Original article
Neurosurgical position causes peripheral nerve injuries?
¿La posición neuroquirúrgica ocasiona lesión de nervio periférico?
Pedro Esquivel-Enríqueza, Iván Pérez-Nerib, Luisa Manrique-Carmonac,
Corresponding author
luisapmanrique@hotmail.com
Corresponding author at: Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, La Fama, Delegación Tlalpan, CP 14269, Ciudad de México, Mexico. Tel.: +52 56063822 ext. 1050; mobile: +52 5543658171.
Corresponding author at: Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, La Fama, Delegación Tlalpan, CP 14269, Ciudad de México, Mexico. Tel.: +52 56063822 ext. 1050; mobile: +52 5543658171.
a Departamento de Anestesiología, Hospital Ángeles Metropolitano, Ciudad de México, Mexico
b Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
c Departamento de Neuroanestesiología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
Read
2683
Timeswas read the article
746
Total PDF
1937
Total HTML
Share statistics
array:25 [ "pii" => "S2444050718300111" "issn" => "24440507" "doi" => "10.1016/j.circen.2018.01.010" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "296" "copyright" => "Academia Mexicana de Cirugía A.C." "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Cir Cir. 2017;85:493-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 773 "formatos" => array:3 [ "EPUB" => 63 "HTML" => 495 "PDF" => 215 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0009741116301190" "issn" => "00097411" "doi" => "10.1016/j.circir.2016.11.001" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "296" "copyright" => "Academia Mexicana de Cirugía A.C." "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Cir Cir. 2017;85:493-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1408 "formatos" => array:3 [ "EPUB" => 69 "HTML" => 969 "PDF" => 370 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ARTÍCULO ORIGINAL</span>" "titulo" => "¿La posición neuroquirúrgica ocasiona lesión de nervio periférico?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "493" "paginaFinal" => "498" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Neurosurgical position causes peripheral nerve injuries?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2118 "Ancho" => 1532 "Tamanyo" => 60264 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Lesión de nervio periférico y peso (p < 0.05).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Esquivel-Enríquez, Iván Pérez-Neri, Luisa Manrique-Carmona" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Esquivel-Enríquez" ] 1 => array:2 [ "nombre" => "Iván" "apellidos" => "Pérez-Neri" ] 2 => array:2 [ "nombre" => "Luisa" "apellidos" => "Manrique-Carmona" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2444050718300111" "doi" => "10.1016/j.circen.2018.01.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444050718300111?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009741116301190?idApp=UINPBA00004N" "url" => "/00097411/0000008500000006/v1_201712170625/S0009741116301190/v1_201712170625/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2444050718300160" "issn" => "24440507" "doi" => "10.1016/j.circen.2018.01.012" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "311" "copyright" => "Academia Mexicana de Cirugía A.C." "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Cir Cir. 2017;85:499-503" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1294 "formatos" => array:3 [ "EPUB" => 80 "HTML" => 960 "PDF" => 254 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Characteristics and risk factors for recurrence of cutaneous squamous cell carcinoma with conventional surgery and surgery with delayed intraoperative margin assessment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "499" "paginaFinal" => "503" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características del carcinoma epidermoide cutáneo y riesgo para el desarrollo de recidivas con cirugía convencional y cirugía con transoperatorio tardío" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1188 "Ancho" => 1583 "Tamanyo" => 317871 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Invasive squamous cell carcinoma at the base of the neck.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Judith Domínguez-Cherit, Georgina Rodríguez-Gutiérrez, Verónica Narváez Rosales, Sonia Toussaint Caire, Verónica Fonte Avalos" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Judith" "apellidos" => "Domínguez-Cherit" ] 1 => array:2 [ "nombre" => "Georgina" "apellidos" => "Rodríguez-Gutiérrez" ] 2 => array:2 [ "nombre" => "Verónica" "apellidos" => "Narváez Rosales" ] 3 => array:2 [ "nombre" => "Sonia" "apellidos" => "Toussaint Caire" ] 4 => array:2 [ "nombre" => "Verónica" "apellidos" => "Fonte Avalos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009741116301347" "doi" => "10.1016/j.circir.2016.11.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009741116301347?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444050718300160?idApp=UINPBA00004N" "url" => "/24440507/0000008500000006/v1_201802220438/S2444050718300160/v1_201802220438/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2444050718300123" "issn" => "24440507" "doi" => "10.1016/j.circen.2016.10.010" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "297" "copyright" => "Academia Mexicana de Cirugía A.C." "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Cir Cir. 2017;85:485-92" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 780 "formatos" => array:3 [ "EPUB" => 66 "HTML" => 477 "PDF" => 237 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Incidence of hip and knee prosthetic infections in a specialised centre of Mexico City" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "485" "paginaFinal" => "492" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incidencia de infecciones protésicas primarias de cadera y rodilla en un centro de la Ciudad de México" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael Franco-Cendejas, Erika Lizbeth Contreras-Córdova, Jaime Arturo Mondragón-Eguiluz, Edgar Samuel Vanegas-Rodríguez, Víctor Manuel Ilizaliturri-Sánchez, Arturo Galindo-Fraga" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Rafael" "apellidos" => "Franco-Cendejas" ] 1 => array:2 [ "nombre" => "Erika Lizbeth" "apellidos" => "Contreras-Córdova" ] 2 => array:2 [ "nombre" => "Jaime Arturo" "apellidos" => "Mondragón-Eguiluz" ] 3 => array:2 [ "nombre" => "Edgar Samuel" "apellidos" => "Vanegas-Rodríguez" ] 4 => array:2 [ "nombre" => "Víctor Manuel" "apellidos" => "Ilizaliturri-Sánchez" ] 5 => array:2 [ "nombre" => "Arturo" "apellidos" => "Galindo-Fraga" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009741116301207" "doi" => "10.1016/j.circir.2016.10.032" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009741116301207?