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PubMed2001

Effect of water supply method and flow rate on drinking behavior and fluid balance in horses.

This study investigated three methods of water supply on drinking preference and behavior in six Standardbred geldings (2-9 years, 505+/-9 kg). The water sources were buckets (B), pressure valve (PV), and float valve (FV) bowls. In an initial drinking preference test, PV was tested at three flow rates: 3, 8, and 16 l/min (PV3, PV8, and PV16), and FV at 3 l/min (FV3). Water intake was measured in l and presented as the percentage of the total daily water intake from each of two simultaneously presented alternatives. The intake from PV8 was greater than from both PV3 (72+/-11% vs. 28+/-11%) and PV16 (90+/-4% vs. 10+/-4%). All horses showed a strong preference for B, 98+/-1% of the intake compared to 2+/-1% from PV8. Individual variation in the data gave no significant difference in preference between the two automatic bowls. In the second part of the study, drinking behavior and fluid balance were investigated when the horses drank from FV3, PV8, and B for 7 consecutive days in a changeover design. Despite a tendency for an increase in total daily drinking time from FV3, the daily water intake was significantly lower (43+/-3 ml/kg) than from PV8 (54+/-2 ml/kg) and B (58+/-3 ml/kg). Daily net water gain [intake-(fecal+urinary output)] was only 0.5+/-3 ml/kg with FV3, resulting in a negative fluid balance if insensible losses are included. These results show that the water supply method can affect both drinking behavior and fluid balance in the horse.

Animals↗
PubMed1995

Fluid balance and pulmonary functions during and after coronary artery bypass surgery: Ringer's acetate compared with dextran, polygeline, or albumin.

The effects on fluid balance, pulmonary functions and economics were evaluated in a randomized comparison of one colloid free and three colloid containing fluid regimens, for 48 hours during and after coronary artery bypass (CAB) surgery. A standard regimen for anaesthesia, extracorporeal circulation and monitoring was used. Only Ringer's acetate (RAc) was used as priming solution for extracorporeal circulation. Forty patients were randomized to receive either RAc, polygeline 35 mg.ml-1 (Haemaccel), dextran 70 (Macrodex) 60 mg.ml-1, or albumin 40 mg.ml-1 in saline whenever fluid volume was needed to stabilize haemodynamics. At the end of the operation, fluid retention was significantly lower in patients receiving polygeline and dextran 70, compared with patients receiving RAc. At 48 hours, however, there were no differences in cumulative fluid balance. Patients in the colloid groups postoperatively had a higher serum colloid osmotic pressure (s-COP), but a higher net lung capillary filtration pressure (delta P) only on the second postoperative day than the RAc group. However, this did not adversely affect intrapulmonary venous admixture, arterial oxygen tension, or time on respirator in the RAc group compared with the colloid groups. The most expensive colloid fluid regimen (albumin) cost about 230 US$ more per patient than the RAc fluid regimen. We conclude that Ringer's acetate for volume replacement to stabilize haemodynamics during and after CAB surgery is associated with increased fluid retention only during the intraoperative period, compared with dextran 70 or polygeline, and with a lower serum colloid osmotic pressure and net lung capillary filtration pressure postoperatively, compared with all three colloid groups. This does not affect pulmonary functions adversely.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1999

Effects of potassium intake on potassium, sodium and fluid balance in exercising horses.

The aim of this study was to investigate the adaptation to an increased potassium (K+) intake in horses and to study whether the regulation of the post exercise K+, sodium (Na+) and fluid balances were altered by an increased K+ intake. Four Standardbred horses were fed 2 levels (4.1 and 5.4 mmol/kg bwt/day) of K+ for 17 days in a crossover design. The effects on K+, Na+ and fluid balance were studied both at rest and in response to 29 km exercise. K+, Na+ and fluid intakes and outputs were balanced within 24 h after a new diet had been introduced. Adaptation consisted primarily of an increased urinary K+ excretion, later followed by an increase in faecal excretion. The increased urinary K+ excretion was associated with an increased mass of urine (1.2-1.4 kg/day) compensated for by an increased water intake. The sweat Na+ concentration was increased on the highest K+ intake (from 123 +/- 5 mmol/l to 138 +/- 3 mmol/l) and the urinary Na+ excretion was lower post exercise on this diet. There were no differences in the magnitude of post exercise hypokalaemia between the diets, and plasma K+ concentration was still reduced 24 h post exercise even when the horses were fed the higher K+ diet. Adaptation to an increased K+ intake was rapid in these horses and consisted mainly of an increased urinary excretion. The response to exercise was unaltered by the increased K+ intake, except for an increased Na+ concentration in sweat.

