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Letter to the Director
Neuromuscular blockade in the management of the difficult airway
Bloqueantes neuromusculares en el manejo de la vía aérea difícil
Á. Pérez Fernández-Escandón
Corresponding author
alviescandon@gmail.com

Corresponding author.
, A.I. Fernández Díez, R. Pérez Blanco, N. Guadalupe Fernández
Departamento de Anestesiología, Reanimación y tratamiento del dolor, Complejo Asistencial Universitario de León, León, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">According to the recommendations of the SEDAR expert committee&#44; neuromuscular blocking agents &#40;NBA&#41; should only be used in potentially difficult intubation when the feasibility of face mask ventilation has been confirmed&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The 4th National Audit Project &#40;NAP4&#41;&#44; meanwhile&#44; reminds us that when face or laryngeal mask ventilation is complicated&#44; the early administration of other anaesthetic agents or NBAs to prevent or treat laryngospasm should be considered&#44; and that anaesthesiologists should never permit airway obstruction and hypoxia requiring a surgical airway without first having administered an NBA&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study has been to evaluate the utility of NBAs in the management of the anticipated or unanticipated difficult airway &#40;DA&#41; during 2016 in a tertiary hospital&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">All patients receiving general anaesthesia and requiring airway manipulation during the period from January 1 to December 31&#44; 2016 were included&#46; Patients undergoing all type of surgeries&#44; except thoracic surgery&#44; were included&#46; Of these&#44; we selected patients diagnosed with DA&#46; In the ASA&#39;s 2013 Airway Algorithm and the Canadian Airway Society&#39;s 2013 guidelines on Difficult Airway with Recommendations for Management&#44; difficult airway is defined as the clinical situation in which a conventionally trained anaesthesiologist experiences difficulty with facemask ventilation of the upper airway&#44; difficulty with tracheal intubation&#44; or both&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4&#44;5</span></a> To this&#44; the Canadians add the difficulty of performing direct or indirect laryngoscopy&#44; or the use of supraglottic devices or surgical airway&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> In order to standardise data collection&#44; we defined DA as patients diagnosed with Han 3-4<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> or Cormack-Lehane 2e and 3a&#44; 3b and 4&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> Difficult mask ventilation &#40;Han 3&#41; was defined as the inability to deliver adequate ventilation due to poor adaptation or sealing&#44; leakage or excessive resistance&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical criteria for DA&#44; clinical signs of DA&#44; clinical tests of difficult intubation&#44; DA-related disease&#44; Han scale&#44; Cormack-Lehane classification&#44; use of inhalation induction or NBAs were noted in a data collection sheet&#46; Airway management was performed by trained anaesthesiologists&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We evaluated the extent to which the use of NBAs affected DA management&#46; Whenever NBAs were used&#44; they were administered before the use of the face mask&#46; The NBA was chosen on the basis of the patient&#39;s clinical status and the strategy chosen by the operating room anaesthesiologist&#46; Non-depolarizing NBAs were used&#44; both aminosteroid and benzylisoquinoline derivatives&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 12&#44;153 patients received general anaesthesia during the 12-month study period&#59; of these&#44; 110 presented DA&#44; which gives an incidence of DA of 0&#46;9&#37; in our setting&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Over 30&#37; of DAs were unanticipated &#40;39&#41;&#59; 71 DAs were anticipated&#44; 23 were already known&#44; and 48 were diagnosed by clinical tests in the preoperative workup&#46; Another 60 patients diagnosed with DA on the basis of clinical tests were later found to have normal airways &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In total&#44; 69&#37; of DAs were resolved at the first attempt&#44; 21&#37; at the second and 9&#37; at the third&#46; We encountered no major complications&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The most widely used rescue device for both anticipated and unanticipated DA was the Airtraq video laryngoscope&#46; There were 10 cases of intubation failure with the Airtraq&#44; which were resolved as follows&#58; in 4 cases using Airtraq plus frova introducer&#59; in 5 cases using a fibrobronchoscope&#59; and in 1 case using a supraglottic device&#46; We performed 19 awake intubations&#44; all using a fibreoptic bronchoscope&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">All patients with unanticipated DAs had received neuromuscular blockade&#59; there was only 1 case of difficult face mask ventilation &#40;Han 3&#41;&#46; Two cases of Han 3 were recorded among patients with anticipated DA that had received neuromuscular blockade&#46; The NBA was always administered without checking ventilation with a face mask&#46; Intubation was uneventful in all patients&#46; Only 1 patient in our series was diagnosed with Han 4&#46; This patient did not receive neuromuscular blockade and a supraglottic device was used&#46; This resulted in inadequate ventilation that required early termination of surgery&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">NBAs were used in the 60 patients diagnosed with DA using clinical tests and who later did not meet study criteria for DA&#46; Ventilation difficulties were not encountered in any of these patients&#44; and all were intubated with direct laryngoscopy at the first attempt&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In an editorial published in 2008&#44; Calder<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> proposed abolishing the rule of confirming the possibility of face mask ventilation before administering NBAs&#46; Since then&#44; numerous articles have been published for<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> and against<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> this proposal&#46; Ketherpal went as far as to classify anaesthesiologists into 2 groups according to their approach to these patients &#8211; checkers and non-checkers&#44; depending on whether facial mask ventilation is confirmed before administering an NBA&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In our experience&#44; NBAs can maintain or improve&#44; but never worsen&#44; ventilation&#46; The 3 Han 3 cases were resolved uneventfully with videolaryngoscope&#46; As far as the case of Han 4 is concerned&#44; we believe that the patient should have received muscle relaxants&#44; as recommended by the guidelines&#44; particularly in view of the fact that optimal laryngeal mask ventilation was not achieved and the surgery had to be concluded early&#46; Used discerningly&#44; NBAs can provide more solutions than problems&#46; This does not mean that NBAs should be used in all DAs&#59; however&#44; there may be a subgroup of patients with DA in which the use of NBAs can optimise airway management&#46; Identifying this subgroup of patients in which the benefit of NBAs outweights the risks may be a promising topic for future research&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Our findings are not specific enough to enable us to recommend one particular NBA over another&#44; as this was not the aim of our study&#46; We set out merely to evaluate the general use of NBAs as an aid to DA management&#46; Guidelines in the use of supraglottic airway devices include the use of NBAs to optimise the first attempt at laryngoscopy&#44; in addition to adequate preoxygenation and patient positioning&#46; The availability of drugs capable of rapidly reversing deep aminosteroidal blocking agents will probably result in more anaesthesiologists using steroidal non-depolarizing muscle relaxants in patients with anticipated DA&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Our study has shown that the approach to DA in clinical anaesthesiology is changing and calls for a review of existing protocols&#46;</p></span>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:12 [
