Guidelines and consensus
Evidence-based clinical practice manual: Postoperative complications management
Recomendaciones basadas en la evidencia del manejo de complicaciones posquirúrgicas en el contexto colombiano
José Andrés Calvachea,
, Érika León Guzmánb, Luz María Gómez Buitragoc, Cecilia García Torresd, Marcela Torrese, Giancarlo Buitragof, Hernando Gaitán Duarteg
Corresponding author
jacalvache@unicauca.edu.co
Corresponding author: Departamento de Anestesiología, Universidad del Cauca. Hospital Universitario San Jose, Cra 6 10N-142 tercer piso, Popayán, Colombia.
Corresponding author: Departamento de Anestesiología, Universidad del Cauca. Hospital Universitario San Jose, Cra 6 10N-142 tercer piso, Popayán, Colombia.
a Anaesthetist, Master in Health Sciences, Clinical Epidemiology; Professor, Universidad del Cauca, Erasmus University Medical Centre Rotterdam, The Netherlands
b Master in Clinical Epidemiology, Universidad Nacional de Colombia, Colombia
c Anaesthetist, Master in Education, Academic Deputy and Researcher, Technology Development Centre, Colombian Society of Anaesthesiology and Resuscitation (S.C.A.R.E.), Colombia
d Anaesthetist; Epidemiologist, Universidad de Caldas, Head of Specialized Advice Department, Colombia
e Researcher, Technology Development Centre, Colombian Society of Anaesthesiology and Resuscitation (S.C.A.R.E.); Master in Clinical Epidemiology; Editor, Cochrane Sexually Transmitted Infections Group, Universidad Nacional de Colombia, Colombia
f Master in Clinical Epidemiology, Master in Economics, Universidad Nacional de Colombia, Colombia
g Gynaecologist and Obstetrician, Master in Clinical Epidemiology, Universidad Nacional de Colombia, Colombia
Read
5869
Timeswas read the article
886
Total PDF
4983
Total HTML
Share statistics
array:24 [ "pii" => "S2256208714001230" "issn" => "22562087" "doi" => "10.1016/j.rcae.2014.10.010" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "182" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "copyrightAnyo" => "2014" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "pgl" "cita" => "Rev Colomb Anestesiol. 2015;43:51-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3177 "formatos" => array:3 [ "EPUB" => 99 "HTML" => 2657 "PDF" => 421 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0120334714001415" "issn" => "01203347" "doi" => "10.1016/j.rca.2014.10.005" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "182" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "documento" => "article" "licencia" => "http://creativecommons.org/licenses/by-nc-nd/3.0/" "subdocumento" => "pgl" "cita" => "Rev Colomb Anestesiol. 2015;43:51-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 11682 "formatos" => array:3 [ "EPUB" => 94 "HTML" => 8482 "PDF" => 3106 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Guías y consensos</span>" "titulo" => "Manual de práctica clínica basado en la evidencia: manejo de complicaciones posquirúrgicas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "51" "paginaFinal" => "60" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Evidence-based recommendations of postoperative complications management in the Colombian context" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figura 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 3856 "Ancho" => 1732 "Tamanyo" => 320669 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Algoritmo manejo pacientes con NVPO que no recibieron profilaxis o en los que fallan los esquemas de prevención.</p> <p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ACP: analgesia controlada por paciente; NVPO: náuseas y vómitos postoperatorios.</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">* No readministrar dexametasona o aprepitant.</p> <p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Los medicamentos mencionados cuentan con registro Invima para ser comercializados dentro del territorio colombiano.</p> <p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Fuente: autores.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Andrés Calvache, Érika León Guzmán, Luz María Gómez Buitrago, Cecilia García Torres, Marcela Torres, Giancarlo Buitrago, Hernando Gaitán Duarte" "autores" => array:7 [ 0 => array:2 [ "nombre" => "José Andrés" "apellidos" => "Calvache" ] 1 => array:2 [ "nombre" => "Érika" "apellidos" => "León Guzmán" ] 2 => array:2 [ "nombre" => "Luz María" "apellidos" => "Gómez Buitrago" ] 3 => array:2 [ "nombre" => "Cecilia" "apellidos" => "García Torres" ] 4 => array:2 [ "nombre" => "Marcela" "apellidos" => "Torres" ] 5 => array:2 [ "nombre" => "Giancarlo" "apellidos" => "Buitrago" ] 6 => array:2 [ "nombre" => "Hernando" "apellidos" => "Gaitán Duarte" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2256208714001230" "doi" => "10.1016/j.rcae.2014.10.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208714001230?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334714001415?idApp=UINPBA00004N" "url" => "/01203347/0000004300000001/v2_201706012200/S0120334714001415/v2_201706012200/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2256208714001084" "issn" => "22562087" "doi" => "10.1016/j.rcae.2014.09.001" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "167" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Colomb Anestesiol. 2015;43:61-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2131 "formatos" => array:3 [ "EPUB" => 84 "HTML" => 1643 "PDF" => 404 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific and Technological Research</span>" "titulo" => "Efficacy of epidural methylprednisolone in radicular pain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "61" "paginaFinal" => "67" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia de la metilprednisolona epidural en el dolor radicular" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1002 "Ancho" => 1622 "Tamanyo" => 77673 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Procedures performed in patients with radicular pain.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Adelaida Álvarez Correa, Roberto Carlo Rivera Díaz, Mario Andrés Arcila Lotero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Adelaida Álvarez" "apellidos" => "Correa" ] 1 => array:2 [ "nombre" => "Roberto Carlo Rivera" "apellidos" => "Díaz" ] 2 => array:2 [ "nombre" => "Mario Andrés Arcila" "apellidos" => "Lotero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0120334714001269" "doi" => "10.1016/j.rca.2014.09.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334714001269?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208714001084?idApp=UINPBA00004N" "url" => "/22562087/0000004300000001/v1_201501210932/S2256208714001084/v1_201501210932/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2256208714001308" "issn" => "22562087" "doi" => "10.1016/j.rcae.2014.11.004" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "187" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "pgl" "cita" => "Rev Colomb Anestesiol. 2015;43:32-50" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3599 "formatos" => array:3 [ "EPUB" => 93 "HTML" => 2950 "PDF" => 556 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Guidelines and consensus</span>" "titulo" => "Evidence-based clinical practice manual: Patient preparation for surgery and transfer to the operating room" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "32" "paginaFinal" => "50" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manual de práctica clínica basado en la evidencia: preparación del paciente para el acto quirúrgico y traslado al quirófano" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Taken from Sánchez et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 422 "Ancho" => 2704 "Tamanyo" => 51506 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Rating scale in a formal consensus (real time Delphi).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "David A. Rincón-Valenzuela, Bibiana Escobar" "autores" => array:2 [ 0 => array:2 [ "nombre" => "David A." "apellidos" => "Rincón-Valenzuela" ] 1 => array:2 [ "nombre" => "Bibiana" "apellidos" => "Escobar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0120334714001464" "doi" => "10.1016/j.rca.2014.10.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334714001464?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208714001308?idApp=UINPBA00004N" "url" => "/22562087/0000004300000001/v1_201501210932/S2256208714001308/v1_201501210932/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Guidelines and consensus</span>" "titulo" => "Evidence-based clinical practice manual: Postoperative complications management" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "51" "paginaFinal" => "60" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Andrés Calvache, Érika León Guzmán, Luz María Gómez Buitrago, Cecilia García Torres, Marcela Torres, Giancarlo Buitrago, Hernando Gaitán Duarte" "autores" => array:7 [ 0 => array:4 [ "nombre" => "José Andrés" "apellidos" => "Calvache" "email" => array:1 [ 0 => "jacalvache@unicauca.edu.co" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Érika León" "apellidos" => "Guzmán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Luz María Gómez" "apellidos" => "Buitrago" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Cecilia García" "apellidos" => "Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Marcela" "apellidos" => "Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Giancarlo" "apellidos" => "Buitrago" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "Hernando Gaitán" "apellidos" => "Duarte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Anaesthetist, Master in Health Sciences, Clinical Epidemiology; Professor, Universidad del Cauca, Erasmus University Medical Centre Rotterdam, The Netherlands" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Master in Clinical Epidemiology, Universidad Nacional de Colombia, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Anaesthetist, Master in Education, Academic Deputy and Researcher, Technology Development Centre, Colombian Society of Anaesthesiology and Resuscitation (S.C.A.R.E.), Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Anaesthetist; Epidemiologist, Universidad de Caldas, Head of Specialized Advice Department, Colombia" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Researcher, Technology Development Centre, Colombian Society of Anaesthesiology and Resuscitation (S.C.A.R.E.); Master in Clinical Epidemiology; Editor, Cochrane Sexually Transmitted Infections Group, Universidad Nacional de Colombia, Colombia" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Master in Clinical Epidemiology, Master in Economics, Universidad Nacional de Colombia, Colombia" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Gynaecologist and Obstetrician, Master in Clinical Epidemiology, Universidad Nacional de Colombia, Colombia" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author: Departamento de Anestesiología, Universidad del Cauca. Hospital Universitario San Jose, Cra 6 10N-142 tercer piso, Popayán, Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recomendaciones basadas en la evidencia del manejo de complicaciones posquirúrgicas en el contexto colombiano" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Sanchez et al." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 327 "Ancho" => 2501 "Tamanyo" => 48920 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Rating scale for real-time use during the Delphi exercise.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Despite advances in perioperative management, post-operative complications continue to affect patient care and recovery, reduce healthcare quality, alter quality of life, and have a significant impact on costs.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A key factor in ensuring the effectiveness of the Post-anaesthetic Care Unit (PACU) is to maintain a balance in the use of resources between patients requiring more care and others who do not.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Different tools have been developed, including checklists<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and various clinical protocols that include detailed steps for patient care on the basis of their clinical status. The use of these tools may shorten length of stay significantly and improve postoperative results.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Post-operative complications may be general or specific for the type of surgery performed and, when they occur, they must be managed taking into consideration the specific clinical characteristics of the individual patient. The group of postoperative complications being broad, we decided to describe only two in this paper, because of their frequency and the degree to which they affect the recovery process: acute postoperative pain and postoperative nausea and vomiting (PONV).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The incidence of severe post-operative pain reported in the literature varies widely, with reports of 75% (Cohen 1980, USA), 33% (Oates 1994, United Kingdom), 46% (Poisson–Saloman 1999, France), 68% (Spanish Society of Pain, 2003), 59% (Apfelbaum 2003, USA).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In Colombia, with data from the San Vicente Paul Hospital, the prevalence of moderate pain 24<span class="elsevierStyleHsp" style=""></span>h after the procedure has been estimated at 31%, and the prevalence of severe pain at rest has been estimated at 22.3%.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The San José Hospital in Popayán reports an incidence of severe postoperative pain within the first hour after surgery of 12.3%, 95%CI (7.1–18.2) and of 4.5%, 95%CI (1.3–8.4) at the 30<span class="elsevierStyleHsp" style=""></span>min assessment. In the PACU, 48.7% of the patients required rescue analgesia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Moreover, the University Hospital in Pereira reports that 51.4% patients did not have pain control 4<span class="elsevierStyleHsp" style=""></span>h after the procedure.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Adverse outcomes resulting from inadequate management of perioperative pain include thromboembolic and pulmonary complications, longer Intensive Care Unit (ICU) stay, readmission for pain management, unnecessary suffering, deterioration of the quality of life, and development of chronic pain.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The global incidence of postoperative nausea and vomiting is approximately 50% and 30%, respectively. In patients with a high risk of PONV, the incidence may be as high as 80%.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The presence of PONV increases the risk of aspiration of gastric contents and is associated with other types of complications, including evisceration and suture dehiscence. PONV delays discharge from the PACU and increases the rate of readmissions after surgery.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The management of pain and PONV must be a priority for the different healthcare institutions as an integral part of healthcare quality. The purpose of this manual was to update and standardize PONV and pain management as part of postoperative care, on the basis of the recent literature and recommendations from Colombian experts.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0035" class="elsevierStylePara elsevierViewall">The process was divided into four phases. During each of the phases, standardized techniques and procedures used as part of the development of evidence-based guidelines and protocols were considered.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Team membership</span><p id="par0040" class="elsevierStylePara elsevierViewall">A group of experts in anaesthesiology and epidemiology was put together to provide the methodological and technical guidelines for the development of the protocol. The members included two methodology coordinators with experience in the development of clinical practice guidelines and evidence-based management protocols who were responsible for coordinating the methodology of the process. Another group consisting of a physician specialized in anaesthesiology and an epidemiologist with experience in critical analysis of scientific evidence was also created. All of the members of the team that prepared the guidelines agreed to participate in the process and signed the disclosure form, which is consistent with the regulations pertaining to the development of evidence-based guidelines and protocols.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Systematic review of the secondary literature</span><p id="par0045" class="elsevierStylePara elsevierViewall">The systematic review was conducted in order to identify the clinical protocols and practice guidelines. The unit of analysis for the review was based on articles published in scientific journals or on technical documents found in the grey literature:<ul class="elsevierStyleList" id="lis0090"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0050" class="elsevierStylePara elsevierViewall">Evidence-based management protocols (or clinical practice Guidelines) with indications or recommendations regarding clinical management by the anaesthesia group</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0055" class="elsevierStylePara elsevierViewall">Published since 2011</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0060" class="elsevierStylePara elsevierViewall">Published in English and Spanish</p></li></ul></p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Search strategy</span><p id="par0065" class="elsevierStylePara elsevierViewall">A sensitive digital search strategy was designed and was conducted on the 19th of August 2014. The sources of information included the Medline and Embase databases of the biomedical scientific literature, as well as the grey literature in Google. Additional sources included international agencies specialized in anaesthesia (Australian and New Zealand College of Anaesthetists (ANZCA), The Association of Anaesthetists of Great Britain and Ireland, Royal College of Anaesthetists, Agency for Health care Research and Quality, American Society of Anaesthesiologists, NICE, Scottish Intercollegiate Guidelines Network).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Selection of the evidence</span><p id="par0070" class="elsevierStylePara elsevierViewall">Based on the results of the search strategies, a database of the potential documents was built and given to two reviewers who worked independently to read the titles and abstracts, and identified the documents that met the requirements. The full texts of the selected documents were downloaded and subjected to final screening.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Quality assessment</span><p id="par0075" class="elsevierStylePara elsevierViewall">The AGREE II tool was used to assess the quality of the evidence found in the previous step. This was a paired quality analysis.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Finally, three documents that met the requirements for use as source documents were selected for adaptation to clinical management. The final identification of the source document was done on the basis of the clinical judgement of the expert, the currency, the detail of the indications (recommendations), and the quality.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Participatory method</span><p id="par0085" class="elsevierStylePara elsevierViewall">A modified Delphi methodology was used (face to face or in real time). The group in charge of preparing the guidelines selected the experts with whom a meeting was then held on Thursday September 18, 2014, at the S.C.A.R.E. facilities. Overall, 28 experts in anaesthesiology and epidemiology participated.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The agenda of the meeting was the following:<ul class="elsevierStyleList" id="lis0095"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">i.</span><p id="par0095" class="elsevierStylePara elsevierViewall">Presentation of the project.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">ii.</span><p id="par0100" class="elsevierStylePara elsevierViewall">Delphi methodology.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">iii.</span><p id="par0105" class="elsevierStylePara elsevierViewall">Results of the evidence.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">iv.</span><p id="par0110" class="elsevierStylePara elsevierViewall">Protocol proposal.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">v.</span><p id="par0115" class="elsevierStylePara elsevierViewall">Vote.</p></li></ul></p><p id="par0595" class="elsevierStylePara elsevierViewall">A nine-category ordinal scale was developed to rate each of the questions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Bearing this in mind, each of the indications proposed was rated as recommended (appropriate), contraindicated (inappropriate) or within a level of uncertainty, in accordance with the median value of the answers given by the experts. Information on the degree of agreement or consensus was presented, together with the results of the response ranges for each of the questions. This rating was based on the descriptive method proposed by Sánchez et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">According to this methodology, the anonymous responses of the experts were collected first, and then the median and the extremes in the range of responses were calculated. When the extreme points in the range fell within one of the three regions of the scale (1–3; 4–6; 7–9), strong agreement was considered to exist and consensus was declared. When the extreme points in the range fell within two consecutive regions (1–3 and 4–6), a relative agreement was considered to exist. When the extreme points in the region were scattered between two non-consecutive regions (1–3 and 7–9) no consensus was considered to exist (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 2</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig. 3</a> shows the results of agreement among the participants in the consensus meeting.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Preparation and drafting of the final document</span><p id="par0140" class="elsevierStylePara elsevierViewall">A final protocol model document was prepared which included the justification for developing the document, the methodology used, and the adaptation of the proposed protocol, following the recommendations from the experts in the participatory method.</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">All of the participants in the writing group and in the expert consensus meeting filled and signed the disclosure form in accordance with the format and recommendation from the Cochrane group.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Copyright</span><p id="par0150" class="elsevierStylePara elsevierViewall">Permission was obtained for the use and translation of the guidelines contained in the series of manuals. Translation and partial reproduction were authorized by Lippincott Williams and Wilkins/Wolters Kluwer Health, Association of Anaesthetists of Great Britain & Ireland & the AAGBI Foundation.</p></span></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Rating of the evidence</span><p id="par0155" class="elsevierStylePara elsevierViewall">Three guidelines were selected, as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">As was described in the section on the methodology, the guidelines were assessed using the AGREE II tool. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 3</a> shows the results of the paired review by the authors. The PONV had a higher rating in most of the domains. However, the transfer guidelines reflect a significant gap in the rating of the third domain.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Postoperative nausea and vomiting (PONV) guidelines</span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Provision of antiemetic treatment for patients with PONV not receiving prophylaxis or for patients failing prevention regimens</span><p id="par0165" class="elsevierStylePara elsevierViewall">When PONV occurs after a surgical procedure, the treatment must use an anti-emetic of a different pharmacological class from the prophylactic agent given intra-operatively. If no anti-emetic prophylaxis is given, the recommendation for treatment is low-dose 5-HT antagonists.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Established alternative treatments for PONV include dexamethasone 2–4<span class="elsevierStyleHsp" style=""></span>mg IV, droperidol, 0.625<span class="elsevierStyleHsp" style=""></span>mg IV, or promethazine 6.25–12.05<span class="elsevierStyleHsp" style=""></span>mg IV. When necessary, propofol 20<span class="elsevierStyleHsp" style=""></span>mg IV may be considered for rescue therapy in patients in the PACU, and is as effective as ondansetron. However, the anti-emetic effect with low-dose propofol is probably short acting.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Aromatherapy with isopropyl alcohol was effective in achieving faster reduction of nausea severity compared to promethazine or ondansetron. However, the relevant studies had limitations and it is not clear whether this is an effective modality for achieving total control of PONV.</p><p id="par0180" class="elsevierStylePara elsevierViewall">A repeat dose for PONV prophylaxis given within the first six hours after the initial dose does not provide additional benefit. After more than six hours, it may be possible to achieve an effect with a second dose of an 5-HT3 antagonist or with the use of butyrophenones (droperidol and haloperidol), although this has not been demonstrated in clinical trials and must be tried only if triple therapy has been used for prophylaxis and if there are no alternatives available for rescue in those cases in which prophylaxis has not been used. The repeated administration of longer-acting drugs like dexamethasone, aprepitant and palonosetron is not recommended.</p><p id="par0185" class="elsevierStylePara elsevierViewall">The rescue attempt must be initiated when the patient presents with PONV and, at the same time, an assessment must be performed in order to rule out a medication or mechanical factor which may be causing nausea and vomiting. Contributing factors may include PCA (patient controlled analgesia) with opioids, blood drainage through the pharyngeal airway, or abdominal factors.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Nausea and vomiting after PACU or hospital discharge</span><p id="par0195" class="elsevierStylePara elsevierViewall">The combination of oral and IV anti-emetics at various time points in the perioperative period reduces this complication. A study found that dexamethasone 8<span class="elsevierStyleHsp" style=""></span>mg IV on induction plus ondansetron 4<span class="elsevierStyleHsp" style=""></span>mg IV at the end of surgery, plus oral ondansetron 8<span class="elsevierStyleHsp" style=""></span>mg after the operation, was more effective at reducing nausea and vomiting after discharge from the PACU or from the hospital than ondansetron 4<span class="elsevierStyleHsp" style=""></span>mg IV alone at the end of surgery.</p><p id="par0200" class="elsevierStylePara elsevierViewall">The combination of haloperidol 2.5<span class="elsevierStyleHsp" style=""></span>mg plus dexamethasone 5<span class="elsevierStyleHsp" style=""></span>mg IV after induction was more effective than droperidol 1.25<span class="elsevierStyleHsp" style=""></span>mg, haloperidol 2<span class="elsevierStyleHsp" style=""></span>mg, or dexamethasone 5<span class="elsevierStyleHsp" style=""></span>mg, alone. All of them were more effective than placebo.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Aprepitant 40<span class="elsevierStyleHsp" style=""></span>mg and 120<span class="elsevierStyleHsp" style=""></span>mg, and ondansetron 4<span class="elsevierStyleHsp" style=""></span>mg reduced PONV to a similar degree during the postoperative period between 0 and 24<span class="elsevierStyleHsp" style=""></span>h; however, 24–48<span class="elsevierStyleHsp" style=""></span>h after surgery, aprepitant 40<span class="elsevierStyleHsp" style=""></span>mg and 120<span class="elsevierStyleHsp" style=""></span>mg had a similar effect, and they were more effective than ondansetron 4<span class="elsevierStyleHsp" style=""></span>mg.</p><p id="par0210" class="elsevierStylePara elsevierViewall">The prophylactic administration of anti-emetics may be justified in patients at high risk of developing nausea and vomiting after PACU or hospital discharge. A systematic review showed that the use of propofol, compared to inhaled anaesthetics, also reduced the incidence of nausea and vomiting (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Some small RCTs have shown effectiveness for prevention with oral disintegration of ondansetron tablets and stimulation of the P6 acupuncture point.</p></span></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Adaptation of the PONV guidelines to the Colombian context</span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Consensus recommendations of Colombian anaesthetists</span><p id="par0220" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">•</span><p id="par0225" class="elsevierStylePara elsevierViewall">Another pharmacological management strategy for PONV is metoclopramide 10<span class="elsevierStyleHsp" style=""></span>mg IV. A recent meta-analysis reported that metoclopramide reduces the incidence of PONV within the first 24<span class="elsevierStyleHsp" style=""></span>h after surgery compared to the control (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.58; 95% CI (0.43–0.78).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Metoclopramide is an alternative to ondansetron and dexamethasone in countries that have experienced shortages of these latter agents or in situations where cost is a barrier to access.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">•</span><p id="par0230" class="elsevierStylePara elsevierViewall">Although ondansetron (IV and tablets) has been approved by INVIMA,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> it is listed in the Mandatory Health Plan (POS) for the indication of use in anti-neoplastic chemotherapy.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">•</span><p id="par0235" class="elsevierStylePara elsevierViewall">Granisetron, tropisetron, propofol, promethazine and droperidol are approved by INVIMA,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> but they are not on the POS schedule. Their availability in the clinical setting depends on local hospital factors.</p></li></ul></p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Post-operative pain guidelines</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Management techniques</span><p id="par0240" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0065"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">•</span><p id="par0245" class="elsevierStylePara elsevierViewall">Anaesthetists in charge of managing perioperative pain must use therapeutic options such as epidural or intra-thecal opioids, patient controlled analgesia (PCA) with systemic opioids, and regional techniques, after conducting an analysis and bearing in mind the risks and benefits for the individual patient.<ul class="elsevierStyleList" id="lis0100"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">–</span><p id="par0250" class="elsevierStylePara elsevierViewall">These modalities should be used preferably over IM opioids prescribed PRN.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">•</span><p id="par0255" class="elsevierStylePara elsevierViewall">The selected therapy must be based on the anaesthetist's own individual experience as well as on the ability to apply each modality safely in every scenario.<ul class="elsevierStyleList" id="lis0075"><li class="elsevierStyleListItem" id="lsti0280"><span class="elsevierStyleLabel">–</span><p id="par0555" class="elsevierStylePara elsevierViewall">This includes the ability to recognize and manage adverse events occurring after the initiation of therapy.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">•</span><p id="par0265" class="elsevierStylePara elsevierViewall">Care is required when using continuous infusion modalities because the cumulative effect of the drug may give rise to adverse events.</p></li></ul></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Multimodal techniques for pain management</span><p id="par0545" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">•</span><p id="par0275" class="elsevierStylePara elsevierViewall">Whenever possible, anaesthetists must use multimodal pain management approaches.<ul class="elsevierStyleList" id="lis0085"><li class="elsevierStyleListItem" id="lsti0285"><span class="elsevierStyleLabel">–</span><p id="par0560" class="elsevierStylePara elsevierViewall">Unless there is a contraindication, patients must receive a regimen based on a time scheme consisting of NSAIDs, COXIBs or acetaminophen and calcium-channel antagonists (gabapentin and pregabalin<a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">a</span></a>).</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">–</span><p id="par0285" class="elsevierStylePara elsevierViewall">A regional block with local anaesthetics must be considered.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">•</span><p id="par0290" class="elsevierStylePara elsevierViewall">Dose regimens must be given with the aim of optimizing efficacy and reducing the risk of adverse events down to a minimum.</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">•</span><p id="par0295" class="elsevierStylePara elsevierViewall">The choice of medication, route of administration, and duration of the therapy must be individualized.</p></li></ul></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Guidelines for the transfer of critically ill patients</span><p id="par0300" class="elsevierStylePara elsevierViewall">Transfer of critically ill patients may be required in three instances: pre-hospital transfer, inter-hospital transfer, and intra-hospital transfer.</p><p id="par0565" class="elsevierStylePara elsevierViewall">Aspects to consider:</p><p id="par0570" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Staff</span></p><p id="par0305" class="elsevierStylePara elsevierViewall">The team must be trained in all aspects of patient transfer and participate in quality and organization training activities, as well as continuous professional development. There must be at least one qualified nurse, an aide and a physician with the specific skills and training for this type of procedure.</p><p id="par0310" class="elsevierStylePara elsevierViewall">Every team must be familiar with the means used for transfer and have the necessary experience in airway management procedures, pulmonary ventilation, cardio-cerebro-pulmonary resuscitation and other foreseen emergency procedures.</p><p id="par0575" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Transfer</span></p><p id="par0315" class="elsevierStylePara elsevierViewall">With all forms of transfer, securing the airway, intravenous access and all the catheters, and providing adequate follow-up before exiting are all critical for effective transfers. Vital sign stabilization must occur before transfer.</p><p id="par0580" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Equipment</span></p><p id="par0320" class="elsevierStylePara elsevierViewall">The required equipment must include:</p><p id="par0325" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ventilation support equipment</span></p><p id="par0585" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0105"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">•</span><p id="par0330" class="elsevierStylePara elsevierViewall">Airway (oral, nasopharyngeal and supraglottic [laryngeal masks] airway management devices)</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">•</span><p id="par0335" class="elsevierStylePara elsevierViewall">Oxygen source, masks, nebulizer</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">•</span><p id="par0340" class="elsevierStylePara elsevierViewall">Self-inflatable bag or manual ventilation devices</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">•</span><p id="par0345" class="elsevierStylePara elsevierViewall">Positive end-expiratory pressure valve</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">•</span><p id="par0350" class="elsevierStylePara elsevierViewall">Suction devices</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">•</span><p id="par0355" class="elsevierStylePara elsevierViewall">Portable ventilator with disconnection and high pressure alarms</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">•</span><p id="par0360" class="elsevierStylePara elsevierViewall">Intubation devices and endotracheal tubes</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">•</span><p id="par0365" class="elsevierStylePara elsevierViewall">Emergency surgical airway equipment</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">•</span><p id="par0370" class="elsevierStylePara elsevierViewall">Difficult airway management equipment</p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">•</span><p id="par0375" class="elsevierStylePara elsevierViewall">Pleural drainage equipment</p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">•</span><p id="par0380" class="elsevierStylePara elsevierViewall">Oxygen supply for the longest estimated transfer time</p></li></ul></p><p id="par0385" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Circulatory support equipment</span><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">•</span><p id="par0390" class="elsevierStylePara elsevierViewall">Monitor/defibrillator</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">•</span><p id="par0395" class="elsevierStylePara elsevierViewall">Pulse oxymeter</p></li><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">•</span><p id="par0400" class="elsevierStylePara elsevierViewall">Aneroid sphygmomanometer with a range of cuff sizes</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">•</span><p id="par0405" class="elsevierStylePara elsevierViewall">Peripheral and central vascular cannulas</p></li><li class="elsevierStyleListItem" id="lsti0185"><span class="elsevierStyleLabel">•</span><p id="par0410" class="elsevierStylePara elsevierViewall">Intravenous fluids and pressure infusion set</p></li><li class="elsevierStyleListItem" id="lsti0190"><span class="elsevierStyleLabel">•</span><p id="par0415" class="elsevierStylePara elsevierViewall">Infusion pumps</p></li><li class="elsevierStyleListItem" id="lsti0195"><span class="elsevierStyleLabel">•</span><p id="par0420" class="elsevierStylePara elsevierViewall">Arterial cannulas and blood pressure transducer kit</p></li><li class="elsevierStyleListItem" id="lsti0200"><span class="elsevierStyleLabel">•</span><p id="par0425" class="elsevierStylePara elsevierViewall">Syringes and needles</p></li><li class="elsevierStyleListItem" id="lsti0205"><span class="elsevierStyleLabel">•</span><p id="par0430" class="elsevierStylePara elsevierViewall">Thoracotomy and pericardiocentesis equipment</p></li><li class="elsevierStyleListItem" id="lsti0210"><span class="elsevierStyleLabel">•</span><p id="par0435" class="elsevierStylePara elsevierViewall">Sharps container and a bag for biologic waste</p></li></ul></p><p id="par0440" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Other equipment</span><ul class="elsevierStyleList" id="lis0110"><li class="elsevierStyleListItem" id="lsti0215"><span class="elsevierStyleLabel">•</span><p id="par0445" class="elsevierStylePara elsevierViewall">Nasogastric tube and bag</p></li><li class="elsevierStyleListItem" id="lsti0220"><span class="elsevierStyleLabel">•</span><p id="par0450" class="elsevierStylePara elsevierViewall">Urinary drainage catheter and bag</p></li><li class="elsevierStyleListItem" id="lsti0225"><span class="elsevierStyleLabel">•</span><p id="par0455" class="elsevierStylePara elsevierViewall">Decongestant nasal spray</p></li><li class="elsevierStyleListItem" id="lsti0230"><span class="elsevierStyleLabel">•</span><p id="par0460" class="elsevierStylePara elsevierViewall">Instruments, sutures, gauze, antiseptic lotions, gloves</p></li><li class="elsevierStyleListItem" id="lsti0235"><span class="elsevierStyleLabel">•</span><p id="par0465" class="elsevierStylePara elsevierViewall">Thermal isolation and temperature control</p></li><li class="elsevierStyleListItem" id="lsti0240"><span class="elsevierStyleLabel">•</span><p id="par0470" class="elsevierStylePara elsevierViewall">Splints, spinal immobilization and physical integrity maintenance devices</p></li><li class="elsevierStyleListItem" id="lsti0245"><span class="elsevierStyleLabel">•</span><p id="par0475" class="elsevierStylePara elsevierViewall">Neonatal/paediatric/obstetric transfer equipment when applicable</p></li><li class="elsevierStyleListItem" id="lsti0250"><span class="elsevierStyleLabel">•</span><p id="par0480" class="elsevierStylePara elsevierViewall">Dressings, bandages, slings, splints and tape</p></li><li class="elsevierStyleListItem" id="lsti0255"><span class="elsevierStyleLabel">•</span><p id="par0485" class="elsevierStylePara elsevierViewall">Cutting scissors and portable flashlight</p></li><li class="elsevierStyleListItem" id="lsti0260"><span class="elsevierStyleLabel">•</span><p id="par0490" class="elsevierStylePara elsevierViewall">Use of personal protection gloves and goggles</p></li><li class="elsevierStyleListItem" id="lsti0265"><span class="elsevierStyleLabel">•</span><p id="par0495" class="elsevierStylePara elsevierViewall">Consider:</p></li></ul><ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0270"><span class="elsevierStyleLabel">–</span><p id="par0500" class="elsevierStylePara elsevierViewall">Alternative vascular access such as intra-osseous devices for adults and children</p></li><li class="elsevierStyleListItem" id="lsti0275"><span class="elsevierStyleLabel">–</span><p id="par0505" class="elsevierStylePara elsevierViewall">Blood for transfusion in case it is indicated</p></li></ul><span class="elsevierStyleBold">Pharmacological agents</span></p><p id="par0510" class="elsevierStylePara elsevierViewall">All medications must be checked and labelled clearly before administration. The range of medications available must include all those required for the treatment of life-threatening medical emergencies and for the treatment of the patient's individual clinical condition.</p></span></span></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Discussion</span><p id="par0515" class="elsevierStylePara elsevierViewall">The focus of this document is the treatment in adult patients of the two most common perioperative complications: PONV and acute post-operative pain. They have both been studied in different populations and management strategies have been published for the management of specific surgical procedures.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16–19</span></a> There are reports in the literature on the use of protocols for Enhanced Recovery after Surgery (ERAS) which still are in need of additional information for the assessment of assess their clinical usefulness.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Although they are important tools, they must evolve continuously.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0520" class="elsevierStylePara elsevierViewall">The European Society of Regional Anaesthesia and Pain Therapy developed the Procedure Specific Postoperative Pain Management (PROSPECT) initiative to establish specific treatment strategies for post-operative pain management on the basis of the individual surgical procedure.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The adaptation of these initiatives to the Colombian setting is an important strategy for tackling a problem that still prevails in our operating rooms, considering that acute pain is frequently underestimated and inadequately treated.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The published international guidelines on post-operative pain management, used as the basis for this Manual, contain several general recommendations for approaching the management of post-operative pain. Depending on the context and the specific logistic conditions of each institution, these recommendations ought to be considered an integral part of institutional and patient care policies. These guidelines do not make concrete recommendations (e.g., the use of a specific drug), but rather emphasize the importance of the process more so than of the specific interventions.</p><p id="par0525" class="elsevierStylePara elsevierViewall">The guidelines for the management of PONV focus in particular on the perioperative situation and consider the individual risk factors reported in the literature (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 4</a>). The full adaptation of the pharmacological management to the Colombian context poses some difficulty, given the limited availability of certain drugs (e.g., transdermal scopolamine). Moreover, other pharmacological compounds recommended by international guidelines are not included in the Colombian Mandatory Healthcare Plan (POS).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> These are described in this document because they are approved by INVIMA and may, therefore, be marketed in this country and used in clinical practice depending on individual hospital settings (<a class="elsevierStyleCrossRef" href="#fig5">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig5"></elsevierMultimedia><p id="par0530" class="elsevierStylePara elsevierViewall">The expert consensus meeting ratified the need to include in the recommendations the use of metoclopramide for the management of PONV. Although this medication was not included in the guidelines described, a recent meta-analysis has reported its effectiveness in the reduction of this complication. This analysis did not include the studies by Fujii, which were challenged on the grounds of validity.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Consequently, the use of metoclopramide is reaffirmed for the Colombian context, particularly because of the high cost of other anti-emetic drugs or because of their non-inclusion in the POS listing.</p><p id="par0535" class="elsevierStylePara elsevierViewall">The description regarding transfer of critically ill patients compiles the information required at an international level. The guidelines include items pertaining to pre-, intra, and inter-hospital transfers. This document focused on recommendations pertaining to staff and equipment required for intra-hospital transfers, based on information endorsed by experts from Australia and New Zealand.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> It is important to develop guidelines specifically adapted for local settings, bearing in mind the peculiarities of the level of care and the limitations inherent to the healthcare system.</p><p id="par0540" class="elsevierStylePara elsevierViewall">There is a need to set up organized teams to work on a continuous basis updating the information related to the management of post-operative complications. It is important to conduct studies describing the use of protocols and checklists at a national level in order to obtain information about weaknesses and opportunities for improving patient safety in anaesthesia. Consequently, direct healthcare providers must do the job of updating the appropriate pharmacological and non-pharmacological strategies for the management of complications using a multidisciplinary approach.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflicts of interest</span><p id="par0590" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres412678" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec388403" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres412677" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Materiales y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec388402" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methodology" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Team membership" ] 1 => array:3 [ "identificador" => "sec0020" "titulo" => "Systematic review of the secondary literature" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Search strategy" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Selection of the evidence" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Quality assessment" ] ] ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Participatory method" ] 3 => array:3 [ "identificador" => "sec0125" "titulo" => "Preparation and drafting of the final document" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Copyright" ] ] ] ] ] 6 => array:3 [ "identificador" => "sec0055" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Rating of the evidence" ] 1 => array:3 [ "identificador" => "sec0065" "titulo" => "Postoperative nausea and vomiting (PONV) guidelines" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0130" "titulo" => "Provision of antiemetic treatment for patients with PONV not receiving prophylaxis or for patients failing prevention regimens" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Nausea and vomiting after PACU or hospital discharge" ] ] ] 2 => array:3 [ "identificador" => "sec0135" "titulo" => "Adaptation of the PONV guidelines to the Colombian context" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0140" "titulo" => "Consensus recommendations of Colombian anaesthetists" ] ] ] 3 => array:3 [ "identificador" => "sec0075" "titulo" => "Post-operative pain guidelines" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Management techniques" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "Multimodal techniques for pain management" ] 2 => array:2 [ "identificador" => "sec0090" "titulo" => "Guidelines for the transfer of critically ill patients" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0120" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0145" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-10-06" "fechaAceptado" => "2014-10-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec388403" "palabras" => array:5 [ 0 => "Postoperative complications" 1 => "Pain, postoperative" 2 => "Postoperative nausea and vomiting" 3 => "Transportation of patients" 4 => "Patient safety" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec388402" "palabras" => array:5 [ 0 => "Complicaciones postoperatorias" 1 => "Dolor postoperatorio" 2 => "Náusea y vómito postoperatorios" 3 => "Transporte de pacientes" 4 => "Seguridad del paciente" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Despite advances in perioperative management, acute pain and postoperative nausea and vomiting continue to be significant complications worldwide. The frequency and the implications of these complications for the process of recovery impact clinical findings, patient quality of care, and hospital costs.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A search and systematic review of the literature after 2011 was conducted. Three international guidelines were selected and they were paired-rated for quality using the AGREE II tool. Management recommendations, adjusted to the Colombian setting, were adopted on the basis of expert consensus, using the Delphi methodology.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Recommendations were generated for adult patients based on the international pain management guidelines for acute pain, postoperative nausea and vomiting, and transfer of critically ill patients. Some of the recommendations are of general nature while others are specific for particular situations. They were all adapted to the Colombian context, bearing in mind the use of drugs which have not received approval from the healthcare authorities or which are not included in the Mandatory Healthcare Plan.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Updating and standardizing clinical management recommendations based on the literature on international guidelines is a useful process, provided it is adapted to the national context. This process and its outcome may be useful for healthcare providers and has a positive effect on patient safety, practitioner performance and efficient use of resources.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A pesar de los avances en el manejo perioperatorio, el dolor agudo y las náuseas y vómito posoperatorio aún son importantes complicaciones a nivel mundial. Su frecuencia de presentación y el grado de afectación en el proceso de recuperación impactan aspectos clínicos, la calidad de la atención de los pacientes y los costos hospitalarios.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Materiales y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó búsqueda y revisión sistemática de la literatura a partir de 2011. Se seleccionaron tres guías internacionales y se calificó la calidad de manera pareada con el instrumento AGREE II. Mediante consenso de expertos y utilizando metodología Delphi, se adaptaron las recomendaciones de manejo adaptadas al medio colombiano.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se generaron recomendaciones para pacientes adultos extraídas de las guías de manejo internacional de dolor agudo, náuseas y vómito posoperatorio y transporte de paciente complicado. Algunas de las recomendaciones son generales y otras especificas para situaciones particulares. Todas fueron adaptadas al contexto colombiano teniendo en cuenta medicamentos que no cuentan con registro sanitario o no están incluidos en el Plan Obligatorio de Salud.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La actualización y estandarización de recomendaciones de manejo clínico basadas en la literatura de guías internacionales es un proceso útil siempre y cuando se adapte al contexto nacional. Este proceso y su resultado puede ser utilizado por prestadores de salud e impactar positivamente la seguridad del paciente, el desempeño de los profesionales sanitarios y la eficiencia de los recursos.</p>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Calvache JA, Leon E, Gomez LM, Garcia C, Torres M, Buitrago G, et al. Recomendaciones basadas en la evidencia del manejo de complicaciones posquirúrgicas en el contexto colombiano. Rev Colomb Anestesiol. 2015;43:51–60.</p>" ] 1 => array:2 [ "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Although gabapentin and pregabaline are approved by INVIma, they are not listed in the Mandatory Healthcare Plan (POS).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Sanchez et al." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 327 "Ancho" => 2501 "Tamanyo" => 48920 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Rating scale for real-time use during the Delphi exercise.</p>" ] ] 1 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 858 "Ancho" => 1573 "Tamanyo" => 82719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Results related to the manual presented.</p>" ] ] 2 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1761 "Ancho" => 2332 "Tamanyo" => 230089 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Quality assessment of the guidelines used for the post-operative complications manual.</p>" ] ] 3 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3699 "Ancho" => 2574 "Tamanyo" => 320796 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Algorithm for the identification of PONV risk.</p>" ] ] 4 => array:8 [ "identificador" => "fig5" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 3856 "Ancho" => 1732 "Tamanyo" => 317002 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Management algorithm for patients with PONV who do not receive prophylaxis or with no prevention regimens.</p> <p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">* Do not readminister dexamethasone or aprepitant.</p> <p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">PAC: Patient Controlled Analgesia, PONV: Post-operative nausea and vomiting.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Name \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Developer group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Language \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Year of publication – update \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Consensus guidelines for the management of postoperative nausea and vomiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">International Anaesthesia Research Society \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">English \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Practice guidelines for acute pain management in the perioperative setting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">American Society of Anesthesiologists \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">English \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Guidelines for transport of critically ill patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Australasian College for Emergency Medicine (ACEM), Australian and New Zealand College of Anaesthetists (ANZCA), College of Intensive Care Medicine of Australia and New Zealand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">English \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab642076.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Guidelines for the management of post-operative complications.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of acute postoperative pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.L. Wu" 1 => "S.N. Raja" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(11)60245-6" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2011" "volumen" => "377" "paginaInicial" => "2215" "paginaFinal" => "2225" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21704871" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of differentiating between elective and emergency postoperative critical care patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Weissman" 1 => "N. Klein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrc.2007.10.039" "Revista" => array:6 [ "tituloSerie" => "J Crit Care" "fecha" => "2008" "volumen" => "23" "paginaInicial" => "308" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18725034" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "WHO surgical safety checklist implementation" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2009" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A clinical pathway in a post-anaesthesia care unit to reduce length of stay, mortality and unplanned intensive care unit admission" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.-S. Eichenberger" 1 => "G. Haller" 2 => "N. Cheseaux" 3 => "V. Lechappe" 4 => "P. Garnerin" 5 => "B. Walder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/EJA.0b013e328347dff5" "Revista" => array:6 [ "tituloSerie" => "Eur J Anaesthesiol" "fecha" => "2011" "volumen" => "28" "paginaInicial" => "859" "paginaFinal" => "866" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21885983" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Dolor posoperatorio en España. Primer documento de consenso. AEC, GEDOS, SEDAR y SED 2005 [Internet]. 2005 [cited 2014 September 9]. Available from: <a href="http://www.aecirujanos.es/libreria_virtual/Documento_consenso_dolor_postoperatorio.pdf">http://www.aecirujanos.es/libreria_virtual/Documento_consenso_dolor_postoperatorio.pdf</a>." ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de dolor agudo posoperatorio y calidad de la recuperación en el Hospital Universitario San Vicente de Paúl, Medellín, Colombia, 2007" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Cadavid" 1 => "J. Mendoza" 2 => "N. Gómez" 3 => "M. Berrío" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "IATREA Rev Méd Univ Antioquia" "fecha" => "2009" "volumen" => "22" "paginaInicial" => "11" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21267112" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidencia de dolor severo post-operatorio en el Hospital Universitario San José de Popayán. Informe preliminar. En paginación" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Muñoz" 1 => "N. Romero" 2 => "J. Calvache" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2014" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Estamos controlando el dolor posquirúrgico?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Machado" 1 => "M. Machado" 2 => "V. Calderón" 3 => "A. Gonzalez" 4 => "F. Escobar" 5 => "R. García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Colomb Anestesiol" "fecha" => "2013" "volumen" => "41" "paginaInicial" => "2132" "paginaFinal" => "2138" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "American Society of Anesthesiologists Task Force on Acute Pain Management" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e31823c1030" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2012" "volumen" => "116" "paginaInicial" => "248" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22227789" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus guidelines for the management of postoperative nausea and vomiting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.J. Gan" 1 => "P. Diemunsch" 2 => "A.S. Habib" 3 => "A. Kovac" 4 => "P. Kranke" 5 => "T.A. Meyer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000000002" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2014" "volumen" => "118" "paginaInicial" => "85" "paginaFinal" => "113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24356162" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manejo de lasnáuseas y vómitos postoperatorios" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Villegas" 1 => "J. García" 2 => "J. Aguayo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cir Esp" "fecha" => "2010" "volumen" => "886" "paginaInicial" => "369" "paginaFinal" => "373" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metodología de calificación y resumen de las opiniones dentro de consensos formales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Sánchez" 1 => "L. Jaramillo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Colomb Psiquiatr" "fecha" => "2009" "volumen" => "38" "paginaInicial" => "777" "paginaFinal" => "785" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic metoclopramide to prevent postoperative nausea and vomiting: a meta-analysis without Fujii's studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G.S. De Oliveira" 1 => "L.J. Castro-Alves" 2 => "R. Chang" 3 => "E. Yaghmour" 4 => "R.J. McCarthy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aes325" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2012" "volumen" => "109" "paginaInicial" => "688" "paginaFinal" => "697" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23015617" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Instituto Nacional de Vigilancia de Medicamentos y Alimentos, Invima [Internet]. Available from: <a href="http://web.sivicos.gov.co:8080/consultas/consultas/consreg_encabcum.jsp">http://web.sivicos.gov.co:8080/consultas/consultas/consreg_encabcum.jsp</a>. Accessed: September 1, 2014." ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de salud y Protección Social. Colombia. Resolución 5521 de 2013. Actualización Plan Obligatorio de Salud (POS) [Internet]. Available from: <a href="http://www.minsalud.gov.co/salud/POS/Actualizacin%20POS%202014/ANEXO%2001.pdf">http://www.minsalud.gov.co/salud/POS/Actualizacin%20POS%202014/ANEXO%2001.pdf</a>. Accessed: September 1, 2014." ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peri-operative care of the elderly 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Griffiths" 1 => "F. Beech" 2 => "A. Brown" 3 => "J. Dhesi" 4 => "I. Foo" 5 => "J. Goodall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.12524" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2014" "volumen" => "69" "paginaInicial" => "81" "paginaFinal" => "98" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24303864" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Palonosetron and aprepitant for the prevention of postoperative nausea and vomiting in patients indicated for laparoscopic gynaecologic surgery: a double-blind randomised trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.Y. Moon" 1 => "C.W. Baek" 2 => "G.J. Choi" 3 => "H.Y. Shin" 4 => "H. Kang" 5 => "Y.H. Jung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2253-14-68" "Revista" => array:5 [ "tituloSerie" => "BMC Anesthesiol" "fecha" => "2014" "volumen" => "14" "paginaInicial" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25165427" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single-dose aprepitant vs ondansetron for the prevention of postoperative nausea and vomiting: a randomized, double-blind phase III trial in patients undergoing open abdominal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Diemunsch" 1 => "T.J. Gan" 2 => "B.K. Philip" 3 => "M.J. Girao" 4 => "L. Eberhart" 5 => "M.G. Irwin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aem133" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2007" "volumen" => "99" "paginaInicial" => "202" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17540667" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with a broad range of moderately emetogenic chemotherapies and tumor types: a randomized, double-blind study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.L. Rapoport" 1 => "K. Jordan" 2 => "J.A. Boice" 3 => "A. Taylor" 4 => "C. Brown" 5 => "J.S. Hardwick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Support Care Cancer Off J Multinatl Assoc Support Care Cancer" "fecha" => "2010" "volumen" => "18" "paginaInicial" => "423" "paginaFinal" => "431" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fast track surgery versus conventional recovery strategies for colorectal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.R. Spanjersberg" 1 => "J. Reurings" 2 => "F. Keus" 3 => "C.J. van Laarhoven" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2011" "paginaInicial" => "CD350076" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fast-track surgery – conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Hoffmann" 1 => "C. Kettelhack" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Surg Res Eur Chir Forsch Rech Chir Eur" "fecha" => "2012" "volumen" => "49" "paginaInicial" => "24" "paginaFinal" => "34" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Procedure specific postoperative pain management, PROSPECT [Internet]. Available from: <a href="http://www.postoppain.org/frameset.htm">http://www.postoppain.org/frameset.htm</a>. Accessed: September 1, 2014." ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Guidelines for transport of critically ill patients. Australasian College for Emergency Medicine (ACEM) Australian and New Zealand College of Anaesthetists (ANZCA) College of Intensive Care Medicine of Australia and New Zealand (CICM) [Internet]. 2013 [cited 2014 Sep 22]. Available from: <a href="http://www.anzca.edu.au/resources/professional-documents/pdfs/ps52-2013-guidelines-for-transport-of-critically-ill-patients.pdf">http://www.anzca.edu.au/resources/professional-documents/pdfs/ps52-2013-guidelines-for-transport-of-critically-ill-patients.pdf</a>." ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Por qué las Unidades del Dolor deben ser multidisciplinarias?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.J. Robaina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Soc Esp Dolor" "fecha" => "2005" "volumen" => "12" "paginaInicial" => "137" "paginaFinal" => "140" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22562087/0000004300000001/v1_201501210932/S2256208714001230/v1_201501210932/en/main.assets" "Apartado" => array:4 [ "identificador" => "955" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Guidelines and consensus" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22562087/0000004300000001/v1_201501210932/S2256208714001230/v1_201501210932/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208714001230?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 33 | 7 | 40 |
| 2024 September | 63 | 6 | 69 |
| 2024 August | 50 | 7 | 57 |
| 2024 July | 39 | 9 | 48 |
| 2024 June | 59 | 5 | 64 |
| 2024 May | 43 | 1 | 44 |
| 2024 April | 47 | 9 | 56 |
| 2024 March | 68 | 6 | 74 |
| 2024 February | 57 | 5 | 62 |
| 2024 January | 113 | 10 | 123 |
| 2023 December | 86 | 20 | 106 |
| 2023 November | 82 | 10 | 92 |
| 2023 October | 134 | 9 | 143 |
| 2023 September | 76 | 5 | 81 |
| 2023 August | 36 | 6 | 42 |
| 2023 July | 60 | 9 | 69 |
| 2023 June | 39 | 11 | 50 |
| 2023 May | 89 | 14 | 103 |
| 2023 April | 58 | 6 | 64 |
| 2023 March | 48 | 11 | 59 |
| 2023 February | 31 | 9 | 40 |
| 2023 January | 35 | 3 | 38 |
| 2022 December | 45 | 5 | 50 |
| 2022 November | 52 | 5 | 57 |
| 2022 October | 39 | 4 | 43 |
| 2022 September | 48 | 19 | 67 |
| 2022 August | 26 | 10 | 36 |
| 2022 July | 18 | 6 | 24 |
| 2022 June | 17 | 6 | 23 |
| 2022 May | 14 | 9 | 23 |
| 2022 April | 28 | 3 | 31 |
| 2022 March | 43 | 20 | 63 |
| 2022 February | 54 | 5 | 59 |
| 2022 January | 66 | 12 | 78 |
| 2021 December | 41 | 9 | 50 |
| 2021 November | 43 | 8 | 51 |
| 2021 October | 22 | 11 | 33 |
| 2021 September | 25 | 13 | 38 |
| 2021 August | 15 | 6 | 21 |
| 2021 July | 21 | 12 | 33 |
| 2021 June | 22 | 11 | 33 |
| 2021 May | 37 | 9 | 46 |
| 2021 April | 56 | 26 | 82 |
| 2021 March | 49 | 6 | 55 |
| 2021 February | 31 | 5 | 36 |
| 2021 January | 17 | 12 | 29 |
| 2020 December | 40 | 4 | 44 |
| 2020 November | 22 | 9 | 31 |
| 2020 October | 7 | 7 | 14 |
| 2020 September | 12 | 6 | 18 |
| 2020 August | 15 | 11 | 26 |
| 2020 July | 10 | 9 | 19 |
| 2020 June | 7 | 1 | 8 |
| 2020 May | 17 | 4 | 21 |
| 2020 April | 6 | 3 | 9 |
| 2020 March | 9 | 0 | 9 |
| 2020 February | 13 | 3 | 16 |
| 2020 January | 10 | 2 | 12 |
| 2019 December | 14 | 10 | 24 |
| 2019 November | 8 | 4 | 12 |
| 2019 October | 2 | 1 | 3 |
| 2019 September | 5 | 1 | 6 |
| 2019 August | 1 | 0 | 1 |
| 2019 July | 4 | 3 | 7 |
| 2019 June | 1 | 5 | 6 |
| 2019 May | 2 | 12 | 14 |
| 2018 December | 1 | 0 | 1 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 12 | 1 | 13 |
| 2018 May | 49 | 7 | 56 |
| 2018 April | 59 | 4 | 63 |
| 2018 March | 50 | 10 | 60 |
| 2018 February | 38 | 6 | 44 |
| 2018 January | 47 | 6 | 53 |
| 2017 December | 32 | 4 | 36 |
| 2017 November | 42 | 3 | 45 |
| 2017 October | 57 | 9 | 66 |
| 2017 September | 118 | 13 | 131 |
| 2017 August | 104 | 6 | 110 |
| 2017 July | 83 | 3 | 86 |
| 2017 June | 95 | 4 | 99 |
| 2017 May | 111 | 9 | 120 |
| 2017 April | 91 | 17 | 108 |
| 2017 March | 75 | 5 | 80 |
| 2017 February | 54 | 5 | 59 |
| 2017 January | 44 | 10 | 54 |
| 2016 December | 69 | 15 | 84 |
| 2016 November | 84 | 8 | 92 |
| 2016 October | 123 | 7 | 130 |
| 2016 September | 160 | 11 | 171 |
| 2016 August | 69 | 7 | 76 |
| 2016 July | 34 | 10 | 44 |
| 2016 June | 0 | 14 | 14 |
| 2016 May | 2 | 13 | 15 |
| 2016 April | 4 | 0 | 4 |
| 2016 March | 4 | 20 | 24 |
| 2016 February | 6 | 19 | 25 |
| 2015 December | 21 | 0 | 21 |
| 2015 November | 78 | 12 | 90 |
| 2015 October | 137 | 16 | 153 |
| 2015 September | 71 | 9 | 80 |
| 2015 August | 66 | 6 | 72 |
| 2015 July | 67 | 12 | 79 |
| 2015 June | 52 | 7 | 59 |
| 2015 May | 73 | 5 | 78 |
| 2015 April | 78 | 14 | 92 |
| 2015 March | 83 | 21 | 104 |
| 2015 February | 99 | 23 | 122 |
| 2015 January | 60 | 10 | 70 |
Show all