM) that is usually performed under general anesthesia (GA) and endotracheal intubation because the prone position is required during the procedure. Figures Figure 1 Introduction Many procedures in Newborns can be performed in Regional Anesthesia (RA). We report a case of AnoRectal Malformation (ARM) repair usually performed in General Anesthesia (GA) and Tracheal Intubation because of the prone position during surgery, carried out in RA. We would like to share our experience with the case of a preterm infant born at 31 weeks gestation with diagnosed VACTERL association (Aesophageal Atresia,AnoRectalMalformation,Hypospadia and suspected Aortic Stenosis). He was firstly operated to correct his Aesophageal Atresia and to prepare a Colostomy. Case Report At 41 weeks of gestation and 3.700 kg of body weight he was deemed fit for ARM repair, before hospital discharge. He was in good general conditions, but with a mild Stridor during wailing of probable tracheal origin. That is why we considered avoiding airways instrumentation for the second procedure, using RA associated with Spontaneous Breathing (SB). In OR under Standard Monitoring (ECG, NIBP, SpO2, ETCO2, Body Temperature) and by a previously positioned PICC (peripherally inserted central catheter) we begun a gradual Sedation with a combination of Ketamine and Dexmetedomidine (KETADEX), respectively 1mg/ml and 1mcg/ml at a dose of 1ml/kg. (1-2) After 5 minutes our patient was at Level 2 of the Pediatric Sedation State Scale (PSSS) and always in SB. (3) A further venous access was inserted and the patient placed in lateral position to perform a Combined Anesthesia (CSE). Under UltraSound guide we identifyed the L4-L5 space, administered Spinal Anesthesia using 0,8mg/kg hyperbaric Bupivacaine 0.5% and inserted an Epidural Catheter (EC). We also gave a supplemental Caudal US guided dose of 1mg/kg of Ropivacaine 0.2%. (4) We placed our patient in supine position to insert a Urinary Catheter and then in the prone position to perform surgery (fig.1), always without need of ventilatory support. At induction we gave O2 via Face Mask and during the ventral position we let our patient breathe spontaneously in Air with Blown-by O2 (Fig.1). At about 40 minutes from the initial KETADEX bolus we started a Dexmetedomidine Continuous Infusion (DCI) at a rate of 0.3mcg/kg/h. The surgical procedure begun without either cardiorespiratory variations or reflex movements. Approximately 2 hours to the DCI start the patient wailed and his Heart Rate and NIBP increased of about 15%, so we gave a KETADEX 0.5 ml/kg bolus. Our patient quickly slept and we consequently increased the DCI to 0.8mcg/kg/h. The surgical procedure lasted 3 hours and 20 minutes without further awakenings or cardiorespiratory variations. The DCI was stopped 20 minutes before the end of the procedure. A 4ml Ropivacaine 0.1% bolus via the EC was given for post-operative analgesia before transporting the patient to our NICU (Neonatal Intensive Care Unit) in a Level 4 Sedation according to the Ramsay Score Scale. An ABG at NICU arrival was good. We decided to keep the Epidural Catheter until the next morning and gave two further boluses of Ropivacaine 1% 3.5 ml, the first at 10 hours after the transfer in NICU and the second at about 20 hours right before removing the EC. Our patient did not need other drugs to treat pain. Since we had never performed this surgical procedure in SB we were ready to switch to General Anesthesia at any moment but both the sedation and the parameters were always good. There is extensive Literature abour Regional Anesthesia, even in the Newborn, reporting lower respiratory complications and superior Pain Control. CSE anesthesia has proved useful providing both a prolonged anesthesia, without the need of adjuvants, and ease to test the EC. Dexmetedomidine proved feasible thanks to its minimal cardiorespirstory effects allowing Spontaneous Breathing even in deep Sedation, unlike drugs like Propofol or Opioids, seeming moreover to prolong Neuraxial Analgesia. The Dexmetedomidine combination with Ketamine (KETADEX©) can be useful in many settings where the patient’s position may impair ventilation and favour regurgitation or aspiration. It offers an excellent level of sedation balancing both drugs’ side effects and can be coupled with Regional Anesthesia. Regional Anesthesia with Sedation in major surgery or sub-umbilical Laparoscopy is very interesting even in absence of comorbodities. (5) Although it is an initial procedure in our anesthesiology group, we think it can be easily reproduced in similar situations. Abbreviations ARM: AnoRectal Malformation RA: Regional Anesthesia