            0 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Empleo cl&#237;nico de bloqueantes neuromusculares y su reversi&#243;n&#46; Recomendaciones del grupo de expertos de la Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Tratamiento del Dolor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; &#193;lvarez G&#243;mez"
                            1 => "J&#46;J&#46; Ari&#241;o Irujo"
                            2 => "C&#46;L&#46; Errando Oyonarte"
                            3 => "F&#46; Mart&#237;nez Torrente"
                            4 => "J&#46; Roig&#233; i Sol&#233;"
                            5 => "F&#46; Gilsanz Rodr&#237;guez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Anestesiol Reanim"
                        "fecha" => "2009"
                        "volumen" => "56"
                        "paginaInicial" => "34"
                        "paginaFinal" => "45"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fourth National Audit Project&#46; Major complications of airway management in the UK&#58; results of the Forth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;M&#46; Cook"
                            1 => "N&#46; Woodall"
                            2 => "C&#46; Frerk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aer058"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2011"
                        "volumen" => "106"
                        "paginaInicial" => "617"
                        "paginaFinal" => "642"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21447488"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Facemask ventilation before or after neuromuscular blocking drugs&#58; where are we now&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/anae.12792"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "2014"
                        "volumen" => "69"
                        "paginaInicial" => "811"
                        "paginaFinal" => "815"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24975378"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice guidelines for management of the difficult airway&#58; an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Apfelbaum"
                            1 => "C&#46;A&#46; Hagberg"
                            2 => "R&#46;A&#46; Caplan"
                            3 => "C&#46;D&#46; Blitt"
                            4 => "R&#46;T&#46; Connis"
                            5 => "D&#46;G&#46; Nickinovich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e31827773b2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2013"
                        "volumen" => "118"
                        "paginaInicial" => "251"
                        "paginaFinal" => "270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23364566"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice guidelines for management of difficult airway&#58; an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "American Society of Anesthesiologists Task Force on Management of the Difficult Airway"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2003"
                        "volumen" => "98"
                        "paginaInicial" => "1269"
                        "paginaFinal" => "1277"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12717151"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The difficult airway with recommendations for management &#8211; Part 1 &#8211; Difficult tracheal intubation encountered in an unconscious&#47;induced patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Law"
                            1 => "N&#46; Broemling"
                            2 => "R&#46;M&#46; Cooper"
                            3 => "P&#46; Drolet"
                            4 => "L&#46;V&#46; Duggan"
                            5 => "D&#46;E&#46; Griesdale"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12630-013-0019-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Anaesth"
                        "fecha" => "2013"
                        "volumen" => "60"
                        "paginaInicial" => "1089"
                        "paginaFinal" => "1118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24132407"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Grading scale for mask ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Han"
                            1 => "K&#46; Tremper"
                            2 => "S&#46; Kheterpal"
                            3 => "M&#46; O&#8217;Reilly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Anaesthesiology"
                        "fecha" => "2004"
                        "volumen" => "101"
                        "paginaInicial" => "267"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Difficult tracheal intubation in obstetrics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;S&#46; Cormack"
                            1 => "J&#46; Lehane"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "1984"
                        "volumen" => "39"
                        "paginaInicial" => "1105"
                        "paginaFinal" => "1111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6507827"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Could &#8220;safe practice&#8221; be compromising safe practice&#63; Should anaesthetists have to demonstrate that the face mask ventilation is possible before giving a neuromuscular blocker&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "I&#46; Calder"
                            1 => "S&#46;M&#46; Yentis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2044.2007.05429.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "2008"
                        "volumen" => "63"
                        "paginaInicial" => "113"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18211439"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of changes of tidal volume during mask ventilation following administration of neuromuscular blocking drugs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Sachdeva"
                            1 => "T&#46;R&#46; Kannan"
                            2 => "C&#46; Mendonca"
                            3 => "M&#46; Patteril"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/anae.12677"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "2014"
                        "volumen" => "69"
                        "paginaInicial" => "826"
                        "paginaFinal" => "832"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24807288"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is it unnecessary to confirm successful facemask ventilation before administration of neuromuscular blocking agent&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Xue"
                            1 => "X&#46; Liao"
                            2 => "Q&#46; Wang"
                            3 => "Y&#46;J&#46; Yuan"
                            4 => "J&#46; Xiong"
                            5 => "J&#46;H&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2044.2011.06774_1.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "2011"
                        "volumen" => "66"
                        "paginaInicial" => "519"
                        "paginaFinal" => "531"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21568986"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Difficult mask ventilation&#58; does it matter&#63;"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;K&#46; Ramachandan"
                            1 => "S&#46; Ketherpal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2044.2011.06933.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "2011"
                        "volumen" => "66"
                        "paginaInicial" => "40"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22074078"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos