Scientific and Technological Research
Predictive and clinical performance of a TCI device for sevoflurane at a conventional workstation: Pharmacokinetic correlation of the model used
Desempeño predictivo y clínico de un dispositivo TCI para sevofluorano en una estación de trabajo convencional: correlación farmacocinética del modelo empleado
César Augusto Candia Aranaa,
, Caridad Greta Castillo Monzóna, José Antonio Álvarez Gómeza, Joaquín Roca Gonzálezb, Javier Hernando Eslava Schmalbachc
Corresponding author
ccandia@hotmail.es
Corresponding author at: Calle Ronda Ciudad de la Unión n° 8, Esc 2, 2A, 30203 Cartagena, Murcia, Spain.
Corresponding author at: Calle Ronda Ciudad de la Unión n° 8, Esc 2, 2A, 30203 Cartagena, Murcia, Spain.
a Anesthesia and Reanimation Specialist, Service of Anesthesia and Reanimation, Cartagena University Hospital Campus, Cartagena, Murcia, Spain
b University Professor “Industrial and Medical Electronics Research Group” Universidad Politécnica de Cartagena, Cartagena, Spain
c University Professor, Health Equity Team, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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En la parte superior central ingresamos las características del paciente. En la porción inferior a la izquierda, la concentración objetivo de sevofluorano empleada con su corrección según la edad y en la parte central la gráfica, en azul, la velocidad de infusión y en rojo el volumen de sevofluorano líquido administrado.</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Fuente: Registro del TCI Sevofluorane<span class="elsevierStyleSup">©</span>; César Augusto Candia Arana y Joaquín Roca González, autores del TCI sevofluorane<span class="elsevierStyleSup">©</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "César Augusto Candia Arana, Caridad Greta Castillo Monzón, José Antonio Álvarez Gómez, Joaquín Roca González, Javier Hernando Eslava Schmalbach" "autores" => array:5 [ 0 => array:2 [ "nombre" => "César Augusto" "apellidos" => "Candia Arana" ] 1 => array:2 [ "nombre" => "Caridad Greta" "apellidos" => "Castillo Monzón" ] 2 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Álvarez Gómez" ] 3 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Roca González" ] 4 => array:2 [ "nombre" => "Javier Hernando" "apellidos" => "Eslava Schmalbach" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2256208714000522" "doi" => "10.1016/j.rcae.2014.05.004" "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/S2256208714000522?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334714000574?idApp=UINPBA00004N" "url" => "/01203347/0000004200000004/v1_201409200154/S0120334714000574/v1_201409200154/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2256208714000923" "issn" => "22562087" "doi" => "10.1016/j.rcae.2014.07.009" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "161" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Colomb Anestesiol. 2014;42:265-71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2052 "formatos" => array:3 [ "EPUB" => 99 "HTML" => 1462 "PDF" => 491 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific and Technological Research</span>" "titulo" => "Based on a survey relative to the practice of simultaneous anaesthesia in Latin-America" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "265" "paginaFinal" => "271" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "A Propósito de una encuesta sobre la práctica habitual de anestesia simultánea en Latinoamérica" ] ] "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" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1041 "Ancho" => 1136 "Tamanyo" => 193558 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CLASA promotional campaign against simultaneous anaesthesia. 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(G) Visual estimations of sponge with 5<span class="elsevierStyleHsp" style=""></span>cc of blood and 5<span class="elsevierStyleHsp" style=""></span>cc of saline solution. (H) Visual estimations of sponge with 25<span class="elsevierStyleHsp" style=""></span>cc of blood and 75<span class="elsevierStyleHsp" style=""></span>cc of saline solution. (I) Visual estimations of sponge with 50<span class="elsevierStyleHsp" style=""></span>cc of blood and 50<span class="elsevierStyleHsp" style=""></span>cc of saline solution. 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César Augusto Candia Arana and Joaquín Roca González authors of TCI sevoflurane©." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1617 "Ancho" => 2500 "Tamanyo" => 346463 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">TCI sevoflurane© Main Screen. In the upper part of the screen enter the patient's characteristics. In the left lower quadrant enter the sevoflurane target concentration used, corrected for age. In the middle of the graph; in blue, the infusion rate and in red the volume of liquid sevoflurane administered.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Low Flow Anesthesia (LFA)</span>, 0,5–1.0<span class="elsevierStyleHsp" style=""></span>l/min, has shown lower consumption of anesthesia gas and reduced health costs,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> it has minimized labor exposure and environmental pollution,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in addition it has enabled the warming and humidifying of inhaled gases;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> characteristics that have been optimized by the use of <span class="elsevierStyleItalic">Minimal-Flow Anesthesia (MFA)</span>, 0.3–0.5<span class="elsevierStyleHsp" style=""></span>l/min.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the association of minimal-flow sevoflurane anesthesia with the accumulation of toxic substances and nephrotoxicity, this fact has not yet been demonstrated in humans<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> during extended surgical procedures,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> or using soda lime.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The use of nitrous oxide (N<span class="elsevierStyleInf">2</span>O) is not recommended in order to avoid the administration of hypoxic mixtures; such as forgoing the use of MFA in patients with large hematomas, severe hemolysis and massive transfusion to prevent the endogenous accumulation of carbon monoxide from degradation of the heme group.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Using a FGF of 2<span class="elsevierStyleHsp" style=""></span>l/min (O<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>Air) FGF and a minimum alveolar concentration for 1<span class="elsevierStyleHsp" style=""></span>h (CAM-h) Ryan and Nielsen<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> calculated the “<span class="elsevierStyleItalic">20-year carbon dioxide emissions equivalent</span>” (CDE<span class="elsevierStyleInf">20</span>) for sevoflurane, and found that it was similar to the emission of a car in a distance of 28<span class="elsevierStyleHsp" style=""></span>km (6980<span class="elsevierStyleHsp" style=""></span>g of CO<span class="elsevierStyleInf">2</span>/h); when associated to 60% N<span class="elsevierStyleInf">2</span>O the effect was increased 5.9 fold.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Different applications have been used to implement LFA and MFA with vaporizer: the Gasman®<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> simulator, the real-time halogenated agent concentration predictive software by Kennedy et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and a software that alerts when the FGF exceeded 1<span class="elsevierStyleHsp" style=""></span>l or 2 MAC-h for sevoflurane.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> These two latter software programs were able to lower the FGF down to 35%<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and 24% respectively.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first workstation with closed circuit control and halogenated compound injection was PHISIOFLEX®,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> was removed from the market because of its high selling price. Later on, the DRAGER-ZEUS® station achieved constant concentrations of inspired oxygen and expired anesthetic agent, resulting in decreased halogenated compound consumption and greater hemodynamic stability.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> A 27% drop in consumption and a reduction of 44% greenhouse gas emissions were recently reported using the AISYS-GE™ workstation ET CONTROL® module.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Initially, the syringe injection of liquid sevoflurane was administered to determine the closed circuit uptake model.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a> The AnaConDa™ device is currently available for injecting the halogenated compound in a non-reinhalation circuit, with anesthetic savings similar to a LFA technique.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the mid-nineties, Candia and Acosta<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> developed the first TCI model for halogenated compounds, based on the equation suggested by Lowe and Ernest.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> This IT application enabled the continuous injection of the halogenated agent, avoiding the administration of boluses and the use of the stopwatch. In a second version, other uptake models were simulated and the infusion was adjusted to the body surface. Later on, Candia and Roca developed the third <span class="elsevierStyleItalic">TCI sevoflurane</span>© version for the current workstations, using MFA.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The primary objectives of the study were to assess the performance of <span class="elsevierStyleItalic">TCI sevoflurane</span>© in the general population of our hospital, using a TCI accepted methodology and to estimate the pharmacokinetic correlation of the model, establishing the area under the curve of the target and expired concentrations. The secondary objectives were: to learn about the behavior of the hemodynamic and respiratory variables, the depth of anesthesia during the first hour and to analyze the relationship between the controller's performance and the patients’ characteristics.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">Prospective, longitudinal, analytical study at the Cartagena University Hospital Complex. The protocol was approved by the hospital's Ethics and Clinical Research Committee and the informed consents were obtained. 30 adult patients meeting the following criteria were recruited: 16–90 years old, ASA I–III and scheduled for elective surgery lasting over 30<span class="elsevierStyleHsp" style=""></span>min. The exclusion criteria were: obstetric patients, heavy smokers and patients with a history of drug addiction. 20<span class="elsevierStyleHsp" style=""></span>min before the procedure the patients were pre-medicated with midazolam 1–2<span class="elsevierStyleHsp" style=""></span>mg or fentanyl 50–100<span class="elsevierStyleHsp" style=""></span>μg. Denitrogenation for 3<span class="elsevierStyleHsp" style=""></span>min with O<span class="elsevierStyleInf">2</span> at 8<span class="elsevierStyleHsp" style=""></span>l/min. TCI propofol and remifentanil induction at effect site concentrations of 3–4.5<span class="elsevierStyleHsp" style=""></span>μg/ml and 3–4.7<span class="elsevierStyleHsp" style=""></span>ng/ml respectively and rocuronium 2DE95. Following intubation, the FDF was reduced to 0.5<span class="elsevierStyleHsp" style=""></span>l/min (O<span class="elsevierStyleInf">2</span> 0.35<span class="elsevierStyleHsp" style=""></span>l/min<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>air 0.15<span class="elsevierStyleHsp" style=""></span>l/min), propofol was suspended and <span class="elsevierStyleItalic">TCI sevoflurane</span>© was initiated with a target concentration of 1.2% (v/v); mean value obtained from the analysis of the trials completed to determine the necessary concentration for a BIS ≤50 in patients ≤40 years old (MAC-BIS<span class="elsevierStyleInf">50</span>).<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22–24</span></a> Remifentanil was used for maintenance based on its synergistic action with sevoflurane.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The TCI was developed with LABVIEW® 6.1 (National Instruments, Austin, USA) software that enabled continuous and variable infusion of liquid sevoflurane at the AESPIRE-VIEW® (GE-Healthcare, Madison, USA) station, using the Harvard Apparatus 22 (South Natick, USA) <span class="elsevierStyleItalic">infusion syringe</span>. Using the parameters of age, weight, size and gender, the following estimates were made: age-adjusted <span class="elsevierStyleItalic">target concentration</span><a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>; oxygen consumption and minute volume<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> and effective pulmonary volume.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> The system's purge dose (circuit-patient) was administered in the first minute. A negative bi-exponential model derived from a closed circuit uptake study was used.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> If needed, TCI interactions were preformed, changing the target concentration with the guidance of the gas analyzer (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The system's volume included an adult-type circuit (M1019499; GE, Helsinki, Finland), the humidifier, the analyzer connection and the oro-tracheal tube. The gas analyzer leaks were added to the model. The soda-lime absorption and degradation of sevoflurane were excluded from the calculations because they were considered of little clinical importance.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> The soda lime used was partially used and humidified. The sevoflurane was placed in a syringe with an <span class="elsevierStyleItalic">adapter</span> (26042; Sedana Medical AB, Sundbyberg, Sweden) and by means of an extension (MFX1954-ALARIS®, Höchberg, Germany) coupled to a modified metallic t-connector in the inspiratory branch, as described by Parra.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> The syringe and the plastic extension maintained their physical stability.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The principal variables were: <span class="elsevierStyleItalic">target concentrations, inspired and expired sevoflurane concentrations</span>, captured every 5<span class="elsevierStyleHsp" style=""></span>s using the S/5™Collect4 software (GE Healthcare, Helsinki, Finland); the measurement precision was 0.15% (v/v), as per the manufacturer's brochure. Secondary variables: systolic blood pressure (SBP), heart rate (HR), end-tidal CO<span class="elsevierStyleInf">2</span> (ETCO<span class="elsevierStyleInf">2</span>), inspired oxygen fraction (FiO<span class="elsevierStyleInf">2</span>), state entropies (SE) and response entropies (RE).</p><p id="par0065" class="elsevierStylePara elsevierViewall">TCI performance<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> was based on the <span class="elsevierStyleItalic">Predictive Error</span> calculation (PE%).<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0070" class="elsevierStylePara elsevierViewall">The bias (<span class="elsevierStyleItalic">MDPE%</span>), inaccuracy (<span class="elsevierStyleItalic">MDAPE%</span>) and the controller oscillation were inferred every 5<span class="elsevierStyleHsp" style=""></span>min. The <span class="elsevierStyleItalic">MDPE%</span> is the PE% median. It is the error sign indicates: overdose (+) or underdose (−). <span class="elsevierStyleItalic">MDAPE%</span> is the PE% <span class="elsevierStyleItalic">mean</span> absolute value. It is the magnitude of error. <span class="elsevierStyleItalic">Wobble</span> is the mean absolute value of the difference between each PE% and the subject's MDPE. It measures each patient's predictive instability or variability. <span class="elsevierStyleItalic">Divergence</span> is the slope of the lineal regression curve of PE% absolute values vs. time, expressed as a divergence percentage per hour; its positive value indicates the trend of the target concentration to move away from the measured or expired concentration in time and its negative value indicates convergence.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The normal distribution of the data was determined using Shapiro–Wilks statistics. The comparison of target, inspired and expired means was done using the signs range test. Chi square or Fischer's Exact Test and the binary logistics regression analysis were used to establish an association between the variables of patients grouped by: age ≥65 years old; gender, BMI ≥30, ASA classification and number of user's TCI interactions <3<span class="elsevierStyleHsp" style=""></span>per hour; compared against the visually grouped parameters of TCI performance: MDPE% <−13%, MDAPE% <15%, wobble <7% and negative divergence.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The data analysis was done with SPSS 21 (IBM®, Armonk, USA) and EXCEL 2007 (Microsoft®, Redmond, USA). The pharmacokinetic analysis of the area under the curve for the target concentration and expired sevoflurane concentration was performed with the pharmacokinetic data generator (pkcollapse) STATA 12 (College Station, USA). The results were expressed as Mean (95% CI) for normal distribution values and Median with interquartile range [IQR 25–75%]* for the non-parametric; the acceptable level of significance was <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05. The estimator used was odds ratio (95% CI). The sample size with an alpha error<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.05 and a beta power<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.8 was 25 patients, estimated according to our pilot study,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> using the <span class="elsevierStyleItalic">variance</span> of MDAPE%<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9.86.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">25 of 30 patients completed the study; three were excluded for missing data and two for circuit leaks. 80% of the patients had a BMI ≥25. 48% of the surgical procedures were laparoscopic (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">target, inspired and expired</span> concentrations showed non-parametric distributions; the <span class="elsevierStyleItalic">sevoflurane</span> expired mean was 18.4% below the <span class="elsevierStyleItalic">target concentration</span> mean used. 84.5% of the values of Predictive Error (<span class="elsevierStyleItalic">PE%</span>) showed normal distribution, so that <span class="elsevierStyleItalic">MDPE%, MDAPE%</span>, <span class="elsevierStyleItalic">wobble and divergence</span> of TCI, was expressed with mean (CI 95%) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In absolute values, <span class="elsevierStyleItalic">MDPE%</span> was consistent with an under-dosing of <0.16%(v/v) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). The average <span class="elsevierStyleItalic">MDAPE%</span> was 16% until minute 40 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Oscillation in average was <10% (0.12%, v/v) between minutes 10 and 55 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">TCI's clinical performance was represented with box-plots (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The SBP dropped by 13% in 50% of the patients at minute 0. HR, ETCO<span class="elsevierStyleInf">2</span>, SE and RE showed no significant changes. FiO<span class="elsevierStyleInf">2</span> showed a rapid decrease following the nitrogen wash in the first 30<span class="elsevierStyleHsp" style=""></span>min and was maintained between 70% and 60% from minutes 30 through 60. The concentration–time area under the curve correlation for target and expired concentrations in each patient was high (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.766) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The performance every 5<span class="elsevierStyleHsp" style=""></span>s was represented in a PE% absolute value histogram (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Among the variables collected, an association was found between the <span class="elsevierStyleItalic">number of user's interactions per hour</span> over the TCI <3 and MDAPE <15%, with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.033 and an Odds Ratio (95% CI) of 7.77 (1.3–46.1). Age <65 years old was related to MDAPE <15% with a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.039 and an Odds Ratio of 0.381 (0.22–0.66). Obesity was related with MDAPE ≥15% with a significance of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.036 unilateral and an Odds Ratio (95% CI) of 4.5 (0.87–23.26). No association was found among the remaining parameters of the controller and grouped characteristics.