Showing posts with label Anesthesia. Show all posts
Showing posts with label Anesthesia. Show all posts

CES Atrakurium (Nambix).. Improved model of taurium. The ideal option in patients with renal hepatic impairment and heart lesions

CES Atrakurium (Nambix):

While cisatracurium (Nimbex) has advantages over some neuromuscular blocking agents, claiming it as the "ideal option" for all patients with renal, hepatic impairment, and heart lesions requires nuanced understanding and context. Here's a breakdown:

Advantages of Cisatracurium:

- Intermediate duration of action:

Provides enough muscle relaxation for surgery without prolonged recovery.

- Minimal cardiovascular effects:

Less likely to cause significant drops in blood pressure or arrhythmias compared to some muscle relaxants.

- Less dependent on kidney and liver function:

Can be used in patients with mild to moderate renal and hepatic impairment with minimal dosage adjustments.

Limitations and Alternatives:

- Not ideal for all heart lesions:

While generally safe in patients with some heart conditions, it's crucial to consider the specific type and severity of the lesion. Consult a healthcare professional for guidance.

- Not entirely independent of kidney and liver function:

Dosage adjustments may still be necessary for severe renal or hepatic impairment.

- Alternatives exist:

Other muscle relaxants like mivacurium or rocuronium might be preferred in specific scenarios depending on the patient's individual profile and surgery requirements.

Therefore, while cisatracurium can be a good option for patients with moderate renal and hepatic impairment, calling it the "ideal option" for all such patients and those with heart lesions is inaccurate and potentially misleading. Each case requires careful evaluation by a healthcare professional to determine the safest and most effective muscle relaxant based on the individual's specific medical history and surgery needs.
Remember, never use any medication without a doctor's prescription and supervision.

Reversing the siege.. Use of cholinesterase inhibitors such as neostigmine at the end of the process to reverse muscular paralysis produced by non-polarizing catheterization drugs

Cholinesterase inhibitors such as neostigmine are used at the end of the process to reverse muscular paralysis produced by non-polarizing catheter drugs, such as alkuronium and fecuronium.

Neustigmine should not be used with antispasmodic blockers, such as suxamethonium, because neostigmine will prolong muscle paralysis.

Neustigmine is also used to treat non-obstructive urinary retention that follows operations.

And for the use of cholinesterase inhibitors in muscle weakness.

Types of medical anesthesia.. General or total anesthesia. Local, partial and mesothelioma. Spinal anesthesia in cases of childbirth and surgeries on the legs

Medical anesthesia can be divided into two types:
- First: general or total anesthesia.
- Second: local anesthesia, and partial and half.

General or total anesthesia is the one that directly affects the brain, ie, the central nervous system, resulting in a complete loss of sensation throughout the body.
The anesthetic moves to the deep state of sleep and receives complete muscle relaxation.

This type is used in large hospitals equipped with modern anesthesia machines.
It is used by specialists in anesthesia.
Non-specialist physicians may not use general anesthesia for the complications that may lead to rapid loss of human life.

And the patient is asleep does not feel the irritation of the pain and his muscles relaxed.
The local anesthesia, which causes the loss of sense in a limited area of ​​the body, because the drug affects the nerve closes the road leading to the brain, the patient loses pain sensation in this part.

Where a local anesthetic is injected into the area where the procedure is performed, resulting in anesthesia of a small part of the body.

There is also in some references the so-called peripheral anesthesia; which is a type of anesthesia; as the patient also loses sensation in a specific area in his body, and muscles in that region is relaxed, and the model known and most prevalent of this type is epidural anesthesia, which spreads in The lower part of the body only.

In local anesthesia, the patient remains aware of what is around him.
The local anesthetic is placed on the place where the sensation is to be removed, or injected around the nerve, feeding the desired area.
Doctors use local anesthesia to perform eye, nose, mouth and skin operations.

It is also possible to distinguish another type of previous species known as spinal anesthesia, a type in which a whole area of ​​the body is anesthetized, the lower region, and this type of anesthesia by injecting local anesthetic, inside the fluid spinal cord, through the hole located, between Lumbar.

Resulting in loss of the lower parts of the body sensation of pain, while the patient remains conscious.
This type of anesthesia was introduced by the Swiss physician Pierre, in 1899, which is used frequently in childbirth and during operations on the legs.

Surgical Anesthesia.. Intravenous administration of barbiturates, injection of ketamine, or pilot agent. Use of inhalation agents supported by other intravenous drugs

For a complete case of complete surgical anesthesia safely and reliably, different types of medications are needed. Special precautions and careful patient monitoring are needed. These drugs may be fatal if used improperly and should only be used by non-specialists as a last resort. Regardless of the anesthesia technique used, whether general or induction anesthesia (local or local), it is necessary to have intubation and mechanically assisted ventilation. A comprehensive preoperative assessment involving, where necessary, appropriate replacement of fluids is required.
Sedation can be induced by intravenous barbiturates, ketamine injections, or by a pilot agent. The use of inhalers is supported by other intravenous drugs. Certain medications can be used to relax muscles. Different drugs may be needed to alter normal physiological functions or to keep the patient in a satisfactory condition during surgery.
Long-term healing. The risk of stopping long-term treatment before surgery may be greater than the risk of persisting. It is essential that the anesthesiologist be informed of all medications taken (or used) by the patient.

Intravenous anesthesia.. Recovery from ketamine anesthesia is associated with a severe risk of hallucinations and other reactions to awakening

Intravenous intravenous anesthetics may be used only to induce anesthesia for minor surgical procedures but are more commonly used for induction only. It may cause apnea and low blood pressure and therefore appropriate recovery means should be available. It is prohibited to use it if the anesthetist is not sure of his ability to maintain an airway. Before attempting an intubation, you should give a muscle relaxant. The requirements vary widely; a smaller dose is recommended in the case of the elderly, frail patients or those with hypoglycaemia.
Intravenous intravenous injection using rapid thiopental is usually not stimulated. Anesthesia lasts for 4-7 minutes; large or repeated doses cause severe breathing and delay recovery.
The anesthesia continues with ketamine for up to 15 minutes after a single intravenous injection and is characterized by depth of sedation. It can be used as a single agent in micro-diagnostic and surgical interventions. Non-anesthetic concentrations of ketamine can be used for analgesia in short-term painful procedures such as dressing burns, therapeutic radiation procedures, bone marrow sampling and minor orthopedic procedures.
Recovery from ketamine anesthesia is associated with a severe risk of hallucinations and other reactions to awakening. Ketamine is especially valuable in children, who are thought to have less hallucinations.

Thiopental sodium.. Induction of anesthesia prior to inhalation anesthetic drugs. Short-term anesthesia. Hyperparathyroidism, cardiovascular disease, shortness of breath or respiratory obstructive pulmonary disease

Thiopental sodium:
Thiopental is a representative intravenous anesthetic drug. There are many medications that can act as alternatives.
Injection, (powder for solution for injection), sodium thiopental, ampoules 0.5 g, and 1 g.
Uses: induction of anesthesia prior to inhalation anesthesia; short-term anesthesia.
Contraindications: inability to maintain an airway; excessive sensitivity to barbiturates, cardiovascular disease, shortness of breath or respiratory obstructive pulmonary disease;
Precautions: Local leakage can cause severe necrosis and tissue breakdown; injection into the artery causes severe pain and may result in arterial contraction; hepatic impairment; pregnancy.
Skillful work. Be warned to do skilled work, such as turning on machines, or driving, for 24 hours and avoiding alcohol abuse for 24 hours as well
Dosage:
Incubation, intravenously as a 2.5% solution (25 mg / ml) for 10-15 seconds, ADULT 100-150 mg, (reduced dose for the elderly and vulnerable) followed by 100-150 mg if necessary according to the response after 60 Second; or up to 4 mg / kg; the child 2-7 mg / kg repeated as necessary according to the response after 60 seconds.
Restructuring. Fresh solutions containing 25 mg / ml should be prepared by mixing 20 ml of injection water with the contents of the ampoule 0.5 g or 40 ml with ampoule 1 g. Any solution prepared 24 hours or in which a cloud, sediment or crystallization occurs should be excluded.
Adverse effects: Rapid injection may result in a severe reduction in blood pressure and coughs; cough, laryngeal spasm and allergic reactions.

Ketamine.. Incitement and maintenance of anesthesia, sedation in painful procedures for a short period. Thyroid poisoning. Hypertension. Tumor or hemorrhage within the brain or any other reason for high intracranial pressure

Ketamine:
Injection (solution for injection), ketamine (hydrochloride) 50 mg per 1 ml, 10 ml vial
Uses: induction and maintenance of anesthesia, pain in painful procedures for a short period.
Anorexia, cerebral hemorrhage, tumor or hemorrhage within the brain or any other cause of intracranial pressure; eye injuries and high intraocular pressure; psychological disorders, especially hallucinations.
Precautions: Additional surgical procedures involving visceral pain are often required (morphine can be used but nitrous oxide supplementation is usually sufficient); avoidance of discomfort of the patient during recovery should be avoided with continuation of observation; pregnancy (Annex 2);
Skillful work. Be warned to do skilled work, such as running machinery or driving, for 24 hours and avoid alcohol abuse for 24 hours as well.
Dosage:
Induction, intramuscular injection, ADULT and CHILD 6.5-13 mg / kg (10 mg / kg usually produced 12-25 minutes anesthesia)
Incubation, intravenous injection during at least one minute, ADULT and CHILD 1-4.5 mg / kg (2 mg / kg usually produced 5-10 minutes anesthetized)
Induction, by intravenous infusion of solution containing 1 mg / ml, ADULT and CHILD Full induction dose 0.5 2 mg / kg; continuous (using fine drip infusion), 10-45 micrograms / kg / min, Response.
Sedation, intramuscular injection, ADULT and CHILD 4 mg / kg initially
Mitigation and giving. As directed by the manufacturer
Adverse effects: Hallucinations and awakening reactions during recovery may be accompanied by irrational behavior (effects rarely last for more than a few hours but may recur at any time within 24 hours); it is common to have a transient rise in pulse speed and blood pressure, Systems; and some cases of low blood pressure and heart failure.

Antihypertensives.. Ether or halothane with nitrous oxide. Full relaxation of muscles in deep anesthesia. Avoid increased bronchial and salicylic secretion using atropine as an anesthetic

A volatile anesthetic such as ether or halothane (with or without nitrous oxide) should be used for induction when intravenous substances are prohibited, especially when intubation is likely to be difficult.
Full relaxation of muscles is achieved in deep anesthesia using ether. Increased bronchial and salivary secretion can be avoided by using atropine as a precursor to anesthesia. Laryngeal spasm may occur during induction and intubation. Local hemorrhagic haemorrhage can cause some problems, and nausea and vomiting after surgery are frequent; recovery time is slow, especially after prolonged administration.
If intubation is likely to be difficult, it is preferable to use halothin. It does not increase salivary or bronchial secretions and the incidence of nausea and vomiting after surgery is low. Severe hepatitis may occur and may be fatal; it is more likely in patients who are frequently anesthetized with halothin in a short period of time.

Ether.. Incitement and maintenance of anesthesia. Postoperative effects include impaired liver function and leukocyte proliferation; nausea and vomiting

Ether, anaesthetic:
A drug subject to international control under the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988)
Pilot fluid.
Uses: induction and anesthesia maintenance (given with different types of incinerators)
Contraindications: severe liver disease; diabetes; kidney dysfunction; high cerebral cerebral fluid pressure.
Precautions: risk of lethal convulsions in febrile patients; pregnancy (Appendix 2); interactions: Appendix 1
Fire hazards. Heat enforcement should not be used during the use of a mixture of ether and oxygen. The operating room and its equipment should be designed to reduce the risk of static charges, especially in hot, dry climates.
Dosage:
Incitement, ADULT and CHILD, amounts to 15% of inhaled gases
Light, moderate, and child anesthesia lasts 3-5% in the air (with or without muscle relaxant); up to 10% in deep anesthesia.
Adverse effects: transient effects after surgery include impaired liver function and leukocyte proliferation; nausea and vomiting;

Halothan.. Incitement and maintenance of anesthesia. High pressure cerebrospinal fluid; Arrhythmia; slow heartbeat; shortness of breath; liver damage

Halothane
Pilot fluid
Uses: induction and maintenance of anesthesia
Contraindications: Date of unknown parenchyma infection or fever of previous exposure to halothane; family history of malignant hyperthermia; high pressure of cerebrospinal fluid;
Precautions: The previous anesthetic history should be taken to determine the previous exposure and previous halothane interactions (at least three months must pass between each re-exposure); avoid dental use in patients under 18 unless treated in hospital (high risk of systemic disorders); Pregnancy and Breastfeeding (Annexes 2 and 3); Interactions: Appendix 1
Dosage:
Induction, use a modified incinerator for this purpose, with a gradual increase in the concentration of inhalant gas up to 2-4% (adult) or 2.1.5% (child) in oxygen or N2O
Continuity, ADULT and CHILD% 2-0.5
Adverse effects: arrhythmia; slow heartbeat; shortness of breath; liver damage.