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444050718300123?idApp=UINPBA00004N" "url" => "/24440507/0000008500000006/v1_201802220438/S2444050718300123/v1_201802220438/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Neurosurgical position causes peripheral nerve injuries?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "493" "paginaFinal" => "498" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pedro Esquivel-Enríquez, Iván Pérez-Neri, Luisa Manrique-Carmona" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Pedro" "apellidos" => "Esquivel-Enríquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Iván" "apellidos" => "Pérez-Neri" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Luisa" "apellidos" => "Manrique-Carmona" "email" => array:1 [ 0 => "luisapmanrique@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Anestesiología, Hospital Ángeles Metropolitano, Ciudad de México, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Neuroanestesiología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, La Fama, Delegación Tlalpan, CP 14269, Ciudad de México, Mexico. Tel.: +52 56063822 ext. 1050; mobile: +52 5543658171." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿La posición neuroquirúrgica ocasiona lesión de nervio periférico?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1382 "Ancho" => 1455 "Tamanyo" => 47802 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Frequency of presentation of peripheral nerve injury (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Positioning patients on the operating table is a major challenge to neuroanaesthetists in their daily practice. The location of intracranial lesions requires various approaches to enable appropriate exposure, preserving the surrounding structures to the utmost; this means that the body and limbs are required to adopt forced postures (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A detailed preoperative assessment, together with the neurosurgeon, of the physiological dynamics and the impact that positioning can have on each patient is important and thus, the best individualised strategy for positioning can be achieved.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite manoeuvres designed to prevent complications, injury to the peripheral nerve is latent in each case; in fact, in reports by the Closed Claim Project, of the American Society of Anaesthesiologists (AS) setting out the most common injury complaints, 22% involve damage to the peripheral nerve.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> Even taking into account a great number of complications, peripheral nerve injury remains uncertain and can range from 0.03%<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> to 0.11%.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Peripheral nerve damage can occur at any time perioperatively: during venous or arterial puncture, when handling the anesthetised patient to position them appropriately or due to continuous compression in forced positions. The mechanism that causes the injury can be direct, due to elongation, ischaemia and/or prolonged compression; elongation injury can range from irregular ischaemia due to disruption of the intraneural vessels, to rupture of connective tissue causing haemorrhage and necrosis, and there can be oedema in the perineurium.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> Ischaemia secondary to tissue compression can be the result of poor perfusion due to arterial occlusion and interruption of nerve blood supply.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, patients with microvasculature disorders, such as those with arterial hypertension,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> diabetes mellitus<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> and smokers,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> are particularly vulnerable to the abovementioned mechanisms of injury.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Little is known about the frequency and risk factors of peripheral nerve injury in our environment, especially in neurosurgical patients. The objective of this study was to correlate the incidence of peripheral nerve injury with the diverse positions of the neurosurgical patient.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A prospective, observational, longitudinal, analytical study performed in the neuroanaesthetics department of the <span class="elsevierStyleItalic">Instituto Nacional de Neurología y Neurocirugía</span>, approved by the institution's scientific and ethics committees.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Participants</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study included 163 patients, ranging in age from 18 to 65 years, from May to November 2010. All the patients had normal preoperative examinations, with no evidence of prior peripheral nerve damage, and ASA I-III physical status. Patients with a Glasgow Coma Scale score lower than 13, those who were discharged intubated or with any postoperative neurological sequelae were excluded.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protocol</span><p id="par0045" class="elsevierStylePara elsevierViewall">The participants were distributed into 4 study groups, according to the position programmed for the cranial lesion resection (planned according to the location of the lesion, the patient's morphology and comorbidities): supine, lateral, ventral and park bench (PB).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The type of anaesthesia was chosen at the discretion of each anaesthetist. The surgical position was checked by an experienced attending neuroanaesthetist, and 3 basic safety and quality elements were checked at the time of surgical positioning: (1) pressure area care; (2) protection of organs vulnerable to ischaemia (nose, eyes, genital organs), and (3) distal limb perfusion.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The diagnosis, surgery planned, patient's age, body mass index, chronic/degenerative diseases, smoking and alcoholism, and transoperative incidents were taken into account.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Postoperative evaluation</span><p id="par0060" class="elsevierStylePara elsevierViewall">A detailed neurological examination was performed of the limbs, movement, muscle strength, osteotendinous reflexes and sensitivity, on leaving the operating theatre and 24<span class="elsevierStyleHsp" style=""></span>h postoperatively.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">All the measurements are presented as means±SD. The nominal data were analysed using the <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span> test. The differences between the values were considered significant with a <span class="elsevierStyleItalic">p</span> value <.05. SPSS was used for all the statistical tests and graphs.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">This study included 163 patients, of whom 51 had an elimination criterion; 112 patients had the necessary data for the statistical analysis; the demographic data are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Two cases of peripheral nerve injury were found (1.78%); both patients had paraesthesia of the region innervated by the ulnar nerve with preserved movement, strength and reflexes, the symptom lasted for less than 24<span class="elsevierStyleHsp" style=""></span>h, and remitted completely. The two cases of postoperative paraesthesia belonged to the PB position group, in the thoracic limb that was underneath the surgical table <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The mean weight of patients who had no peripheral nerve damage was 72.3<span class="elsevierStyleHsp" style=""></span>kg, and 89<span class="elsevierStyleHsp" style=""></span>kg (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05) of those who did. Body mass index was not significant in the analysis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Thirty-three percent of the patients were smokers, 2 patients with peripheral nerve injury were smokers, no statistical significance presented in the analysis, although a tendency was observed (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.065).</p><p id="par0090" class="elsevierStylePara elsevierViewall">Among the transoperative incidents, 4 cases of hypotension were reported, of which one was peripheral nerve injury positive (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.06).</p><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the analysis of the presence of the variables and their relationship with the presence of peripheral nerve damage.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">In this study, undertaken exclusively with neurosurgical patients, we found that the frequency of peripheral nerve injury comprised 1.78% of cases (2 cases out of 112); within the range reported in the literature. The largest published case series on injuries secondary to anaesthetic positions is that by Welch et al.,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> who retrospectively studied 380,680 cases from a database of patients who received anaesthesia over a period of 10 years; 480 patients had characteristics for a potential perioperative peripheral nerve injury, of these 359 were removed because they did not meet the perioperative definition of peripheral nerve injury, the 112 remaining patients fulfilled the inclusion criteria, comprising .029% of cases; in the analysis by subgroup, 8.9% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13,346) of the neurosurgical patients had peripheral nerve injury.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Menezes et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> published a study in 2013 that included 172 patients from all surgical specialties; a frequency of peripheral nerve damage of 4.7% was reported.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In 1987, Alvine and Schurrer<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> presented a series of 6538 postoperative cases (none neurosurgical), and found an incidence of .26% (17 patients) ulnar nerve injury. They performed a follow up at 6 months, and found that 5 patients still had discomfort and reduced nerve conduction velocity.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Another of our findings related to position and presence of injury; the 2 patients had been placed in the PB position. This type of surgical position is frequent in the posterior fossa approach; the patient is placed in a lateral position with flexed neck and head rotated towards the floor, the contralateral arm is flexed and hangs free from the head of the operating table, and the other arm is aligned to the patent's trunk.