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">This study evaluated the predictive and clinical performance and the pharmacokinetic correlation of a sevoflurane TCI device, using MFA from the beginning of anesthesia. A target concentration of 1.2% (v/v) enabled a stable sevoflurane expired concentration. A 0.6 MAC maintained the stability of the hemodynamic, respiratory and depth of anesthesia parameters evaluated. The oxygen–air gas mixture used maintained the FiO<span class="elsevierStyleInf">2</span> at safe levels during the 1-h evaluation (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><p id="par0115" class="elsevierStylePara elsevierViewall">Traditionally, MFA has used modified FGF and changes in the vaporizer dial.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Its validation using sevoflurane showed an overdose of less than 20%<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34,35</span></a>; on the contrary, <span class="elsevierStyleItalic">TCI sevoflurane</span>© showed less than 16% sub-dosing. <span class="elsevierStyleItalic">TCI sevoflurane</span>© detected halogenated compound traces and reached the target concentration in the expired branch in 35<span class="elsevierStyleHsp" style=""></span>s and 04:07<span class="elsevierStyleHsp" style=""></span>min respectively (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The AnaConDa™<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> device achieved the same parameters in 3:50<span class="elsevierStyleHsp" style=""></span>min and 13:09<span class="elsevierStyleHsp" style=""></span>min. <span class="elsevierStyleItalic">TCI sevoflurane</span>© reached the target concentration in less time due to the administration of a bolus in the first minute; in contrast, AnaConDa™ requires a manual and constant infusion that delays the induction in the OR.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Time-to-extubation was 7<span class="elsevierStyleHsp" style=""></span>min in average, which is consistent with the three time constants (<span class="elsevierStyleItalic">τ</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.5<span class="elsevierStyleHsp" style=""></span>min) needed to washout 95% of the sevoflurane in the brain and with the three half-lives of the proportional first order equilibrium constant between the alveolus and the effect site (<span class="elsevierStyleItalic">T</span><span class="elsevierStyleInf">1/2</span> Keo<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.4<span class="elsevierStyleHsp" style=""></span>min).<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a><span class="elsevierStyleItalic">TCI sevoflurane</span>© enabled normocapnia using a tidal volume between 7 and 8<span class="elsevierStyleHsp" style=""></span>ml/kg; as opposed to the AnaConDa™ where the dead space requires an increased tidal volume of 10<span class="elsevierStyleHsp" style=""></span>ml/kg for preventing hypercapnia and water vapor condensation.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> AnaConDa™ also absorbs the exhaled CO<span class="elsevierStyleInf">2</span> that is re-inhaled in the following breath, creating a dead space equivalent to 180<span class="elsevierStyleHsp" style=""></span>ml additional to the 100<span class="elsevierStyleHsp" style=""></span>ml of internal volume. In the opinion of the authors, this effect should be studied and changed prior to the adoption of this device in the practice of anesthesia.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Initially, the performance of TCI devices was considered acceptable with <span class="elsevierStyleItalic">MDPE%</span> <±20% and MDAPE% 20–40%.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Recently<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> a good performance has been accepted as <span class="elsevierStyleItalic">MDPE%</span> <±15% and <span class="elsevierStyleItalic">MDPE%</span> <25%, a condition that is achieved with <span class="elsevierStyleItalic">TCI sevoflurane</span>© (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39–43</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">The population age range in this study was wide (16–88); the association identified between <span class="elsevierStyleItalic">MDAPE%</span> ≥15% in patients over 65 years old may be explained by the presence of comorbidities as evidenced by the absence of ASA I patients in this group. In AnaConDa™ using the Enlund et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> model, the <span class="elsevierStyleItalic">MDAPE%</span> was higher because of several reasons: use of a re-breathing circuit, (0.5–8%), inclusion of pediatric patients and 30-s induction. In contrast to Belda et al.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> and Soro et al.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> that found lower MDAPE%, using non-rebreathing circuits, fixed concentrations per groups of patients, narrow age ranges and a 10-min induction. Soro et al.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> explained their differences to the Belda et al.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> study because the evaluation time was less than an hour and their measurements were affected by the early fatty tissue uptake. In terms of the association between MDAPE >15% and BMI >30, <span class="elsevierStyleItalic">TCI sevoflurane</span>© showed differences; the first evaluation<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> did not include morbid obese patients, showing: positive <span class="elsevierStyleItalic">MDPE%</span>, low <span class="elsevierStyleItalic">MDAPE%</span> and <span class="elsevierStyleItalic">wobble</span>, with negative <span class="elsevierStyleItalic">divergence</span>. In the current evaluation, <span class="elsevierStyleItalic">MDPE%</span> was negative and the <span class="elsevierStyleItalic">MDAPE%</span> doubled, probably as a result of two factors: smaller calculated circuit volume and higher percentage of overweight and obesity in the population evaluated (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">TCI sevoflurane</span>© showed an average sevoflurane consumption of 6.9<span class="elsevierStyleHsp" style=""></span>ml in 71<span class="elsevierStyleHsp" style=""></span>min. The closed loop ET Control®<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> device showed a higher consumption of sevoflurane of 11<span class="elsevierStyleHsp" style=""></span>ml/h. Our reduced consumption may be explained by the use of MFA from the start of the infusion and by the low concentration used. The ET Control® introduces automatic variations both in the FGF and in the electronic vaporizer dial.