Anesthesia with inhaled gas.. Nitrous oxide. Management of myocardial infarction, myocardial infarction and acute acute asthma

Nitrous oxide, used to maintain anesthesia. It is so weak that it is not used alone, but it allows the dose of other anesthetics to be reduced. It has a strong analgesic effect.
Oxygen should be routinely added during anesthesia using inhalers, even if the air is used as carrier gas, to prevent hypoxemia
Oxygen is also used in the management of angina, myocardial infarction, acute acute asthma.
Identification of inhaled gas cylinders. International Standard ISO 32), Gas cylinders for medical use 1977) It is required to write on the cylinders containing N2O the name of the contents in clear and indelible letters, preferably also the chemical code N2O. The cylinder neck from the LED to the shoulder must be blue. Cylinders containing oxygen for medical use should bear the name of the contents in clear and indelible letters and preferably the chemical code O2. The cylinder neck must be from white to white. Cylinders containing a mixture of nitrous oxide and oxygen must have a label in the same shape and carry the neck white and blue.

Nitrous oxide.. Obstetrics for obstetric purposes, for the management of the treatment of injuries during physical therapy after surgery and for continuous pain

Nitrous oxide
Gas inhalation
Uses: maintenance of anesthesia in combination with other anesthetics (halothin, ether or ketamine) and muscle relaxants; obstruction for obstetric purposes, for management of injuries, post-operative physiotherapy and continuous pain in the final stage of the disease.
Contraindications: clear air pooling in the pleural, pericardial or peritoneal cavity; intestinal obstruction; middle ear obstruction; arterial air embolism; pressure relief disease; chronic obstructive pulmonary disease;
Precautions: Reduce employee exposure;
Dosage:
Anesthesiology, ADULT and CHILD Nitrous oxide mixed with 25-30% oxygen.
Inoculation, 50% nitrous oxide mixed with 50% oxygen.
Adverse effects: nausea and vomiting, macromolecular anemia after prolonged administration, reduced white cell formation;

Oxygen.. Maintain adequate oxygen pressure in anesthetic anesthesia. Avoid ironing when using oxygen with ether

Oxygen
Gas inhalation
Uses: To maintain sufficient oxygen pressure in anesthetic anesthesia.
Fire hazards. Avoid use of ironing When using oxygen with ether, the reduction valves should not be lubricated in oxygen cylinders (explosion risk).
Dosage:
The concentration of oxygen in anesthetic gases should not be less than 21% in any case
Adverse effects: concentrations higher than 80% have a toxic effect on the lungs and lead to pulmonary congestion, perfusion and congestion.

Spinal anesthesia.. Lidocaine. Glucose or bupifacaine. glucose. Abdominal surgery and lower limbs

Spinal anesthesia is one of the most useful anesthetic techniques and can be used extensively in abdominal surgery and lower extremities.
It is a major procedure that requires considerable experience and training.
Lidocaine 5% can be used in glucose or bupivacaine 0.5% in glucose, but the second most likely is due to the length of its effect.

Surface Anesthesia and Blockage.. Topical eye drops of tetracaine are used for local anesthesia of cornea and conjunctiva

Surface Anesthesia:
Topical preparations of lidocaine are available and topical eye drops of tetracaine are used for local anesthesia of the cornea and conjunctiva.
Blockage:
Nerve blockage can provide safe and effective anesthesia, but doing so requires great training and exercise.
However, when skills are available, techniques such as armpit or ankle blockade are of great value.
Both lidocaine 1% or bupivacaine 0.5% are appropriate.
Bobipacaine has the advantage that its effectiveness is longer.

Local anesthesia.. Addition of epinephrine (adrenalin) reduces local blood flow, slows the uptake of local anesthesia and prolongs its effect

Many simple surgical procedures can be performed that do not interfere with the body's cavities and do not require muscle relaxation through local anesthesia. A caesarean section may also be performed under local anesthesia.
The local anesthetic drug chosen is lidocaine 0.5% with or without epinephrine.
Do not give more than 4 mg / kg body weight of pure lidocaine or 7 mg / kg body weight of lidocaine with epinephrine at a time.
The addition of epinephrine (adrenalin) reduces local blood flow, slows absorption of the local anesthetic drug and lengthens its effect.
It is necessary to be careful when using epinephrine for this reason, because the increase may result in ischemic necrosis. It should not be added to used injections for fingers or appendages.

Local anesthetics.. dentist. Short and surface interventions. Generation procedures. Specialized techniques for local anesthesia

Drugs used in metastatic anesthesia (also called local or peripheral anesthesia) are used by creating a reversible blockade to connect through nerve fibers.
Local anesthetics are widely used in dentistry, for short and superficial interventions, for obstetric procedures, and for specialized techniques for local anesthesia requiring high skills.
When patient cooperation is required, the patient must be prepared psychologically to accept the proposed procedure.
Recovery equipment and equipment must be readily available at all times.
Local anesthetic injections should be given slowly to detect unintentional intravenous injection.

Bupifacaine hydrochloride.. Peripheral anesthesia; spinal anesthesia; spinal anesthesia; postoperative pain relief

Bupivacaine hydrochloride:
Bupifacaine is a representative of topical anesthetics. There are many medications that can act as alternatives.
Injection (solution for injection), bopifacaine hydrochloride 2.5 mg / ml (0.25%), ampoule 10 ml; 5 mg / ml (0.5%); ampoule 10 ml; 5 mg / ml (0.5%); With glucose 75 mg / ml (7.5%), ampoule 4 ml.
Uses: aerodynamic anesthesia; peripheral anesthesia of the peripheral and vertical nerve; spinal anesthesia; postoperative pain relief.
Contraindications: adjoining skin infection, inflamed skin; coagulant anticoagulant treatment; severe anemia or heart disease; spinal and epidural anesthesia in a patient suffering from dehydration or hypotension.
Precautions: dysfunction of the respiratory function; hepatic dysfunction (Appendix 5); epilepsy; porphyria; muscular dystrophy;
Dosage:
Local filtration, using 0.25% solution, ADULT up to 150 mg (60 ml).
Peripheral nerve blockage, using 0.5% solution, ADULT up to 150 mg (30 ml).
Annual anesthesia, using 0.5% solution, is 9-18 mg (1.8-3.6 ml).
Lumbar dorsal occlusion in surgery, using 0.5% solution, ADULT 50-100 mg (10-20 ml).
Lumbar obstruction in labor, using 0.25-0.5% solution, adult (female) up to 60 mg (maximum 12 ml).
Myocardial occlusion in surgery, using 0.25-0.5% solution, adult up to 150 mg (maximum 30 ml).
Cerebral occlusion in labor, using 0.25-0.5% solution, adult (female) up to 100 mg (maximum 20 ml).
Note: The maximum cumulative safe dose for adults and children of 0.25% pipipacaine solution is 1.5 mg / kg.
Use lower doses for patients with wasting, elderly, epilepsy or severe illness.
Do not use solutions containing preservatives for spinal, epidural, angular or intravenous anesthesia.
Adverse effects: when overdosed or following a vascular injection, dizziness, dizziness, dyspepsia, anxiety, tremors and occasional convulsions are followed by drowsiness, loss of consciousness and decreased breathing; cardiovascular poisoning includes low blood pressure, heart blockage and cardiac arrest; Hypersensitivity and allergic reactions; in some cases of epidural anesthesia complications occur in urine retention, fecal incontinence, headache, back pain or loss of sense of the perineum;

Lidocaine hydrochloride.. Surface anesthesia of mucous membranes. Anesthesia. Peripheral neuropathy. Dental Anesthesia. Spinal anesthesia. Local anesthesia in the vein

Lidocaine hydrochloride:
Lidocaine is a representative of local anesthesia. There are many medications that can act as alternatives.
Injection (solution for injection), lidocaine hydrochloride 5 mg / ml (0.5%), ampoule 20 ml; 10 mg / ml (1%); ampoule 20 ml; 50 mg / ml (5% , Ampoule 2 ml mixed with glucose 75 mg / ml (7.5%).
Injection (solution for injection) with epinephrine, lidocaine hydrochloride 10 mg / ml (1%) with epinephrine 5 μg per ml (1 in 200000), 20 ml ampoule.
Injection (solution for injection) with epinephrine (for dental use), lidocaine hydrochloride 20 mg / ml (2%) with epinephrine 12.5 μg per ml (1 in 80,000), 2.2 ml dental cartridge.
Gelma or topical solution, lidocaine hydrochloride 20-40 mg / ml (2-4%).
Uses: surface anesthesia of the mucous membranes; aerodynamic anesthesia; peripheral neurodegenerative obstruction; dental anesthesia; spinal anesthesia; intravenous intravenous anesthesia;
Contraindications: adjoining skin infection, inflamed skin; anticoagulant therapy, severe anemia or heart disease; spinal or epidural anesthesia in the patient or impaired blood volume.
Avoid (or use very carefully) solutions containing epinephrine (adrenaline) for ring or limb blockade (risk of ischemic necrosis); pregnancy; breast feeding.
Dosage:
Simple solutions
Local anesthesia and peripheral nerve blockage, using 0.5% solution, ADULT up to 250 mg (up to 50 ml).
Local anesthesia and peripheral nerve blockage, using 1% solution, ADULT up to 250 mg (up to 25 ml).
Surface, pharyngeal and tracheal anesthesia, using 4% solution, adult 40-200 mg (1-5 ml).
Surface anesthesia of the urethra, using 4% solution, for adult 400 mg (10 ml).
Cerebral anesthesia, using 5% solution (with 7.5% glucose), ADULT 50-75 mg (1-5.1 ml).
Solutions containing epinephrine.
Local anesthesia and peripheral nerve blockage, using 0.5% solution with epinephrine, ADULT up to 400 mg (up to 80 ml).
Local anesthesia and peripheral nerve blockage, using 1% solution with epinephrine, ADULT up to 400 mg (up to 4 ml).
Sunni anesthesia, using 2% solution with epinephrine, ADULT 20-100 mg (1-5 ml).
Note: The maximum safe dose of lidocaine for adults and children is 0.5% or 1% lidocaine, 4 mg / kg; 0.5% or 1% lidocaine + epinephrine 5 μg / ml (1 in 200000), 7 mg / kg.
Use the lowest doses in patients with wasting, the elderly, epilepsy or severe illness.
Do not use solutions containing preservatives for spinal, epidural or sacral anesthesia, or intravenous.
Adverse effects: When overdosing or following a vascular injection, dizziness, dizziness, dyspepsia, anxiety, tremors and sometimes convulsions are followed by drowsiness, loss of consciousness and decreased breathing; cardiovascular poisoning includes low blood pressure, heart blockage and cardiac arrest; Allergies and allergic reactions; sometimes complications occur when using epidural anesthesia involving urinary retention, fecal incontinence, headache, back pain or loss of the perineum sensation; very rarely deformity and paralysis occur.

Epidrin hydrochloride.. Prevention of hypotension during childbirth under spinal anesthesia or epidural anesthesia

Ephedrine hydrochloride:
Epidermine hydrochloride is a complementary medicine.
Injection (solution for injection), ephedrine hydrochloride 30 mg / ml, ampoule 1 ml.
Uses: Prevention of hypotension during childbirth under spinal anesthesia or epidural anesthesia.
Hyperthyroidism; diabetes; ischemic heart disease; hypertension; glaucoma occlusion; renal impairment (Appendix 4); pregnancy and breast feeding.
Dosage:
To prevent hypotension during childbirth under spinal anesthesia, by intravenous injection of a solution containing 3 mg / ml, ADULT (female) 3-6 mg (maximum dose 9 mg), repeat as necessary every 3-4 Minutes; maximum cumulative dose 30 mg.
Adverse effects: loss of appetite, increased salivation, nausea, vomiting; rapid heartbeat (in the fetus as well), arrhythmias, angina, angiogenesis with hypertension, vasodilation with hypotension; Anxiety, irritability, confusion, tremor; difficulty urinating; sweating, large; change in blood glucose concentration.
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