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In this type of position, the ulnar nerve can be damaged with increased pressure to the ulnar channel at the level of the elbow secondary to excessive flexion of the elbow (>90°)<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a>; this description coincides with the clinical findings reported in the 2 positive cases in our study.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Obesity is one of the risk factors associated with damage to the peripheral nerve and the ulnar nerve in particular, although in the past this condition was associated with thin patients due to the lack of protective subcutaneous fatty tissue.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> The 2 patients from our study who were affected weighed more than 89<span class="elsevierStyleHsp" style=""></span>kg, with a body mass index >30, as reported by Baumann et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a>; overweight patients are vulnerable to compression against the surgical table and the retractor bars, showing reduced amplitude of somatosensory evoked potentials (SSEP). The series by Menezes et al. found that a body mass index greater than 30 is significantly associated with peripheral nerve injury.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Smoking was another risk factor associated with peripheral nerve injury<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a>; we found no association in our results. Similarly, the affected patients had no other associated substance abuse.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Diabetes mellitus has been reported as a predisposing factor for the condition<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a>; however, we found no correlation with the cases that were positive in our study.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Ischaemia has been proposed by several authors as a pathophysiological mechanism of the injury. In this regard, transoperative incidents were recorded in our study, such as episodes of hypotension,<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> which were not statistically significant.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Chronic arterial hypertension is another proposed risk factor that predisposes the blood vessels to ischaemia as it progresses. Neither of the 2 patients affected were reported as hypertensive.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Nowadays, intraoperative monitoring technology has achieved a reduction in complications across the board; in this case specifically, SSEP have been shown to be useful for the early detection of peripheral nerve injury.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> In a published study by Ying et al.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> 485 patients were analysed retrospectively who had undergone microvascular decompression (hemifacial spasm and trigeminal neuralgia) in the PB position; the ulnar and median nerves of these patients were routinely monitored bilaterally by SSEP; only 14 (2.9%) patients had intraoperative changes with a reduction in amplitude of 50%; this change is considered a potential risk for postoperative nerve injury. In these cases, the position of the patient was checked and it was found that excessive traction of the shoulder, hyperextension of the neck and compression of the elbow were the probable causes of this reduction; the patients did not undergo postoperative follow up, therefore we cannot specify the clinical outcome; even when these tools enable us to establish these changes objectively and immediately, apparently the sensitivity of monitoring is low.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Peripheral nerve injury can be difficult to detect and can even go unnoticed by the medical team, especially in a neurosurgical scenario, since patients can considerer the symptoms normal after the event and not report them as important. Likewise, physical neurological examination is limited if an efficient neurological examination is not performed before the patient goes for surgery.</p><p id="par0160" class="elsevierStylePara elsevierViewall">One of the limitations of this study is that there was no objective evaluation such as transoperative or postoperative monitoring of evoked potentials, such as electromyography or conduction velocities. Similarly, the number of patients was low for detecting complications and made comparison between groups difficult.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusion</span><p id="par0165" class="elsevierStylePara elsevierViewall">Although the frequency of peripheral nerve injury is low and the condition is transitory, it is important to understand the mechanisms that lead to it to prevent its postoperative onset. Although positioning is team work (anaesthetist, surgeon, nurse), it is down to the anaesthetist as a leader in the operating theatre to ensure the optimal placement of the patient on the operating table.</p><p id="par0170" class="elsevierStylePara elsevierViewall">In our centre, at least 4 patients are operated per week in the PB position; broad experience has enabled the development of techniques and solutions to ensure minimal complications for patients. Even so, positioning remains a challenge for neurosurgeons and neuroanaesthetists.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical disclosures</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of human and animal subjects</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidentiality of data</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0190" class="elsevierStylePara elsevierViewall">This paper received no source of funding.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres987017" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec954570" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres987018" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec954571" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Protocol" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Postoperative evaluation" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 9 => array:3 [ "identificador" => "sec0050" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interest" ] 12 => array:2 [ "identificador" => "xack334571" "titulo" => "Acknowledgments" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-05-26" "fechaAceptado" => "2016-11-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec954570" "palabras" => array:3 [ 0 => "Neurosurgical procedures" 1 => "Peripheral nerve injuries" 2 => "Peripheral neuropathies" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec954571" "palabras" => array:3 [ 0 => "Procedimientos neuroquirúrgicos" 1 => "Lesión nervio periférico" 2 => "Neuropatía periférica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Positioning during neurosurgical procedures is a challenge for surgical teams even if precautions are taken, the mechanisms underlying peripheral nerve injury (elongation, compression or ischaemia) are latent and it is important to know the frequency of occurrence in our environment.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To analyse the frequency of peripheral nerve injury secondary to surgical positioning.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Prospective study including 163 patients scheduled for neurosurgical procedures. Four groups: supine, lateral, ventral and park bench were analysed by neurological exploration in order to detect injury and relate with risk factors already described.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In this study 112 patients were included, two patients who were under park bench position experienced paresthesias in ulnar region of less than 24 hours’ duration; statistically significant correlation with body weight greater than 85<span class="elsevierStyleHsp" style=""></span>kg.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The incidence of peripheral nerve injury is low, understanding the mechanisms that may originate it helps towards prevention and early detection of complications.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El posicionamiento durante el procedimiento neuroquirúrgico es un desafío para el equipo quirúrgico, aun cuando se tomen precauciones los mecanismos causantes de lesión de nervio periférico por elongación, isquemia o compresión es latente y es importante conocer la frecuencia de presentación en nuestro medio.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizar la frecuencia de lesión nerviosa periférica secundaria al posicionamiento quirúrgico.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se estudió prospectivamente a 163 pacientes (18 a 65 años) llevados a procedimientos neuroquirúrgicos. Grupos de acuerdo con posición quirúrgica programada: decúbito dorsal, decúbito lateral, decúbito ventral y park bench (PB). Se hizo una exploración neurológica detallada al ingreso, al egreso y a las 24<span class="elsevierStyleHsp" style=""></span>h postoperatorias con el fin de detectar clínica de lesión y relación con factores de riesgo descritos en otras series.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se obtuvieron datos completos en 112 pacientes, 2 pacientes posicionados en PB presentaron parestesias en la región cubital con duración menor a 24<span class="elsevierStyleHsp" style=""></span>h; correlación estadísticamente significativa con peso corporal mayor de 85<span class="elsevierStyleHsp" style=""></span>kg.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La frecuencia de presentación de lesión de nervio periférico es baja, la comprensión de los mecanismos que pueden originarlo ayudan a la prevención y detección temprana de complicaciones.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as: Esquivel-Enríquez P, Pérez-Neri I, Manrique-Carmona L. ¿La posición neuroquirúrgica ocasiona lesión de nervio periférico? Cir Cir. 2017;85:493–498.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1382 "Ancho" => 1455 "Tamanyo" => 47802 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Frequency of presentation of peripheral nerve injury (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2118 "Ancho" => 1532 "Tamanyo" => 59524 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Peripheral nerve injury (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anatomical region \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Common surgical approach \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Position \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Position of limbs \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Frontal region, transnasal approach \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anterior parasagittal craniotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Supine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anatomical position of shoulders, elbows and wrists, flexed knees \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Temporal lobe, lateral base of skull base, suboccipital area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subtemporal craniotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The shoulder touching the bed aligned to the body and the arm extended; free arm flexed, lower limbs flexed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateral portion of the cerebellum, parieto-occipital region, posterior fossa and pineal region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lateral suboccipital craniotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Park bench \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The body lateral with the free arm hanging between the table and the head of the table, with head rotated towards the floor, shoulder and upper arms extended. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Suboccipital region and spinal cord \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Suboccipital craniotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retracted shoulders, elbows and wrists in rotation, flexion or extension, extended or flexed knees. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1676370.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Common neurosurgical approaches.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Supine group<br>(<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>61) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lateral group<br>(<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>23) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ventral group<br>(<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PB group<br>(<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>, mean (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44.3±1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41.27±3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.08±4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46.8±3.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ASA classification (1/2/3)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/20/39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/12/11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/6/7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/4/11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (kg)<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>, mean (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.6±1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76.09±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68.5±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78.8±4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body mass index BMI (weight/height<span class="elsevierStyleSup">2</span>)<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>, mean (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.4±0.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.0±0.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.7±1.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.0±1.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes (yes/no) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7/54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension (yes/no) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19/42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6/17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alcoholism (yes/no) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10/51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Marihuana use (yes/no) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cocaine use (yes/no) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balanced General Anaesthetic/total intravenous anaesthesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46/15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18/5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15/0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1676368.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Years.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">American Society of Anaesthesiology classification.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Kilograms.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">(weight/height<span class="elsevierStyleSup">2</span>).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Demographic results.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Peripheral nerve injury</th><th class="td" title="table-head " align="left" valign="top" scope="col">Chi-squared test \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Risk estimation (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Present \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absent \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.881 (.82–.93) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.37 (80.66–.81) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alcohol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.37 (.2–5.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.24 (.18–.33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Marihuana \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cocaine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">128 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1676369.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Correlation of peripheral nerve damage with risk factors.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posición del paciente en neurocirugía. Estrategias y abordajes en neurocirugía craneal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Manrique-Carmona" 1 => "L. Rodríguez-Arias" 2 => "A. Aguirre-Espinosa" 3 => "G. Castillo-Velázquez" 4 => "V. García-Navarro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "edicion" => "1.ª ed." "fecha" => "2015" "paginaInicial" => "87" "paginaFinal" => "101" "editorial" => "AMOLCA, Actualidades Médicas, C.A" "editorialLocalizacion" => "México" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0105" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Closed claims’ analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Metzner" 1 => "K.L. Posner" 2 => "M.S. Lam" 3 => "K.B. Domino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bpa.2011.02.007" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Anaesthesiol" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "263" "paginaFinal" => "276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21550550" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0110" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perioperative peripheral nerve injuries: a retrospective study of 380,680 cases during a 10-year period at a single institution" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.B. Welch" 1 => "C.M. Brummett" 2 => "T.D. Welch" 3 => "K.K. Tremper" 4 => "A.M. Shanks" 5 => "P. Guglani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e3181af61cb" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2009" "volumen" => "111" "paginaInicial" => "490" "paginaFinal" => "497" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19672188" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0115" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perioperative peripheral nerve injuries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Lalkhen" 1 => "K. Bhatia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "CEACCP" "fecha" => "2012" "volumen" => "12" "paginaInicial" => "38" "paginaFinal" => "42" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0120" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[discussion]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraoperative positioning nerve injuries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.J. Winfree" 1 => "D.G. Kline" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.surneu.2004.03.024" "Revista" => array:6 [ "tituloSerie" => "Surg Neurol" "fecha" => "2005" "volumen" => "63" "paginaInicial" => "5" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15639509" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0125" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Positioning injuries in anesthesia: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Schubert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Adv Anesth" "fecha" => "2008" "volumen" => "26" "paginaInicial" => "31" "paginaFinal" => "65" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0130" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accumulation of microvascular target organ damage in newly diagnosed hypertensive patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Triantafyllou" 1 => "P. Anyfanti" 2 => "X. Zabulis" 3 => "E. Gavriilaki" 4 => "P. Karamaounas" 5 => "E. Gkaliagkousi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jash.2014.04.008" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Hypertens" "fecha" => "2014" "volumen" => "8" "paginaInicial" => "542" "paginaFinal" => "549" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24913569" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0135" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between hypertension comorbidity and microvascular complications in type 2 diabetes patients: a nationwide cross-sectional study in Thailand" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Hurst" 1 => "B. Thinkhamrop" 2 => "H.T. Tran" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4093/dmj.2015.39.5.395" "Revista" => array:6 [ "tituloSerie" => "Diabetes Metab J" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "395" "paginaFinal" => "404" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26566497" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0140" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vascular pathology from smoking: look at the microcirculation!" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Leone" 1 => "L. Landini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Vasc Pharmacol" "fecha" => "2013" "volumen" => "11" "paginaInicial" => "524" "paginaFinal" => "530" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22022776" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0145" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posición neuroquirúrgica y lesión de nervio periférico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Manrique-Carmona" 1 => "P. Esquivel-Enríquez" 2 => "M. González-Villavelázquez" 3 => "M. Osorio-Santiago" 4 => "A. Obregón-Corona" 5 => "I. Pérez-Neri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Neurocien" "fecha" => "2011" "volumen" => "16" "numero" => "SII" "paginaInicial" => "10" "paginaFinal" => "13" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0150" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Injuries resulting from positioning for surgery: incidence and risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Menezes" 1 => "R. Rodrigues" 2 => "R. Tranquada" 3 => "S. Müller" 4 => "K. Gama" 5 => "T. Manso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Med Port" "fecha" => "2013" "volumen" => "26" "paginaInicial" => "12" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23697352" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0155" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative ulnar-nerve palsy. Are there predisposing factors?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.G. Alvine" 1 => "M.E. Schurrer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Jt Surg Am" "fecha" => "1987" "volumen" => "69" "paginaInicial" => "255" "paginaFinal" => "259" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0160" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risks and benefits of patient positioning during neurosurgical care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Rozet" 1 => "M.S. Vavilala" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anclin.2007.05.009" "Revista" => array:6 [ "tituloSerie" => "Anesthesiol Clin" "fecha" => "2007" "volumen" => "25" "paginaInicial" => "631" "paginaFinal" => "653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17884711" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0165" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications associated with prone positioning in elective spinal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.M. DePasse" 1 => "M.A. Palumbo" 2 => "M. Haque" 3 => "C.P. Eberson" 4 => "A.H. Daniels" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5312/wjo.v6.i3.351" "Revista" => array:6 [ "tituloSerie" => "World J Orthop" "fecha" => "2015" "volumen" => "6" "paginaInicial" => "351" "paginaFinal" => "359" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25893178" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0170" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraoperative SSEP detection of ulnar nerve compression or ischemia in an obese patient: a unique complication associated with a specialized spinal retraction system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.B. Baumann" 1 => "W.C. Welch" 2 => "M.J. Bloom" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Phys Med Rehabil" "fecha" => "2000" "volumen" => "81" "paginaInicial" => "130" "paginaFinal" => "132" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10638889" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0175" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cigarette smoking and ulnar mononeuropathy at the elbow" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.K. Richardson" 1 => "S.C. Jamieson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Phys Med Rehabil" "fecha" => "2004" "volumen" => "83" "paginaInicial" => "730" "paginaFinal" => "734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15314539" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0180" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetic neuropathies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.I. Vinik" 1 => "T.S. Park" 2 => "K.B. Stansberry" 3 => "G.L. Pittenger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s001250051477" "Revista" => array:6 [ "tituloSerie" => "Diabetologia" "fecha" => "2000" "volumen" => "43" "paginaInicial" => "957" "paginaFinal" => "973" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10990072" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0185" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nerve injury associated with regional anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Borgeat" 1 => "G. Ekatodramis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Top Med Chem" "fecha" => "2001" "volumen" => "1" "paginaInicial" => "199" "paginaFinal" => "203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11895136" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0190" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical usefulness of somatosensory evoked potentials for detection of peripheral nerve and brachial plexus injury secondary to malpositioning in microvascular decompression" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Ying" 1 => "X. Wang" 2 => "H. Sun" 3 => "Y. Tang" 4 => "Y. Yuan" 5 => "S. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/WNP.0000000000000212" "Revista" => array:6 [ "tituloSerie" => "J Clin Neurophysiol" "fecha" => "2015" "volumen" => "32" "paginaInicial" => "512" "paginaFinal" => "515" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26629760" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack334571" "titulo" => "Acknowledgments" "texto" => "<p id="par0200" class="elsevierStylePara elsevierViewall">This paper was written as a subspecialty thesis in Neuroanaesthetics for P. Esquivel-Enríquez, endorsed by the National Autonomous University of Mexico. It is also a posthumous homage to Dr. Esquivel-Enríquez’ brilliant but unfortunately short career.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/24440507/0000008500000006/v1_201802220438/S2444050718300111/v1_201802220438/en/main.assets" "Apartado" => array:4 [ "identificador" => "44603" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24440507/0000008500000006/v1_201802220438/S2444050718300111/v1_201802220438/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444050718300111?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 1 | 13 |
| 2024 October | 18 | 8 | 26 |
| 2024 September | 65 | 9 | 74 |
| 2024 August | 35 | 4 | 39 |
| 2024 July | 18 | 5 | 23 |
| 2024 June | 21 | 4 | 25 |
| 2024 May | 23 | 3 | 26 |
| 2024 April | 40 | 11 | 51 |
| 2024 March | 60 | 10 | 70 |
| 2024 February | 42 | 4 | 46 |
| 2024 January | 22 | 10 | 32 |
| 2023 December | 36 | 7 | 43 |
| 2023 November | 46 | 9 | 55 |
| 2023 October | 50 | 8 | 58 |
| 2023 September | 26 | 4 | 30 |
| 2023 August | 14 | 6 | 20 |
| 2023 July | 11 | 6 | 17 |
| 2023 June | 12 | 6 | 18 |
| 2023 May | 29 | 11 | 40 |
| 2023 April | 8 | 3 | 11 |
| 2023 March | 26 | 1 | 27 |
| 2023 February | 18 | 3 | 21 |
| 2023 January | 24 | 7 | 31 |
| 2022 December | 23 | 19 | 42 |
| 2022 November | 21 | 14 | 35 |
| 2022 October | 16 | 16 | 32 |
| 2022 September | 21 | 11 | 32 |
| 2022 August | 30 | 7 | 37 |
| 2022 July | 14 | 9 | 23 |
| 2022 June | 21 | 15 | 36 |
| 2022 May | 30 | 12 | 42 |
| 2022 April | 31 | 12 | 43 |
| 2022 March | 21 | 8 | 29 |
| 2022 February | 30 | 5 | 35 |
| 2022 January | 47 | 14 | 61 |
| 2021 December | 35 | 15 | 50 |
| 2021 November | 18 | 10 | 28 |
| 2021 October | 28 | 14 | 42 |
| 2021 September | 14 | 14 | 28 |
| 2021 August | 24 | 11 | 35 |
| 2021 July | 11 | 10 | 21 |
| 2021 June | 13 | 10 | 23 |
| 2021 May | 32 | 7 | 39 |
| 2021 April | 43 | 29 | 72 |
| 2021 March | 25 | 14 | 39 |
| 2021 February | 15 | 5 | 20 |
| 2021 January | 17 | 16 | 33 |
| 2020 December | 17 | 14 | 31 |
| 2020 November | 11 | 7 | 18 |
| 2020 October | 20 | 8 | 28 |
| 2020 September | 13 | 12 | 25 |
| 2020 August | 15 | 12 | 27 |
| 2020 July | 24 | 12 | 36 |
| 2020 June | 19 | 13 | 32 |
| 2020 May | 23 | 9 | 32 |
| 2020 April | 22 | 4 | 26 |
| 2020 March | 34 | 3 | 37 |
| 2020 February | 19 | 5 | 24 |
| 2020 January | 19 | 7 | 26 |
| 2019 December | 19 | 12 | 31 |
| 2019 November | 15 | 9 | 24 |
| 2019 October | 18 | 5 | 23 |
| 2019 September | 20 | 12 | 32 |
| 2019 August | 12 | 0 | 12 |
| 2019 July | 18 | 6 | 24 |
| 2019 June | 44 | 11 | 55 |
| 2019 May | 94 | 38 | 132 |
| 2019 April | 28 | 15 | 43 |
| 2019 March | 11 | 6 | 17 |
| 2019 February | 14 | 5 | 19 |
| 2019 January | 12 | 5 | 17 |
| 2018 December | 4 | 3 | 7 |
| 2018 November | 8 | 2 | 10 |
| 2018 October | 10 | 8 | 18 |
| 2018 September | 12 | 7 | 19 |
| 2018 August | 14 | 11 | 25 |
| 2018 July | 17 | 5 | 22 |
| 2018 June | 22 | 15 | 37 |
| 2018 May | 16 | 17 | 33 |
| 2018 April | 23 | 4 | 27 |
| 2018 March | 30 | 5 | 35 |
| 2018 February | 4 | 2 | 6 |
Show all