</p><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">TCI sevoflurane</span>© environmental impact may be theoretically lower, because it uses half the MAC and one fourth of the FGF used in the Rian & Nielsen trial.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The devices suggesting changes in the vaporizer and the FGF are able to temporarily reduce consumption; however, upon removal, FGF rises again and hence requires consistent supervision to maintain the reduction achieved.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12,48</span></a> As <span class="elsevierStyleItalic">TCI sevoflurane</span>© is constantly operating with MFA from the start, savings may be maintained upon its implementation.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Because TCI sevoflurane© is an open loop controller, it was unable to correct the biological variability on its own. The calculations neglected the absorption and degradation of sevoflurane due to the soda lime,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> and the metabolism of sevoflurane (3–5%) was not corrected either. Consequently, the model may be optimized though it will never be perfect for every patient, as highlighted by Hendricks.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> A gas analyzer will be then required to make all the adjustments. It is therefore recommended to do control group validations with vaporizer, include validated longer and safe procedures MFA<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> so that in the future TCI syringes may be available that include the sevoflurane option to simplify the MFA technique. Another potential development with this device is using the every 5-s gas analyzer measurements to automatically correct predictive errors with a fuzzy logic controller or PID (proportional-integral-derivative) controller. This would compensate the drift the area under the curve and the error trend, additionally using anesthetic depth measurements to adjust the halogenated agent expired concentration at the desired level of hypnosis, as has been published for isofluorane<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> and more recently for propofol<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> in our environment.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">TCI sevoflurane© showed a good performance, the <span class="elsevierStyleItalic">target concentration</span> was rapidly achieved and was maintained stable with few interactions needed with the device in the first hour. There were no overdoses or clinically significant disruptions, maintaining an adequate depth of anesthesia. A TCI for sevoflurane was available at a conventional workstation; the vaporizer was not used in this study, while the MFA was used from the start of the anesthesia, guided by the halogenated agent concentrations. Performance was similar to other devices used for the administration of inhaled anesthesia such as AnaConDa and intravenous TCIs. Keeping in mind the low consumption of sevoflurane observed in our study, we may then conclude that there was a reduction in labor exposure, environmental pollution and monetary costs.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors’ own resources.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare. The <span class="elsevierStyleItalic">TCI sevoflurane</span>© algorithm was written by César A. Candia Arana and programmed by Joaquín Roca González.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres371164" "titulo" => array:6 [ 0 => "Abstract" 1 => "Introduction" 2 => "Objectives" 3 => "Methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec350332" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres371165" "titulo" => array:6 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivos" 3 => "Metodología" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec350331" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack93462" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-01-10" "fechaAceptado" => "2014-04-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec350332" "palabras" => array:5 [ 0 => "Anesthetics inhalation" 1 => "Global warming" 2 => "Pharmacokinetics" 3 => "Economics pharmaceutical" 4 => "Anesthesia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec350331" "palabras" => array:5 [ 0 => "Anestésicos por inhalación" 1 => "Calentamiento global" 2 => "Farmacocinética" 3 => "Economía farmacéutica" 4 => "Anestesia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Good governance of resources and global warming has attracted interest on minimal flow (0.3–0.5<span class="elsevierStyleHsp" style=""></span>l/min) inhalation anesthesia.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To evaluate the predictive and clinical performance of a TCI (Target-controlled infusion) device, and its pharmacokinetic correlation for sevoflurane.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Prospective, longitudinal, and analytical study on 25 adult patients. Fresh gas flow used 0.5<span class="elsevierStyleHsp" style=""></span>l/min. Target concentration of 1.2% (v/v). Continuous and variable infusion into the circuit of the anesthesia workstation. Controller developed with LABVIEW 6.1. Hemodynamic, respiratory and anesthetic depth data collected every 5<span class="elsevierStyleHsp" style=""></span>s using the anesthesia workstation software. <span class="elsevierStyleItalic">Bias</span> (<span class="elsevierStyleItalic">Median of Predictive Error, MDPE%</span>), <span class="elsevierStyleItalic">inaccuracy</span> (<span class="elsevierStyleItalic">Absolute Mean of Predictive Error, MDAPE%</span>), <span class="elsevierStyleItalic">wobble</span>, and <span class="elsevierStyleItalic">divergence</span> of the TCI device were determined in the first hour. STATA-12 pk collapse was used to analyze the area under the curve of the target and expired concentrations. The results are expressed as mean (95% CI) and median [IQR]*.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Target concentration used 1.22 [1.14–1.37]%*, reached in 04:07 [03:15–06:15]* min:s (expiratory branch). Anesthetic duration 1:10:50 (00:56:57–1:24: 43) h:min:s. Sevoflurane consumption 6.9 (5.7–8.0) ml. <span class="elsevierStyleItalic">MDPE%</span> −12.8 (−17.6 to −8.1) %; <span class="elsevierStyleItalic">MDAPE%</span> 15.9 (11.9–19.8) %; <span class="elsevierStyleItalic">wobble</span> 6.9 (5.0–8.7)% and <span class="elsevierStyleItalic">divergence</span> 0.89% (−5.96 to 7.7)%h-1. Interactions per hour on the TCI of 3 (2–4). Correlation of the area under the curve, Spearman's rho<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.8577, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.00001. ≥15% inaccuracy was associated with age >65 years and obesity.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The TCI sevoflurane© showed good performance, and the target concentration was rapidly reached and remained stable, with few interactions with the device needed during the first hour. There were neither overdosing nor clinically significant alterations.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La racionalización de recursos y el calentamiento global han despertado el interés en la anestesia inhalatoria con flujos mínimos (0,3-0,5 l/min).</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Conocer el desempeño predictivo, clínico y la correlación farmacocinética de un dispositivo target-controlled infusion (TCI) para sevofluorano.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Metodología</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo, longitudinal y analítico en 25 pacientes adultos. Flujo de gas fresco empleado 0,5 l/min. Concentración objetivo de sevofluorano 1,2% v/v. Infusión continua y variable en el circuito de la estación de anestesia. Controlador desarrollado con LABVIEW 6.1. Datos hemodinámicos, respiratorios y profundidad anestésica capturados cada 5 s con software de la estación de anestesia. Se determinó en la primera hora: sesgo (MDPE%), inexactitud (MDAPE%), oscilación y divergencia del TCI; análisis del área bajo la curva de las concentraciones objetivo y espirada con pkcollapse STATA-12. Resultados expresados en media (IC 95%) y mediana [IQR]*</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Concentración objetivo empleada 1,22 [1,14-1,37]%*, alcanzada en 04:07 [03:15-06:15]* min:s (en rama espiratoria). Duración anestésica 1:10:50 (0:56:57-1:24:43) h:min:s. Consumo de sevofluorano 6,9 (5,7- 8,0) ml. MDPE% -12,8 (−17,6 a −8,1)%; MDAPE% 15,9 (11,9-19,8) %; oscilación 6,9 (5,0-8,7) % y divergencia 0,89 (−5,96-7,7)%h-1. Interacciones por hora sobre el TCI de 3 (2-4). Correlación del área bajo la curva, Spermann rho = 0,8577; p < 0,00001.La inexactitud ≥ 15% se asoció con edad > 65 años y obesidad.</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El TCI sevoflurane© mostró buen desempeño, la concentración objetivo se alcanzó rápidamente y se mantuvo estable, siendo necesarias pocas interacciones sobre el dispositivo durante la primera hora. No hubo sobredosificación ni alteraciones clínicas significativas.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as: Candia Arana CA, Castillo Monzón CG, Álvarez Gómez JA, González JR, Eslava Schmalbach JH. Desempeño predictivo y clínico de un dispositivo TCI para sevofluorano en una estación de trabajo convencional: Correlación farmacocinética del modelo empleado. Rev Colomb Anestesiol. 2014;42:255–264.</p>" ] ] "multimedia" => array:10 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: TCI sevoflurane© log. César Augusto Candia Arana and Joaquín Roca González authors of TCI sevoflurane©." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1617 "Ancho" => 2500 "Tamanyo" => 346463 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">TCI sevoflurane© Main Screen. In the upper part of the screen enter the patient's characteristics. In the left lower quadrant enter the sevoflurane target concentration used, corrected for age. In the middle of the graph; in blue, the infusion rate and in red the volume of liquid sevoflurane administered.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1911 "Ancho" => 3099 "Tamanyo" => 348508 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">TCI sevoflurane performance in the first hour. (A) The <span class="elsevierStyleItalic">predictive errors</span> (PE) % of the 25 patients every 5<span class="elsevierStyleHsp" style=""></span>s in the first hour. (B–D) The bias (<span class="elsevierStyleItalic">MDPE%</span>) MDAPE% and wobble from minute 3 through 60; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>14,761 observations. The solid line represents the mean (95% CI) and the dashed line represents the median.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3577 "Ancho" => 3277 "Tamanyo" => 309208 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Hemodynamic, respiratory and anesthetic depth parameters. The upper part shows the systolic blood pressure (SBP) and the heart rate (HR) with basal pre-induction values and every 10<span class="elsevierStyleHsp" style=""></span>min for the first TIC infusion hour. In the middle, the tele-expiratory CO<span class="elsevierStyleInf">2</span> (ETCO<span class="elsevierStyleInf">2</span>) and the oxygen inspired fraction (FiO<span class="elsevierStyleInf">2</span>); the dividing lines represent the median. The lower section shows the state entropy (SE) and response entropy (RE); the dividing lines represent the accepted anesthetic depth range. The data are expressed as median [IQR]*.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1089 "Ancho" => 1651 "Tamanyo" => 106560 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The concentration–time area under the curve (AUC) correlation for target and expired concentrations of sevoflurane. Data every 5<span class="elsevierStyleHsp" style=""></span>s in the 25 patients; Spearman's rho of the AUC for each patient was 0.875.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1577 "Ancho" => 1652 "Tamanyo" => 70948 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Sevoflurane TCI performance expressed in absolute value ranges for PE% (APE%). Ordered histogram of the APE% from minute 3 and every 5<span class="elsevierStyleHsp" style=""></span>s. <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>14.761 observations. Clinical performance was defined as “optimal”, “Good”, “acceptable”, “inadequate” and “poor” when APE% was ≤10%, 11–20%, 21–30%, 31–40%, or >40%, respectively.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "tabla" => array:2 [ "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Qualitative variables in absolute numbers (percentage).