Aldosterone↗
PubMed1985

Hemodynamically significant PDA: an echocardiographic and clinical assessment of incidence, natural history, and outcome in very low birth weight infants maintained in negative fluid balance.

Fifty very low birth weight (VLBW) infants (750-1500 g, 27-33 weeks gestational age) were assigned at random to one of two groups of negative fluid balance and underwent prospective clinical and echocardiographic examinations during the first month of life. The purpose was to determine: the effect of fluid restriction on the incidence of ductal shunting, the reliability of the physical examination in diagnosing significant ductal shunting, and the relationship between significant ductal shunting and outcome in such infants. None of the infants had manipulations to close the ductus during the first week of life. Using routine structural and functional echocardiographic indices as criteria for the diagnosis of hemodynamically significant ductal shunting (hsPDA), we found that the two fluid-balance groups (8%-10% weight loss vs 13%-15% weight loss) did not significantly differ in incidence of hsPDA, duration of ventilation, or development of BPD. These two groups were then combined for further analysis: 32 (64%) of 50 VLBW infants had hsPDA during the first week of life. The group of infants with hsPDA did not differ significantly from that without hsPDA in birth weight or gestational age, but had a significantly lower Apgar score (P less than 0.04) and was significantly more likely to require ventilator support for RDS (P less than 0.01). Although when present a typical ductal murmur was specific for the development of significant ductal shunting, no murmur was heard in 21 (66%) of 32 infants with early hsPDA.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗
PubMed1987

Fluid balance in food-deprived lactating goats drinking saline.

Fluid balance was studied in four lactating goats during two 3 week periods, which included 30 h periods of food deprivation. In one period the goats were given 0.9% NaCl to drink, and in the other they were given water. Prior to food deprivation, fluid intake and urinary flow were similar in the two groups, but urinary Na+ excretion was higher in the saline-drinking goats. The plasma renin activity was depressed in saline-drinking goats, while the plasma aldosterone concentration was the same both in saline-drinking and water-drinking animals. Food deprivation depressed fluid intake and urine flow in all goats, but the reduction was more pronounced in goats drinking saline. The urinary Na+ and K+ excretion also decreased, in both groups, as did plasma Na+ concentration and osmolality. The plasma protein concentration increased in both groups, indicating that hypovolaemia had developed. The renin-angiotensin-aldosterone system (r.a.a.s.) became activated in goats drinking water, but not in the group drinking saline. It is suggested that sodium retention may have attenuated the activation of the r.a.a.s. in the latter group. The results of this study show that hyponatraemic hypovolaemia develops during starvation in lactating goats, regardless of the sodium state of the animals. The possibility that the hyponatraemic hypovolaemia is secondary to an impeded Na+ and fluid absorption from the rumen reticulum is discussed.

Aldosterone↗
PubMed1988

Effects of hypobaria on lung fluid balance in awake sheep.

Effects of hypobaria on lung fluid balance were studied in five awake sheep with chronic lung lymph fistulas using a decompression chamber. Each sheep was exposed to three conditions of 6,600-m-simulated high altitude in random order as follows: 1) 6,600-m-simulated hypoxic hypobaria (barometric pressure 326 Torr, 21% inspired O2 fraction), 2) 6,600-m-simulated normoxic hypobaria (barometric pressure 326 Torr, 65% inspired O2 fraction), and 3) 6,600-m-simulated normoxic hypobaria (barometric pressure 326 Torr, 65% inspired O2 fraction) after pretreatment with a 2-h pure O2 inhalation (i.e., denitrogenation) to allow elimination of dissolved gases, especially N2, from the blood and tissues. We observed that under both hypoxic hypobaria and normoxic hypobaria, lung lymph flow (Qlym) significantly increased from the base-line values of 6.4 +/- 0.3 to 13.0 +/- 1.0 ml/h and 6.0 +/- 0.2 to 9.4 +/- 0.3 ml/h, respectively (P less than 0.05) and that the lymph-to-plasma protein concentration ratio remained unchanged. Moreover, pretreatment with a 2-h denitrogenation inhibited the increase in Qlym. These results suggest that rapid exposure to hypobaria causes an increase in pulmonary vascular permeability and that intravascular air bubble formation may account for this permeability change.

Altitude↗
PubMed1989

Effect of glucose polymer ingestion on energy and fluid balance during exercise.

Nine male triathletes were studied during 160 min of exercise at 65% VO2 max on two occasions to examine the effect of glucose polymer ingestion on energy and fluid balance. During one trial they received 200 ml of a 10% glucose polymer solution at 20 min intervals during exercise (CHO), while in the other they received an equal volume of a sweet placebo (CON). On average, blood glucose levels (CON = 4.2 +/- 0.2 mmol l-1, CHO = 4.8 +/- 0.1, mean +/- S.E.) and respiratory exchange ratios (CON = 0.84 +/- 0.01, CHO = 0.87 +/- 0.01) during exercise were higher (P less than 0.05) as a result of the glucose polymer ingestion. There were no differences between trials, however, in the estimated plasma volume changes during exercise. Exercise time to exhaustion at an intensity corresponding to 110% VO2 max, performed 5 min after the submaximal exercise, was not influenced by glucose polymer ingestion. Relative to a control exercise bout conducted without prior exercise, however, sprint performance and postexercise blood lactate accumulation were impaired in both trials. It is concluded that glucose polymer ingestion maintains blood glucose levels and a high rate of carbohydrate oxidation during prolonged exercise, without compromising fluid balance.

Adult↗
PubMed1987

Influence of variations in blood haemoglobin concentration on the calculation of blood loss and volumetric irrigating fluid balance during transurethral resection of the prostate.

Blood loss in 38 patients undergoing transurethral resection of the prostate (TURP) was calculated in four different ways by using various reference blood haemoglobin determinations (B-Hb) during the course of preparation and surgery. Blood loss became greater the later the B-Hb was drawn. This increase was because variations in B-Hb acted to underestimate the loss of plasma. The variations also distorted the irrigating fluid balance to give too low values for the absorption of irrigating fluid. It is possible to correct for the errors in blood loss and volumetric fluid balance by the use of haemodilution factors. Haemodilution was greater in patients with complications such as absorption of irrigating fluid or excessive blood loss than in patients without such features if Ringer's acetate was used for i.v. fluid supplementation. With dextran 40, all patients had a similar degree of haemodilution.

Aged↗
PubMed2005

Acute effects of tidal volume strategy on hemodynamics, fluid balance, and sedation in acute lung injury.

OBJECTIVE: To examine the effects of mechanical ventilation with a tidal volume of 6 mL/kg compared with 12 mL/kg predicted body weight on hemodynamics, vasopressor use, fluid balance, diuretics, sedation, and neuromuscular blockade within 48 hrs in patients with acute lung injury and acute respiratory distress syndrome. DESIGN: Retrospective analysis of a previously conducted randomized, clinical trial. SETTING: Two adult intensive care units at a tertiary university medical center and a large county hospital. PATIENTS: One hundred eleven patients who were enrolled in the National Institutes of Health ARDS Network trial at the University of California, San Francisco. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Compared with 12 mL/kg predicted body weight, treatment with a tidal volume of 6 mL/kg predicted body weight had no adverse effects on hemodynamics. There were also no differences in the need for supportive therapies, including vasopressors, intravenous fluids, or diuretics. In addition, there were no differences in body weight, urine output, and fluid balance. Finally, there was no difference in the need for sedation or neuromuscular blockade between the two tidal volume protocols. CONCLUSIONS: When compared with ventilation with 12 mL/kg predicted body weight, patients treated with the lung-protective 6 mL/kg predicted body weight tidal volume protocol had no difference in their supportive care requirements. Therefore, concerns regarding potential adverse effects of this protocol should not preclude its use in patients with acute lung injury or the acute respiratory distress syndrome.

Adult↗
PubMed1991

Body composition, nutrition, and fluid balance during the first two weeks of life in preterm neonates weighing less than 1500 grams.

To determine whether body weight during the first 2 weeks of life in preterm infants weighing less than 1500 gm reflects nutritional status or fluid balance, we studied total body water (TBW) (deuterium oxide dilution), extracellular volume (sucrose dilution), and plasma volume (Evans blue dilution), together with intake-output studies of nitrogen, fluid, and sodium on day 1 (median age 0.3 day), at a weight loss of 7.8% of birth weight (median age 3.4 days), and after birth weight was regained (median age 8.9 days) in eight clinically stable preterm infants (birth weight 810 to 1310 gm, gestational age 26 to 30 weeks) receiving ventilatory support. During the initial weight loss we found no evidence of catabolism. Body solids (weight--TBW) remained unchanged, there was nitrogen retention, and energy intake was sufficient to meet energy expenditure by day 2. However, we found evidence of fluid loss: TBW (mean +/- SD, -95 +/- 99 ml), extracellular volume (-98 +/- 63 ml), and interstitial volume (-102 +/- 75 ml) decreased significantly, indicating negative fluid and sodium balances. Blood volume and plasma volume remained unchanged. With the regaining of birth weight there was no increase in body solids despite a high degree of nitrogen retention, but there was a positive fluid balance although no significant increase in any body fluid compartment was found. We conclude that the observed postnatal weight changes reflect changes in interstitial volume.

Body Composition↗
PubMed2002

Exercise-induced changes in atrial peptides in relation to neuroendocrine responses and fluid balance in the horse.

Previous data show that, in horses, plasma atrial natriuretic peptides (ANP and NT-ANP) remain elevated for a long time after exercise. To study whether exercise-induced changes in hormonal and fluid balance explain this, we measured plasma concentrations of COOH- and NH2-terminal atrial natriuretic peptides (ANP(99-129) and NT-ANP(1-98) together with arginine vasopressin (AVP), adrenocorticotrophin (ACTH), beta-endorphin, cortisol, catecholamines, and indicators of fluid balance in six Finnhorses after a graded submaximal exercise test on a treadmill. After exercise, AVP and catecholamines diminished rapidly; atrial peptides, ACTH, beta-endorphin, and cortisol remained elevated longer. ANP reached its peak value at 5 min and NT-ANP at 30 min post-exercise. At 60 min, ANP was still significantly increased and NT-ANP even above its level at the end of exercise. The different temporal patterns of ANP and NT-ANP are most probably explained by differences in their plasma half-lives. The post-exercise increase in NT-ANP indicates that the release of atrial peptides is stimulated during recovery after exercise. The rapid decrease in AVP and catecholamines suggests that these hormones do not explain the long-lasting increase in atrial peptides. Cortisol remained elevated longer and it may have contributed to some extent. After exercise, the packed cell volume (PCV) decreased more slowly than plasma total protein and electrolytes, which refers to a slow post-exercise return in blood volume. Taken together, the present results show that the long-lasting post-exercise increase in plasma atrial peptides in horses is most probably explained by elevated central blood volume and that the role of vasoactive hormones is small.

Adrenocorticotropic Hormone↗
PubMed1997

Effects of altered body fluid balance and high blood pressure on the plasma brain natriuretic peptide in rats.

The present study was aimed to investigate the regulatory mechanisms of BNP release. Effects of acute and chronic perturbations in body fluid balance, changes in BP, and regulatory roles of NO and endothelin systems on BNP release were examined in rats. Although acute extracellular volume expansion did not have significant effects on plasma BNP, prolonged high-salt intake increased plasma BNP levels. Plasma BNP levels were also higher in 2K1C rats compared with the control. Although infusion of L-NAME increased the plasma BNP in control, it did not further affect the plasma BNP in rats with high-salt intake. Although L-arginine (20 mg.kg-1 per min) per se did not have significant effects on plasma BNP, it blocked the stimulatory effect of L-NAME (200 micrograms.kg-1 per min). Plasma BNP was severalfold increased following a single injection of endothelin (0.3 micrograms/kg) in normal and high-salt intake groups, the magnitude of which was not significantly affected by the high-salt intake. Although indomethacin did not have significant effects on plasma BNP in normal rats, it blocked the stimulatory effect of 2K1C hypertension. It is concluded that BNP is regulated by chronic changes in body fluid balance and blood pressure. It is also suggested that endothelin and NO systems may directly regulate the secretion of BNP in vivo. An endogenous prostaglandin synthesis may be involved in the stimulated release of BNP in hypertension.

Animals↗
PubMed1996

Effects of long-term treatment with enalapril or hydralazine on the renin-angiotensin-aldosterone system and fluid balance in dogs with naturally acquired mitral valve regurgitation.

OBJECTIVE: To study long-term effects of enalapril, an angiotensin-converting enzyme inhibitor, and hydralazine, an arteriodilator, on renin-angiotensin-aldosterone system and fluid balance before and after administration of furosemide. ANIMALS: 22 dogs with clinical signs of congestive heart failure (CHF) attributable to mitral regurgitation. PROCEDURE: After initial examination, 12 dogs received enalapril and 10 received hydralazine. Dogs were re-examined 3 weeks and 6 months after initial examination. Furosemide was added after the 3-week examination, and at 6 months, dogs had received furosemide for at least 4 months. RESULTS: Angiotensin II and aldosterone plasma concentrations were low before treatment, and only aldosterone became significantly decreased after enalapril monotherapy. Concentrations of both hormones and heart rate increased in dogs receiving hydralazine monotherapy, and fluid retention was evident. After long-term treatment with either of the 2 drugs together with furosemide, angiotensin II and aldosterone values increased in both groups. Natriuresis and kaliuresis developed in all dogs, with greatest effect in those receiving enalapril and furosemide. These dogs had decreased plasma sodium concentration, whereas potassium concentration was equally decreased in both groups. After 6 months, the enalapril group, but not the hydralazine group, had increased cardiac size. All dogs had moderate reduction of weight and were azotemic, although changes were more pronounced in those of the hydralazine group. CONCLUSION: The 2 drugs have different effects on the renin-angiotensin-aldosterone system and fluid balance in dogs with CHF.

Aldosterone↗
PubMed1994

Fluid balance versus blood flow autoregulation in the elevated human limb: the role of venous collapse.

This study evaluated the postural vascular adjustment in the human forearm which may be responsible for the recent observation that transcapillary fluid balance is maintained above the level of the heart while blood flow decreases in a linear fashion. In this study further evidence was provided that a posturally graded profile of collapsed veins holds for both an overall increase of resistance with height and compensation for hydrostatic effects on capillary pressure. This was achieved by manipulating peripheral venous profile/volume: a proximal outlet resistance (upper arm cuff) was used for re-opening of collapsed distal veins. In test (a), 12 healthy subjects underwent recordings of fluid reabsorption rate and blood flow in a 20-cm segment of their forearm horizontally placed at 36 cm above heart level (third intercostal space). Applying upper arm cuff pressures randomly between 0 and 25 mmHg (0-3.33 kPa) for 15 min led to maxima of blood flow and reabsorption rates at inflations of 5 or 10 mmHg (0.67 or 1.33 kPa). This was attributed to minima in postcapillary resistance facilitating flow and reducing capillary pressure. In test (b) the flow-maximizing outlet resistance found was studied for its effect in different forearm positions (-18, 0, 18, 36, 54 cm relative to heart level). Blood flow then showed a shift of its maximum from heart level to 36 cm above heart level, while the reabsorption rate increased above 18-cm height--in contrast to previous findings with a free circulation. It was therefore concluded that the venous profile in the forearm adjusts postcapillary resistance in such a way that local dehydration is confined at the cost of blood supply. Thicker and less collapsable veins may ensure better flow autoregulation during impaired fluid balance--as seen in the legs.

Adult↗
PubMed1989

Influence of the fluid balance on the cortisol and glucose responses to transurethral prostatic surgery.

The serum cortisol and blood glucose concentrations were followed for up to 2 h after 35 transurethral prostatic resections performed under epidural anaesthesia. No significant variation in either of these levels was recorded in connection with the seven operations during which there was no disturbance of the fluid balance, or the seven where there was elevation in the central venous pressure indicative of intravenous fluid overload. In contrast, both the serum cortisol and the blood glucose level showed a significant increase in the nine patients with a blood loss of more than 800 ml, and in the nine recording absorption of irrigant in excess of 300 ml and immediate development of hyponatraemia. On the other hand, this response did not occur in the three patients with irrigant absorption where hyponatraemia developed with a delay of at least 20 min. These results suggest that the effect of surgery on the serum cortisol and blood glucose levels may be modified by disturbances of the fluid balance developing in the course of the operation.

Absorption↗
PubMed1993

Evidence for altered transcapillary fluid balance in women with the premenstrual syndrome.

Redistribution of body fluids has been suggested as a possible pathophysiological mechanism for the premenstrual syndrome (PMS). To elucidate this hypothesis, transcapillary fluid balance was studied in ten women with well defined PMS. Wick-methods were used for measuring colloid osmotic and hydrostatic interstitial pressures on the thorax and on the leg. The capillary filtration coefficient was measured by strain gauge plethysmography. From the follicular to the luteal phase the interstitial colloid osmotic pressure on the leg was significantly reduced (mean 3.6 mm Hg, p = 0.005), whereas the interstitial colloid osmotic pressure on the thorax remained constant. The capillary filtration coefficient increased 30% (mean 5.3 x 10(-4) ml/min/100 gm/mm Hg, p = 0.04) from the follicular to the luteal phase. No change was observed in body weight. These findings indicate an instability of vascular regulation in women with premenstrual syndrome, and lend support to the hypothesis that redistribution of fluid, rather than water retention, is responsible for the subjective symptoms such as bloatedness, in the premenstrual syndrome.

Adult↗
PubMed1982

Lung fluid balance in lambs before and after birth.

To study lung fluid balance before and after birth, we measured lung lymph flow and concentrations of protein in lymph and plasma of 22 unanesthetized fetal lambs and compared results with previous studies done on 26 newborn lambs, 1-2 wk old. Lymph flow, relative to lung mass, was less in fetuses than in newborns; lymph protein clearance was not significantly different. Less lymph flow before birth probably reflects less available surface area for fluid exchange in microcirculation of fetal lungs, compared with newborn lungs, with no difference in endothelial permeability to protein. Extravascular lung water, measured gravimetrically for 24 fetuses (10 without labor, nine in labor, five 6 h after vaginal birth), decreased by 45% (15 +/- 2 g/kg body wt) before birth and by an additional 38% (6 +/- 1 g/kg) after birth. In five lambs killed after birth, we measured lung lymph flow before and during labor and for 6 h after breathing began. Lymph flow was unaffected by labor but increased transiently after birth, accounting for 11% of the liquid removed from lungs postnatally. Liquid clearance studies performed in eight anesthetized 3-wk-old lambs confirmed the observation that lung lymphatics drain only a small fraction of liquid in potential air spaces. Most of that liquid probably leaves the lungs directly through pulmonary circulation.

Animals↗
PubMed1990

Fluid balance in sheep lungs before and after extracorporeal perfusion.

Lung fluid balance was studied in sheep under the following conditions: 1) unanesthetized, standing in a metabolic cage; 2) anesthetized, in a supine position; 3) 1 h after extracorporeal perfusion; and 4) either 4-6 h after extracorporeal perfusion (i.e., control experiments) or 1.5 h after left atrial pressure was increased by 15 cmH2O. Lung lymph flow rate (QL), plasma and lymph concentrations for nine protein fractions, urea permeability-surface area product (PS), urea effective diffusivity (D1/2S), and extravascular lung water (VE) were measured under each condition. Bloodless wet and dry lung weights were measured at the end of each experiment. QL increased and lymph-to-plasma concentration ratio for total proteins (L/P) decreased after the sheep were anesthetized and placed in a supine position. This possibly resulted from an increase in microvascular pressure induced by anesthesia and/or reorientation of the lungs. PS, D1/2S, and VE decreased, indicating a decrease in perfused surface area associated with a decreased cardiac output or alteration in lung orientation. After 90 min of extracorporeal perfusion, no significant differences were found in QL, PS, and D1/2S compared with those measured during the anesthetized period. No changes in PS or D1/2S could be detected after an average of 4.2 h of extracorporeal perfusion. The average bloodless wet-to-dry lung weight ratio [(W-D)/D] was 3.77 +/- 0.12, well within the range for normal sheep lungs. An increase in venous pressure of 15 cmH2O produced a response similar to that observed in the unanesthetized sheep lung lymph preparation: QL increased, L/P decreased, PS and D1/2S did not increase, and VE and (W-D)/D increased slightly.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