GA: General Anesthesia VACTERL: Vertebral defects, Anal atresia, Cardiovascular anomalies, Tracheoesophageal fistula, Renal defects, Limb anomalies SB: Spontaneous Breathing OR: Operating Room ECG electrocardiogram, NIBP non-invasive blood pressure, SpO2 peripheral oxygen saturation, ETCO2 end tidal CO2 PICC: Peripherally Inserted Central Catheter KETADEX: Ketamine and Dexmetedomidine PSSS: Pediatric Sedation State Scale CSE: Combined Spinal-Epidural anesthesia EC: Epidural Catheter US: Ultrasound DCI: Dexmetedomidine Continuous Infusion NICU: Neonatal Intensive Care Unit ABG: Arterial Blood Gas Declarations Ethics approval and consent to participate: 'Not applicable' Consent for publication: We have the consent of the patient's parents, even if the personal data are not reported and the photo is not recognisable Funding : none Author Contribution Authors' contributions: EF carried out the procedure and drafted the letter. PP helped during the surgery and translated the letter. LT read and approved the final manuscript. Acknowledgements: 'Not applicable' Availability of data and materials: 'Not applicable' Competing interests : The authors declare that they have no competing interests References Ibacache ME, Muñoz HR, Fuentes R, Cortínez LI. Dexmedetomidine–ketamine combination and caudal block for superficial lower abdominal and genital surgery in children. Paediatr Anesth. 2015;25(5):499-505. McVey JD, Tobias JD. Dexmedetomidine and ketamine for sedation during spinal anesthesia in children. J Clin Anesth. 2010;22(7):538-545. Cravero JP, Askins N, Sriswasdi P, Tsze DS, Zurakowski D, Sinnott S. Validation of the pediatric sedation state scale. Pediatrics.2017;139(5):e20162897. Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019 Apr;122(4):509-517. doi: 10.1016/j.bja.2018.11.030. Epub 2019 Feb 1. PMID: 30857607; PMCID: PMC6435837. Opfermann P, Marhofer P, Springer A, Metzelder M, Zadrazil M, Schmid W. A prospective observational study on the feasibility of subumbilical laparoscopic procedures under epidural anesthesia in sedated spontaneously breathing infants with a natural airway. Paediatr Anaesth. 2022 Jan;32(1):49-55. doi: 10.1111/pan.14302. Epub 2021 Oct 8. PMID: 34582607; PMCID: PMC9292952. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 04 Oct, 2024 Submission checks completed at journal 04 Oct, 2024 First submitted to journal 04 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5121809","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":362436983,"identity":"eae8c035-4e92-4ca1-912c-485fe46394cb","order_by":0,"name":"Eufrasia Frattarelli","email":"data:image/png;base64,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","orcid":"","institution":"Azienda Ospedaliera San Camillo-Forlanini","correspondingAuthor":true,"prefix":"","firstName":"Eufrasia","middleName":"","lastName":"Frattarelli","suffix":""},{"id":362436984,"identity":"320a3bd9-593a-4748-8679-f01e33f72a64","order_by":1,"name":"Paola Presutti","email":"","orcid":"","institution":"Azienda Ospedaliera San Camillo-Forlanini","correspondingAuthor":false,"prefix":"","firstName":"Paola","middleName":"","lastName":"Presutti","suffix":""},{"id":362436985,"identity":"1ff9cba2-ca7a-407e-bb54-172bc086c79f","order_by":2,"name":"Luigi Tritapepe","email":"","orcid":"","institution":"Azienda Ospedaliera San Camillo-Forlanini","correspondingAuthor":false,"prefix":"","firstName":"Luigi","middleName":"","lastName":"Tritapepe","suffix":""}],"badges":[],"createdAt":"2024-09-20 08:07:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5121809/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5121809/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79281626,"identity":"f632236f-72b9-446e-b5c4-3f1ce4eb6590","added_by":"auto","created_at":"2025-03-26 13:36:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":433257,"visible":true,"origin":"","legend":"\u003cp\u003ePatient positioned for surgery\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5121809/v1/e3e6ab9b3fd625e1480516a6.png"},{"id":79281627,"identity":"99eac767-9e67-4668-a8b1-38bacc9aaf0c","added_by":"auto","created_at":"2025-03-26 13:36:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":850505,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5121809/v1/99905506-2c3b-495d-b803-9bb304376ffd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Regional Anesthesia and Spontaneous Breathing in AnoRectalMalformation (ARM) repair procedure","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMany procedures in Newborns can be performed in Regional Anesthesia (RA). We report a case of AnoRectal Malformation (ARM) repair usually performed in General Anesthesia (GA) and Tracheal Intubation because of the prone position during surgery, carried out in RA.\u003c/p\u003e\n\u003cp\u003eWe would like to share our experience with the case of a preterm infant born at 31 weeks gestation with diagnosed VACTERL association (Aesophageal Atresia,AnoRectalMalformation,Hypospadia and suspected Aortic Stenosis). He was firstly operated to correct his Aesophageal Atresia and to prepare a Colostomy.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eAt 41 weeks of gestation and 3.700 kg of body weight he was deemed fit for ARM repair, before hospital discharge. He was in good general conditions, but with a mild Stridor during wailing of probable tracheal origin. That is why we considered avoiding airways instrumentation for the second procedure, using RA associated with Spontaneous Breathing (SB).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn OR under Standard Monitoring (ECG, NIBP, SpO2, ETCO2, Body Temperature) and by a previously positioned PICC (peripherally inserted central catheter) we begun a gradual Sedation with a combination of Ketamine and Dexmetedomidine (KETADEX), respectively 1mg/ml and 1mcg/ml at a dose of 1ml/kg. (1-2)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter 5 minutes our patient was at Level 2 of the Pediatric Sedation State Scale (PSSS) and always in SB. (3)\u003c/p\u003e\n\u003cp\u003eA further venous access was inserted and the patient placed in lateral position to perform a Combined Anesthesia (CSE). Under UltraSound guide we identifyed the L4-L5 space, administered Spinal Anesthesia using 0,8mg/kg hyperbaric Bupivacaine 0.5% and inserted an Epidural Catheter (EC). We also gave a supplemental Caudal US guided dose of 1mg/kg of Ropivacaine 0.2%. (4)\u003c/p\u003e\n\u003cp\u003eWe placed our patient in supine position to insert a Urinary Catheter and then in the prone position to perform surgery (fig.1), always without need of ventilatory support. At induction we gave O2 via Face Mask and during the ventral position we let our patient breathe spontaneously in Air with Blown-by O2 (Fig.1).\u003c/p\u003e\n\u003cp\u003eAt about 40 minutes from the initial KETADEX bolus we started a Dexmetedomidine Continuous Infusion (DCI) at a rate of 0.3mcg/kg/h. The surgical procedure begun without either cardiorespiratory variations or reflex movements. Approximately 2 hours to the DCI start the patient wailed and his Heart Rate and NIBP increased of about 15%, so we gave a KETADEX 0.5 ml/kg bolus. Our patient quickly slept and we consequently increased the DCI to 0.8mcg/kg/h.\u003c/p\u003e\n\u003cp\u003eThe surgical procedure lasted 3 hours and 20 minutes without further awakenings or cardiorespiratory variations. The DCI was stopped 20 minutes before the end of the procedure.\u003c/p\u003e\n\u003cp\u003eA 4ml Ropivacaine 0.1% bolus via the EC was given for post-operative analgesia before transporting the patient to our NICU (Neonatal Intensive Care Unit) in a Level 4 Sedation according to the Ramsay Score Scale. An ABG at NICU arrival was good. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe decided to keep the Epidural Catheter until the next morning and gave two further boluses of Ropivacaine 1% 3.5 ml, the first at 10 hours after the transfer in NICU and the second at about 20 hours \u0026nbsp;right before removing the EC. Our patient did not need other drugs to treat pain.\u003c/p\u003e\n\u003cp\u003eSince we had never performed this surgical procedure in SB we were ready to switch to General Anesthesia at any moment but both the sedation and the parameters were always good.\u003c/p\u003e\n\u003cp\u003eThere is extensive Literature abour Regional Anesthesia, even in the Newborn, reporting lower respiratory complications and superior Pain Control. CSE anesthesia has proved useful providing both a prolonged anesthesia, without the need of adjuvants, and ease to test the EC.\u003c/p\u003e\n\u003cp\u003eDexmetedomidine proved feasible thanks to its minimal cardiorespirstory effects allowing Spontaneous Breathing even in deep Sedation, unlike drugs like Propofol or Opioids, seeming moreover to prolong Neuraxial Analgesia.\u003c/p\u003e\n\u003cp\u003eThe Dexmetedomidine combination with Ketamine (KETADEX\u0026copy;) can be useful in many settings where the patient\u0026rsquo;s position may impair ventilation and favour regurgitation or aspiration. It offers an excellent level of sedation balancing both drugs\u0026rsquo; side effects and can be coupled with Regional Anesthesia.\u003c/p\u003e\n\u003cp\u003eRegional Anesthesia with Sedation in major surgery or sub-umbilical Laparoscopy is very interesting even in absence of comorbodities. (5)\u003c/p\u003e\n\u003cp\u003eAlthough it is an initial procedure in our anesthesiology group, we think it can be easily reproduced in similar situations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eARM: AnoRectal Malformation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRA: Regional Anesthesia\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGA: General Anesthesia\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVACTERL: Vertebral defects, Anal atresia, Cardiovascular anomalies, Tracheoesophageal fistula, Renal defects, Limb anomalies\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSB: Spontaneous Breathing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOR: Operating Room\u003c/p\u003e\n\u003cp\u003eECG electrocardiogram, NIBP non-invasive blood pressure, SpO2 peripheral oxygen saturation, ETCO2 end tidal CO2\u003c/p\u003e\n\u003cp\u003ePICC: Peripherally Inserted Central Catheter\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKETADEX: Ketamine and Dexmetedomidine\u003c/p\u003e\n\u003cp\u003ePSSS: \u0026nbsp; Pediatric Sedation State Scale\u003c/p\u003e\n\u003cp\u003eCSE: Combined Spinal-Epidural anesthesia\u003c/p\u003e\n\u003cp\u003eEC: \u0026nbsp; Epidural Catheter\u003c/p\u003e\n\u003cp\u003eUS: Ultrasound\u003c/p\u003e\n\u003cp\u003eDCI: Dexmetedomidine Continuous Infusion\u003c/p\u003e\n\u003cp\u003eNICU: \u0026nbsp; Neonatal Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eABG: Arterial Blood Gas\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u0026apos;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe have the consent of the patient\u0026apos;s parents, even if the personal data are not reported and the photo is not recognisable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003enone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: EF carried out the procedure and drafted the letter. PP helped during the surgery and translated the letter. LT read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u0026apos;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u0026apos;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eIbacache ME, Mu\u0026ntilde;oz HR, Fuentes R, Cort\u0026iacute;nez LI. Dexmedetomidine\u0026ndash;ketamine combination and caudal block for superficial lower abdominal and genital surgery in children. Paediatr Anesth. 2015;25(5):499-505.\u003c/li\u003e\n \u003cli\u003eMcVey JD, Tobias JD. Dexmedetomidine and ketamine for sedation during spinal anesthesia in children. J Clin Anesth. 2010;22(7):538-545.\u003c/li\u003e\n \u003cli\u003eCravero JP, Askins N, Sriswasdi P, Tsze DS, Zurakowski D, Sinnott S. Validation of the pediatric sedation state scale. Pediatrics.2017;139(5):e20162897.\u003c/li\u003e\n \u003cli\u003eWiegele M, Marhofer P, L\u0026ouml;nnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019 Apr;122(4):509-517. doi: 10.1016/j.bja.2018.11.030. Epub 2019 Feb 1. PMID: 30857607; PMCID: PMC6435837.\u003c/li\u003e\n \u003cli\u003eOpfermann P, Marhofer P, Springer A, Metzelder M, Zadrazil M, Schmid W. A prospective observational study on the feasibility of subumbilical laparoscopic procedures under epidural anesthesia in sedated spontaneously breathing infants with a natural airway. Paediatr Anaesth. 2022 Jan;32(1):49-55. doi: 10.1111/pan.14302. Epub 2021 Oct 8. PMID: 34582607; PMCID: PMC9292952.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5121809/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5121809/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMany neonatal procedures can be performed under regional anesthesia (RA). We describe a case of anorectal malformation (ARM) that is usually performed under general anesthesia (GA) and endotracheal intubation because the prone position is required during the procedure.\u003c/p\u003e","manuscriptTitle":"Regional Anesthesia and Spontaneous Breathing in AnoRectalMalformation (ARM) repair procedure","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-26 13:36:00","doi":"10.21203/rs.3.rs-5121809/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-04T20:20:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-04T17:17:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2024-10-04T17:16:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1c61f1ce-2959-492b-95da-7b0eb19c4956","owner":[],"postedDate":"March 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T17:23:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-26 13:36:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5121809","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5121809","identity":"rs-5121809","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}