</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Quantitative variables expressed as mean (CI 95%) and median [IQR]<span class="elsevierStyleSup">*</span>.</p>" "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=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(37.0–52.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Weight (kg)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(76.0–91.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Height (cm)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">176.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">163.0–171.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Body surface (m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(1.9–2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">BMI (kg/m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(27.3–32.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(52%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(48%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Obesity (BMI</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">30)</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(48%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(52%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ASA classification</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASA I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(32.%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASA II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(48%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASA III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(20%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Surgical specialty</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>General surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(76%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maxillofacial surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(16%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ENT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Intravenous anesthesia</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Propofol (mg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">203.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(182–225) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Remifentanil (μg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">833.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(592–1075) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rocuronium (mg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[50–65]<span class="elsevierStyleSup">*</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab560249.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Patient characteristics, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>25.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "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=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Concentrations</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Target used (%, v/v) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[1.14–1.37]<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inspired (%, v/v) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[1.24–1.52]<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Expired (%, v/v) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.99–1.21]<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Time</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>To detect sevoflurane traces<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">00:35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(00:32–00:38) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>To reach the target inspired concentration<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">01:28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(01:11–01:45) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>To reach the target expired concentration<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">04:07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[03:15–06:15]<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>To extubate<a class="elsevierStyleCrossRefs" href="#tblfn0015"><span class="elsevierStyleSup">a,b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">07:00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(06:11–7:48) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Number of interaction in the 1st hour</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(1.9–3.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Infusion time (h:min)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1:11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(0:57–1:25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Consumption (ml)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(5.7–8.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Bias (MDPE%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−12.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(−17.6–(−8.1)) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Inaccuracy (MDAPE%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(12.1–19.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Wobble (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(5.0–8.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Divergence (%h</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">−1</span></span><span class="elsevierStyleItalic">)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(−6.0–7.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab560250.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Expressed as mean (95% CI) and median [IQR]<span class="elsevierStyleSup">*</span>.</p>" ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Time (min:s).</p>" ] 2 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">From the end of the sevoflurane infusion and circuit wash.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">TCI sevoflurane© performance.</p>" ] ] 7 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Model \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Bias MPDE % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Inaccuracy MDAPE % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Wobble % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Divergence % h<span class="elsevierStyleSup">−1</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Propofol</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1. Marsh. Morbidly obese patients<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−32.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−1.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2. Marsh. Healthy adults<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3. Marsh. Orientals<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4. Schnider. Healthy adults<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Remifentanil</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5. Minto. Healthy adults<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−15.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab560248.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Intravenous TCI performance.</p>" ] ] 8 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "tabla" => array:3 [ "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">3 and 4: sevoflurane 1% target concentration.</p>" "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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Device \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Time (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">BMI</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Bias MDPE% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Inaccuracy MDAPE% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Wobble % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Divergence % h<span class="elsevierStyleSup">−1</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Kennedy<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not available</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="9" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="9" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">AnaConDa</span>™</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2. Enlund<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">248 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[23.0–28.0]<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3. Belda<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">360 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(23.7–27.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4. Soro<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[23.8–27.0]<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−11.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="9" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="9" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">TCI Sevoflurane</span>©</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5. Piloto<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(23.9–30.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−15.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6. Actual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(27.3–32.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−12.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab560247.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Absolute data expressed as mean (95% CI), median [IQR]<span class="elsevierStyleSup">*</span>.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Inhalation devices performance.</p>" ] ] 9 => array:5 [ "identificador" => "eq0005" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "Predictive error (PE)%=Expired concentration−Target concentrationTarget concentration×100" "Fichero" => "si1.jpeg" "Tamanyo" => 6164 "Alto" => 66 "Ancho" => 429 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:51 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pharmacoeconomics of volatile inhalational anaesthetic agents: an 11-year retrospective analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 0 | 5 |
| 2024 October | 25 | 8 | 33 |
| 2024 September | 32 | 7 | 39 |
| 2024 August | 47 | 9 | 56 |
| 2024 July | 24 | 12 | 36 |
| 2024 June | 24 | 8 | 32 |
| 2024 May | 14 | 8 | 22 |
| 2024 April | 41 | 7 | 48 |
| 2024 March | 30 | 9 | 39 |
| 2024 February | 31 | 21 | 52 |
| 2024 January | 36 | 14 | 50 |
| 2023 December | 57 | 23 | 80 |
| 2023 November | 59 | 13 | 72 |
| 2023 October | 46 | 21 | 67 |
| 2023 September | 33 | 10 | 43 |
| 2023 August | 21 | 7 | 28 |
| 2023 July | 21 | 8 | 29 |
| 2023 June | 27 | 4 | 31 |
| 2023 May | 56 | 3 | 59 |
| 2023 April | 55 | 5 | 60 |
| 2023 March | 30 | 2 | 32 |
| 2023 February | 18 | 4 | 22 |
| 2023 January | 27 | 11 | 38 |
| 2022 December | 23 | 7 | 30 |
| 2022 November | 37 | 8 | 45 |
| 2022 October | 56 | 13 | 69 |
| 2022 September | 17 | 13 | 30 |
| 2022 August | 13 | 9 | 22 |
| 2022 July | 16 | 17 | 33 |
| 2022 June | 11 | 14 | 25 |
| 2022 May | 20 | 14 | 34 |
| 2022 April | 29 | 10 | 39 |
| 2022 March | 32 | 35 | 67 |
| 2022 February | 18 | 13 | 31 |
| 2022 January | 20 | 22 | 42 |
| 2021 December | 14 | 24 | 38 |
| 2021 November | 14 | 15 | 29 |
| 2021 October | 20 | 12 | 32 |
| 2021 September | 16 | 23 | 39 |
| 2021 August | 11 | 10 | 21 |
| 2021 July | 11 | 11 | 22 |
| 2021 June | 13 | 8 | 21 |
| 2021 May | 15 | 13 | 28 |
| 2021 April | 28 | 6 | 34 |
| 2021 March | 9 | 5 | 14 |
| 2021 February | 5 | 11 | 16 |
| 2021 January | 10 | 7 | 17 |
| 2020 December | 14 | 4 | 18 |
| 2020 November | 11 | 12 | 23 |
| 2020 October | 8 | 5 | 13 |
| 2020 September | 17 | 12 | 29 |
| 2020 August | 9 | 8 | 17 |
| 2020 July | 9 | 8 | 17 |
| 2020 June | 10 | 2 | 12 |
| 2020 May | 10 | 5 | 15 |
| 2020 April | 9 | 3 | 12 |
| 2020 March | 22 | 5 | 27 |
| 2020 February | 12 | 3 | 15 |
| 2020 January | 11 | 5 | 16 |
| 2019 December | 10 | 4 | 14 |
| 2019 November | 6 | 3 | 9 |
| 2019 October | 5 | 5 | 10 |
| 2019 September | 7 | 4 | 11 |
| 2019 August | 5 | 1 | 6 |
| 2019 July | 3 | 20 | 23 |
| 2019 June | 3 | 20 | 23 |
| 2019 May | 1 | 41 | 42 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 4 | 3 | 7 |
| 2018 May | 23 | 3 | 26 |
| 2018 April | 31 | 5 | 36 |
| 2018 March | 22 | 13 | 35 |
| 2018 February | 21 | 5 | 26 |
| 2018 January | 33 | 2 | 35 |
| 2017 December | 28 | 4 | 32 |
| 2017 November | 24 | 4 | 28 |
| 2017 October | 28 | 11 | 39 |
| 2017 September | 46 | 5 | 51 |
| 2017 August | 44 | 9 | 53 |
| 2017 July | 42 | 5 | 47 |
| 2017 June | 50 | 17 | 67 |
| 2017 May | 55 | 12 | 67 |
| 2017 April | 54 | 21 | 75 |
| 2017 March | 47 | 30 | 77 |
| 2017 February | 33 | 6 | 39 |
| 2017 January | 19 | 13 | 32 |
| 2016 December | 39 | 18 | 57 |
| 2016 November | 32 | 11 | 43 |
| 2016 October | 43 | 18 | 61 |
| 2016 September | 69 | 10 | 79 |
| 2016 August | 41 | 10 | 51 |
| 2016 July | 27 | 7 | 34 |
| 2016 June | 0 | 21 | 21 |
| 2016 May | 3 | 29 | 32 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 0 | 29 | 29 |
| 2016 January | 0 | 19 | 19 |
| 2015 December | 15 | 18 | 33 |
| 2015 November | 53 | 13 | 66 |
| 2015 October | 63 | 17 | 80 |
| 2015 September | 77 | 18 | 95 |
| 2015 August | 70 | 11 | 81 |
| 2015 July | 55 | 11 | 66 |
| 2015 June | 48 | 2 | 50 |
| 2015 May | 56 | 11 | 67 |
| 2015 April | 39 | 9 | 48 |
| 2015 March | 47 | 15 | 62 |
| 2015 February | 53 | 12 | 65 |
| 2015 January | 42 | 14 | 56 |
| 2014 December | 78 | 17 | 95 |
| 2014 November | 59 | 13 | 72 |
| 2014 October | 209 | 22 | 231 |
| 2014 September | 15 | 8 | 23 |
Show all