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“ Albumin was decreased by 46% with intratracheal ropivacaine (38% with intravenous ropivacaine; P < 0.05), and inflammatory mediators were decreased by 48–59% (69–81% with intravenous ropivacaine; P < 0.01).”
“Furthermore, the patient had severe hypoalbuminemia albumin 24 g/L), which resulted in the increase of the unbound ropivacaine plasma concentration that was responsible for the toxic side effects.”