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Trial registered on ANZCTR
Registration number
ACTRN12617000098336
Ethics application status
Approved
Date submitted
2/12/2016
Date registered
17/01/2017
Date last updated
17/01/2017
Type of registration
Retrospectively registered
Titles & IDs
Public title
A suitable sedative dose of remifentanil for both mother and fetus in fetoscopic surgery
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Scientific title
Suitable sedative dose of remifentanil in women undergoing fetoscopic laser photocoagulation for twin-twin transfusion syndrome
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Secondary ID [1]
288868
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None
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Universal Trial Number (UTN)
U1111-1190-5506
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Pregant with twin-twin transfusion syndrome(TTTS)
298159
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Condition category
Condition code
Anaesthesiology
300961
300961
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0
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Anaesthetics
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Reproductive Health and Childbirth
300962
300962
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0
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Fetal medicine and complications of pregnancy
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Surgery
300963
300963
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0
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Surgical techniques
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
According to different rates of remifentanil administration, R1, R2 and R3 group are administered different dose rate of remifentanil (0.05micro-g/kg/min and 0.08micro-g/kg/min). Anesthesia induction of CSEA was done 5min before remifentanil administration. Intravenous remifentanil was administrated before operation and stopped after laser photocoagulation. Dose administered and logged by anaesthetist.
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Intervention code [1]
296553
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Treatment: Drugs
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Comparator / control treatment
remifentanil administrative dose rate of 0.02micro-g/kg/min as comparator state
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Control group
Dose comparison
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Outcomes
Primary outcome [1]
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mean arterial pressure (MAP) by digital sphygmomanometer
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Assessment method [1]
300387
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Timepoint [1]
300387
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Before induction of anesthesia (T0), 5 min after CSEA (T1), the time when fetal immobilization after remifentanil administration (T2), incision (T3), and laser coagulation (T4)
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Primary outcome [2]
300388
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oxygen saturation (SpO2) by pulse oximeter
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Assessment method [2]
300388
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Timepoint [2]
300388
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Before induction of anesthesia (T0), 5 min after CSEA (T1), the time when fetal immobilization after remifentanil administration (T2), incision (T3), and laser coagulation (T4)
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Primary outcome [3]
300389
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Fetal movement by ultrasound
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Assessment method [3]
300389
0
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Timepoint [3]
300389
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Before induction of anesthesia (T0), 5 min after CSEA (T1), the time when fetal immobilization after remifentanil administration (T2), incision (T3), and laser coagulation (T4)
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Secondary outcome [1]
329862
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fetal movement recovering time by ultrasound
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Assessment method [1]
329862
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Timepoint [1]
329862
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from the timepoint of stopping administered drugs to fetal movement
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Secondary outcome [2]
330331
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Kreb's score for fetal heart rate by ultrasoud
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Assessment method [2]
330331
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Timepoint [2]
330331
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Before induction of anesthesia (T0), 5 min after CSEA (T1), the time when fetal immobilization after remifentanil administration (T2), incision (T3), and laser coagulation (T4)
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Secondary outcome [3]
330332
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Respiratory rate (RR) of mother by digit respiratory monitor
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Assessment method [3]
330332
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Timepoint [3]
330332
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Before induction of anesthesia (T0), 5 min after CSEA (T1), the time when fetal immobilization after remifentanil administration (T2), incision (T3), and laser coagulation (T4)
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Secondary outcome [4]
330333
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Heart rate of mother by digit electrocardiogram
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Assessment method [4]
330333
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Timepoint [4]
330333
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Before induction of anesthesia (T0), 5 min after CSEA (T1), the time when fetal immobilization after remifentanil administration (T2), incision (T3), and laser coagulation (T4)
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Secondary outcome [5]
330334
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Anxiety of mother by visual analog test (AVAT) by test standard
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Assessment method [5]
330334
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Timepoint [5]
330334
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Before induction of anesthesia (T0), 5 min after CSEA (T1), the time when fetal immobilization after remifentanil administration (T2), incision (T3), and laser coagulation (T4)
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Secondary outcome [6]
330335
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Maternal arterial oxygen partial pressure (PaO2) by blood gas analysis
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Assessment method [6]
330335
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Timepoint [6]
330335
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Before induction of anesthesia (T0) and laser coagulation (T4)
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Secondary outcome [7]
330336
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Maternal arterial carbon dioxide partial pressure (PaCO2) by blood gas analysis
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Assessment method [7]
330336
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Timepoint [7]
330336
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Before induction of anesthesia (T0) and laser coagulation (T4)
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Eligibility
Key inclusion criteria
Thirty patients with TTTS pregnancies (18-26 weeks’ gestation, maternal age 19-35 years) undergoing elective fetoscopic laser photocoagulation were included in this study. All patients were American Society of Anesthesiologists (ASA) physical status I-II
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Minimum age
19
Years
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Maximum age
35
Years
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
with cardiopulmonary comorbid conditions and emergent indications for intervention (e.g. fetal asphyxia, abruptio placenta, umbilical cord prolapse).
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
central randomisation by computer
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a randomisation table created by computer software
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 4
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
SPSS version 11.0 software was used for statistical analysis. The paired t-test and analysis of variance were performed for intragroup and intergroup measurement data. The chi-squared test was used to compare numeric data.
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Recruitment
Recruitment status
Active, not recruiting
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Date of first participant enrolment
Anticipated
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Actual
1/04/2016
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Date of last participant enrolment
Anticipated
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Actual
28/10/2016
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Date of last data collection
Anticipated
28/04/2017
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Actual
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Sample size
Target
30
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Accrual to date
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Final
30
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Recruitment outside Australia
Country [1]
8428
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China
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State/province [1]
8428
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Liaoning
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Funding & Sponsors
Funding source category [1]
295101
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Hospital
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Name [1]
295101
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Department of anesthesiology, Shengjing hospital, China medical university
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Address [1]
295101
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NO. 36, Sanhao street, Heping district, Shenyang,110003
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Country [1]
295101
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China
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Primary sponsor type
Hospital
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Name
Department of anesthesiology, Shengjing hospital, China medical university
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Address
NO. 36, Sanhao street, Heping district, Shenyang, 110003
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Country
China
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Secondary sponsor category [1]
293919
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Hospital
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Name [1]
293919
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Department of obstetric, Shengjing hospital, China medical university
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Address [1]
293919
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NO. 36, Sanhao Street, Heping District, Shenyang, 110003
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Country [1]
293919
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China
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
296457
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Ethics committee of Shengjing Hospital of China Medical University
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Ethics committee address [1]
296457
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NO. 36, Sanhao Street, Heping district, Shenyang, 110003
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Ethics committee country [1]
296457
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China
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Date submitted for ethics approval [1]
296457
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12/08/2015
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Approval date [1]
296457
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16/03/2016
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Ethics approval number [1]
296457
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2016PS29J
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Summary
Brief summary
We observed the impact of different intravenous pumping rates of remifentanil on the mother and fetus under combined spinal epidural anesthesia (CSEA) in fetoscopic surgery. Thirty patients with twin-twin transfusion syndrome (TTTS) pregnancies undergoing fetoscopic laser photocoagulation were randomized into three groups (R1, R2 and R3, ten cases per group, 0.02micro-g/kg/min, 0.05micro-g/kg/min and 0.08micro-g/kg/min), according to different rates of remifentanil administration. Anesthesia induction of CSEA was done 5min before remifentanil administration. Intravenous remifentanil was administrated before operation and stopped after laser photocoagulation. During the period, we monitored fetal movement through ultrasonic test. Operation started when fetal immobilization. We recorded the time of fetal immobilization and fetal movement recovering. Fetal movement and Kreb's score for fetal heart rate were simultaneously recorded. Maternal changes in oxygen saturation (SpO2), respiratory rate (RR), mean arterial pressure (MAP), heart rate (HR), and anxiety visual analog test (AVAT)were recorded at the following time points, before induction of anesthesia (T0), 5 min after CSEA (T1), the time when fetal immobilization after remifentanil administration (T2), incision (T3), and laser coagulation (T4). Maternal arterial oxygen partial pressure(PaO2) and arterial carbon dioxide partial pressure(PaCO2) were measured on T0 and T4. Maternal cardiopulmonary function remained stable after remifentanil administration. PaCO2 showed no significant difference in three groups on T0 and T4(P>0.05). SpO2, RR, MAP, HR, PaO2, AVAT values and Kreb's scores were decreased in turn from R1 to R3 group (p<0.05). There were two cases of fetal movements during laser photocoagulation in R1 groups, but none in R2 and R3 groups. The time for fetal immobilization fetal movement recovering were shorten in turn from R1 to R3 group (p<0.05). In fetoscopic surgery for TTTS, CSEA combined with a suitable dose of remifentanil can improve the maternal and fetal sedative effects without adverse effects. We propose that the appropriate rate of remifentanil dose in combination with CSEA during TTTS surgery is 0.05micro-g/kg/min.
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Trial website
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Trial related presentations / publications
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Public notes
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Attachments [1]
1279
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/AnzctrAttachments/370414-Ethics approval.pdf
(Ethics approval)
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Attachments [2]
1282
1282
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/AnzctrAttachments/370414(v02-12-2016-00-46-57)-Participant consent.pdf
(Participant information/consent)
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Contacts
Principal investigator
Name
64714
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Prof Ping Zhao
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Address
64714
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NO.36, Sanhao street, Heping district, Shenyang,110003
Department of anesthesiology, Shengjing hospital of China medical university
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Country
64714
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China
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Phone
64714
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+86-024-25672468
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Fax
64714
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Email
64714
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[email protected]
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Contact person for public queries
Name
64715
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Guang Han
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Address
64715
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NO.36, Sanhao street, Heping district, Shenyang,110003
Department of anesthesiology, Shengjing hospital of China medical university
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Country
64715
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China
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Phone
64715
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+86-18940258839
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Fax
64715
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Email
64715
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[email protected]
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Contact person for scientific queries
Name
64716
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Guang Han
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Address
64716
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NO.36, Sanhao street, Heping district, Shenyang,110003
Department of anesthesiology, Shengjing hospital of China medical university
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Country
64716
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China
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Phone
64716
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+86-18940258839
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Fax
64716
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Email
64716
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF