COVID-19
Regístrese
covid
Colombian Journal of Anesthesiology
Buscar en
Colombian Journal of Anesthesiology
Toda la web
Inicio Colombian Journal of Anesthesiology Evidence-based clinical practice manual: Postoperative controls
Journal Information
Back to article

Statistics

Follow this link to access the full text of the article

Guidelines and consensus
Evidence-based clinical practice manual: Postoperative controls
Manual de práctica clínica basado en la evidencia: controles posquirúrgicos
Cristina Alexandra Benavides Caroa, Franklyn Edwin Prieto Alvaradob,
Corresponding author
franklyn.prieto@gmail.com

Corresponding author at: Calle 22B, No. 66-46 Consultorios 403–404, Clínica Universitaria Colombia, Bogotá, Colombia.
, Marcela Torresc, Giancarlo Buitragod, Hernando Gaitán Duartee, Cecilia Garcíae, Luz María Gómez Buitragof
a Anesthesiologist MD – Specialist in Bioethics, Clínica Universitaria Colombia, Bogotá, Colombia
b Epidemiologist MD, Public Health MSc, Bioethics MSc, Universidad Nacional de Colombia, Bogotá, Colombia
c Pharmacist Chemist, Clinical Epidemiology MSc, Editorial Manager, Cochrane Sexually Transmitted Infections Group, Universidad Nacional de Colombia, Bogotá, Colombia
d Medical Doctor, Clinical Epidemiology MSc, Master in Economics, IECAS, Universidad Nacional de Colombia, Bogotá, Colombia
e Medical Doctor Specialist, Clinical Epidemiology MSc, Technology Evaluation and Health Policies Group, Universidad Nacional de Colombia, Bogotá, Colombia
f Anesthesiologist MD, Epidemiology MSc, Head of the Medical Advisory Department S.C.A.R.E, Researcher at the Technological Development Center S.C.A.R.E., Bogotá, Colombia
Read
6738
Times
was read the article
1055
Total PDF
5683
Total HTML
Share statistics
 array:24 [
  "pii" => "S2256208714001266"
  "issn" => "22562087"
  "doi" => "10.1016/j.rcae.2014.11.001"
  "estado" => "S300"
  "fechaPublicacion" => "2015-01-01"
  "aid" => "185"
  "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;43:20-31"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3332
    "formatos" => array:3 [
      "EPUB" => 93
      "HTML" => 2798
      "PDF" => 441
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0120334714001440"
      "issn" => "01203347"
      "doi" => "10.1016/j.rca.2014.10.008"
      "estado" => "S300"
      "fechaPublicacion" => "2015-01-01"
      "aid" => "185"
      "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;43:20-31"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 28502
        "formatos" => array:3 [
          "EPUB" => 88
          "HTML" => 10742
          "PDF" => 17672
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Gu&#237;as y consensos</span>"
        "titulo" => "Manual de pr&#225;ctica cl&#237;nica basado en la evidencia&#58; Controles posquir&#250;rgicos"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "20"
            "paginaFinal" => "31"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Evidence-based clinical practice manual&#58; Postoperative controls"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "fuente" => "Fuente&#58; autores&#46;"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 956
                "Ancho" => 1638
                "Tamanyo" => 86777
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Resultados del acuerdo con relaci&#243;n al manual presentado&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Cristina Alexandra Benavides Caro, Franklyn Edwin Prieto Alvarado, Marcela Torres, Giancarlo Buitrago, Hernando Gait&#225;n Duarte, Cecilia Garc&#237;a, Luz Mar&#237;a G&#243;mez Buitrago"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "Cristina Alexandra"
                "apellidos" => "Benavides Caro"
              ]
              1 => array:2 [
                "nombre" => "Franklyn Edwin"
                "apellidos" => "Prieto Alvarado"
              ]
              2 => array:2 [
                "nombre" => "Marcela"
                "apellidos" => "Torres"
              ]
              3 => array:2 [
                "nombre" => "Giancarlo"
                "apellidos" => "Buitrago"
              ]
              4 => array:2 [
                "nombre" => "Hernando"
                "apellidos" => "Gait&#225;n Duarte"
              ]
              5 => array:2 [
                "nombre" => "Cecilia"
                "apellidos" => "Garc&#237;a"
              ]
              6 => array:2 [
                "nombre" => "Luz Mar&#237;a"
                "apellidos" => "G&#243;mez Buitrago"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2256208714001266"
          "doi" => "10.1016/j.rcae.2014.11.001"
          "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/S2256208714001266?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334714001440?idApp=UINPBA00004N"
      "url" => "/01203347/0000004300000001/v2_201706012200/S0120334714001440/v2_201706012200/es/main.assets"
    ]
  ]
  "itemSiguiente" => 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 Anestesiolog&#237;a y Reanimaci&#243;n"
    "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"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2256208714001229"
    "issn" => "22562087"
    "doi" => "10.1016/j.rcae.2014.10.009"
    "estado" => "S300"
    "fechaPublicacion" => "2015-01-01"
    "aid" => "181"
    "copyright" => "Sociedad Colombiana de Anestesiolog&#237;a y Reanimaci&#243;n"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "pgl"
    "cita" => "Rev Colomb Anestesiol. 2015;43:9-19"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3312
      "formatos" => array:3 [
        "EPUB" => 88
        "HTML" => 2546
        "PDF" => 678
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Guidelines and consensus</span>"
      "titulo" => "Evidence-based clinical practice manual: Cardiopulmonary-cerebral resuscitation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "9"
          "paginaFinal" => "19"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Manual de práctica clínica basado en la evidencia: Reanimación cardiocerebropulmonar"
        ]
      ]
      "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" => "fig0015"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "fuente" => "<span class="elsevierStyleItalic">Source</span>: Adapted of (8)."
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1428
              "Ancho" => 2500
              "Tamanyo" => 265560
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Chain of Survival</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "José Ricardo-Navarro Vargas, Hernando Matiz-Camacho, Javier Osorio-Esquivel"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "José"
              "apellidos" => "Ricardo-Navarro Vargas"
            ]
            1 => array:2 [
              "nombre" => "Hernando"
              "apellidos" => "Matiz-Camacho"
            ]
            2 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Osorio-Esquivel"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0120334714001403"
        "doi" => "10.1016/j.rca.2014.10.004"
        "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/S0120334714001403?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208714001229?idApp=UINPBA00004N"
    "url" => "/22562087/0000004300000001/v1_201501210932/S2256208714001229/v1_201501210932/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Guidelines and consensus</span>"
    "titulo" => "Evidence-based clinical practice manual: Postoperative controls"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "20"
        "paginaFinal" => "31"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Cristina Alexandra Benavides Caro, Franklyn Edwin Prieto Alvarado, Marcela Torres, Giancarlo Buitrago, Hernando Gaitán Duarte, Cecilia García, Luz María Gómez Buitrago"
        "autores" => array:7 [
          0 => array:3 [
            "nombre" => "Cristina Alexandra"
            "apellidos" => "Benavides Caro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Franklyn Edwin"
            "apellidos" => "Prieto Alvarado"
            "email" => array:1 [
              0 => "franklyn.prieto@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Marcela"
            "apellidos" => "Torres"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Giancarlo"
            "apellidos" => "Buitrago"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Hernando"
            "apellidos" => "Gaitán Duarte"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Cecilia"
            "apellidos" => "García"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Luz María"
            "apellidos" => "Gómez Buitrago"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:6 [
          0 => array:3 [
            "entidad" => "Anesthesiologist MD &#8211; Specialist in Bioethics, Clínica Universitaria Colombia, Bogotá, Colombia"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Epidemiologist MD, Public Health MSc, Bioethics MSc, Universidad Nacional de Colombia, Bogotá, Colombia"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Pharmacist Chemist, Clinical Epidemiology MSc, Editorial Manager, Cochrane Sexually Transmitted Infections Group, Universidad Nacional de Colombia, Bogotá, Colombia"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Medical Doctor, Clinical Epidemiology MSc, Master in Economics, IECAS, Universidad Nacional de Colombia, Bogotá, Colombia"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Medical Doctor Specialist, Clinical Epidemiology MSc, Technology Evaluation and Health Policies Group, Universidad Nacional de Colombia, Bogotá, Colombia"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Anesthesiologist MD, Epidemiology MSc, Head of the Medical Advisory Department S.C.A.R.E, Researcher at the Technological Development Center S.C.A.R.E., Bogotá, Colombia"
            "etiqueta" => "f"
            "identificador" => "aff0035"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>: Calle 22B, No. 66-46 Consultorios 403&#8211;404, Clínica Universitaria Colombia, Bogotá, Colombia."
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Manual de práctica clínica basado en la evidencia: controles posquirúrgicos"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 956
            "Ancho" => 1638
            "Tamanyo" => 80245
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Results related to the manual presented.</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Source: Authors.</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The practice of anesthesiology has made considerable progress in terms of patient safety. The drop in surgery, anesthesia and perioperative care-associated mortality has been possible trough mechanisms such as improved monitoring techniques, the development and dissemination of clinical practice guidelines and other systematic approaches aimed at reducing the number of errors.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A meta-analysis including 87 trials measuring mortality in over 3000 patients &#8211; out of 21.4 million that received general anesthesia for a surgical procedure &#8211; found that the anesthesia-related mortality has decreased from 357 per million (95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>324&#8211;394) from 1960 to 1969 to 52 per million during the first decade of this current century. The contribution of anesthesia to perioperative mortality prior to 1980 was 3.4% and dropped to 2.9% between 2000 and 2009. The least developed countries exhibit a 5.49 fold risk of dying from anesthesia.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Another meta-analysis reported a reduction in perioperative mortality between 1954 and 2006 and when comparing Brazil&#39;s perioperative mortality against the developed countries, no differences were found.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The registry trial of 1.37 million elective surgeries in Germany (ASA I and II), from 1999 to 2010, indicated that 26.2 of every million patients operated on, experienced a serious complication or died (95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19.4&#8211;34.6). Of these latter patients, 7.3 of every million could be associated with anesthesia or with problems related to the anesthesiologist care (95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.9&#8211;12.3). Only one case out of eighty was due to post-anesthesia care problems.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The most frequent complications in postoperative care units are nausea and vomiting, with an incidence rate between 10 and 30%.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A retrospective trial including 18.473 patients detected 23% complications: 6.9% of upper respiratory tract problems; 2.7% hypotension; 1.4% dysrhythmias; 1.1% hypertension; 0.6% altered mental status and 0.6% of major cardiac events.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Oxygen desaturation is one of the most frequent major problems.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Postoperative complications affect the survival of both major surgery patients and the elderly.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> During the first days after surgery, complications such as lung failure, acute myocardial infarction, bleeding, acute heart failure and delirium may be identified.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> It has been reported than 19.3% of unplanned admissions to the ICU are related to anesthesia and that 5.4% could be prevented. However, according to the findings, 52% of those admissions may be due to anesthesia and between 74 and 92% could be prevented.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">An adequate postoperative approach results in a considerable increase in survival and reduces adverse events and unplanned ICU admissions. This handbook includes the key aspects that should be kept in mind for such adequate approach. The implementation of post-anesthesia care protocols contributes to reduce the hospital stay, the complications, the mortality and unplanned critical care admissions.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Postoperative or post-anesthesia care was defined as the care administered at a postoperative care unit. This care must be improved so that the patient begins to recover or for an adequate transfer to more complex care units.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The prevention of complications in this unit may lead to early discharge and availability of beds to admit patients from the ORs. Whenever complications arise, patients require timely intervention or the decision is made to transfer them to more complex care units.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A key condition for improved efficacy is the balance between the care provided to those patients that need extra care and those that do not. The handbook of Postsurgical Controls includes a set of recommendations based on the concepts of the American Society of Anesthesia,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> trough a process of adaptation of clinical care guidelines. Initially some considerations following anesthesia are discussed, and then the key aspects regarding the patient&#39;s admission to the PACU, his/her evaluation and monitoring. The second part of the handbook focuses on the prophylaxis or treatment for nausea and vomiting; treatment during emergency situations and the recovery from anesthesia, including the use of antagonists for sedatives, analgesics and neuromuscular block. Finally, the procedures for discharge of the patient from the postoperative care unit are established.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Definitions</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Post-anesthetic care.</span></span> Actions undertaken to manage the patient following a surgical procedure that required anesthesia.</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Anesthesia recovery.</span></span> Period of time during which the effect of anesthesia slowly fades away following. The evaluation of recovery, depending on the type of anesthesia, determines the patient&#39;s discharge from the postoperative care unit.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Postoperative care unit.</span></span> The area in the operating rooms with the infrastructure and necessary equipment and resources for the recovery of patients that received general or regional anesthesia, or sedation.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Post-anesthesia evaluation and monitoring.</span></span> Regular evaluation and follow-up of the patient&#39;s vital signs and special conditions during the postoperative period, aimed at optimizing the patient&#39;s condition to enable his/her safe discharge from the OR environment.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Methodology</span><p id="par0065" class="elsevierStylePara elsevierViewall">The process included four phases. Each phase used standardized techniques and procedures for the development of evidence-based guidelines and protocols.</p><span id="sec0315" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">1. Make up of the handbook development team</span><p id="par0075" class="elsevierStylePara elsevierViewall">A team of expert anesthesiologists and epidemiologists was organized and entrusted with the task of defining the methodological guidelines for preparing the evidence-based handbook. The team members accepted to participate in the process and had no conflicts of interest to disclose.</p></span><span id="sec0320" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">2. Systematic review of secondary literature</span><p id="par0085" class="elsevierStylePara elsevierViewall">A systematic review was performed to identify the clinical practice protocols and guidelines with indications or recommendations for anesthesiology management. The analysis focused on articles published in scientific journals or technical documents &#8211; gray literature &#8211; published since 2011, both in English and Spanish.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Search strategy</span><p id="par0090" class="elsevierStylePara elsevierViewall">An electronic search strategy sensitive to documents meeting the established criteria was designed. The initial search was completed on August 2014.</p><p id="par0095" class="elsevierStylePara elsevierViewall">A second search included databases from protocol compilers and meta-browser agencies. Additional searchers were undertaken for guidelines in websites of anesthesiology national and international organizations and of the top ten US hospitals in 2014.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> No new clinical practice guidelines were identified in these sources. The sources of information are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a>.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0325" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Search strategies design and implementation</span><p id="par0105" class="elsevierStylePara elsevierViewall">For the initial search some keywords were identified (natural language), corresponding to the health condition or area of interest (anesthesia, perioperative care, and clinical protocols). Then a baseline search strategy was developed using controlled terminology (tMeSH, Emtree and DeCS) and free language (spelling variations, plurals, synonyms, acronyms and abbreviations).</p><p id="par0110" class="elsevierStylePara elsevierViewall">Using the baseline strategy, searchers were adapted to the various resources using extended terminology, field identifiers (title and abstract), truncation, and Boolean and proximity operators &#8211; when possible.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Searches were completed in depositories of clinical protocols, tracking keywords using the &#8220;search&#8221; tool in the Internet browser, in addition to a reproducible search in Google and Google Scholar, with no language or date of publications restrictions.</p><p id="par0120" class="elsevierStylePara elsevierViewall">For the second search the keywords were changed (anesthesia, postoperative care, post-anesthesia care, clinical protocols, clinical care guidelines), maintaining the comprehensive first search process.</p><p id="par0125" class="elsevierStylePara elsevierViewall">A logbook or report was generated for each search to ensure reproducibility and transparency. The references were consolidated on a Microsoft Excel database.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Trained staff did the searches audited by a Cochrane Collaboration <span class="elsevierStyleItalic">Trials Search Coordinator</span>.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results of the search strategies</span><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a> shows the results of the two phases of the search strategy.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Selection of evidence</span><p id="par0140" class="elsevierStylePara elsevierViewall">As of the first phase of the search, 193 references consistent with the objective of the handbook were identified, even if these were not clinical practice guidelines. Twelve documents were identified as clinical practice guidelines on postoperative care during the clearance process of the two search phases.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Two experts reviewed these twelve documents: one thematic (anesthesiologist) and one methodological (epidemiologist). The experts checked that the guidelines met the inclusion and exclusion criteria and were evidence-based. Four of the twelve documents met the criteria. The information about the criteria used is shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 3</a>.</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Quality assessment</span><p id="par0150" class="elsevierStylePara elsevierViewall">The tool AGREE II (<span class="elsevierStyleItalic">Appraisal of Guidelines for Research and Evaluation</span>) was used to assess the quality of the evidence selected.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> This quality analysis was done in a paired mode. The documents meeting the eligibility requirements as source documents for this Handbook were identified. <a class="elsevierStyleCrossRef" href="#sec0340">Appendix A</a> summarize this process.</p><p id="par0155" class="elsevierStylePara elsevierViewall">In accordance with the grading, the clinical practice guideline to be adopted corresponds to the American Society of Anesthesiology<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> that is an update of the 2002 Guidelines.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In the opinion of the expert anesthesiologist, the recommendations on the conditions of the post-operative care room, the patient&#39;s admission and discharge from the room, were complemented with the guidelines of <span class="elsevierStyleItalic">The Association of Anesthetists of Great Britain and Ireland</span><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and the <span class="elsevierStyleItalic">Scottish Intercollegiate Guidelines Network</span>.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Availability and power of evidence under the baseline clinical practice guidelines</span><p id="par0160" class="elsevierStylePara elsevierViewall">The baseline clinical practice guidelines considered both the scientific evidence and the opinion of experts. <a class="elsevierStyleCrossRef" href="#tbl0030">Table 4</a> is a summary of the rating of scientific evidence published in journals. The category of level of evidence refers to the strength and validity of the research design. The levels refer to the strength and quality of the findings summarized in each trial (for example: statistical findings, types of data, and number of trials reporting or replicating the findings) in both categories of evidence.</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">In accordance with the outcomes, the intervention was considered to be beneficial (B), harmful (H), or equivocal (E) when no statistically significant differences were identified.</p></span></span><span id="sec0330" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">3. Participative method</span><p id="par0175" class="elsevierStylePara elsevierViewall">A modified Delphi method was used.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The group developer team selected the experts and convened them to a meeting held on September 18, 2014 at S.C.A.R.E.&#8217;s headquarters. Twenty-eight anesthesiologist and epidemiologists attended the meeting.</p><p id="par0180" class="elsevierStylePara elsevierViewall">After presenting the clinical contents of the handbook and following the experts&#8217; discussion, the following characteristics were evaluated for compliance:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ease of Implementation</span>. Potential ease of use of the handbook by the various institutions.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Up-to-Date information</span>. Whether the indications are consistent with the current evidence.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Relevancy</span>. Whether the indications are relevant to most of the surgical environments.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8211;</span><p id="par0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ethical Considerations</span>. Whether using this handbook was ethical.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8211;</span><p id="par0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patient Safety</span>. Whether the patient may be exposed to a high risk when using this handbook.</p></li></ul></p><p id="par0210" class="elsevierStylePara elsevierViewall">A numeric nine-category scale was used to score each one of the characteristics identified. Each indication suggested was rated as recommended (appropriate), contraindicated (inappropriate), or uncertain.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> exhibits the results of the agreement reached by the participants in the consensus.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Preparation and drafting of the final document</span><p id="par0220" class="elsevierStylePara elsevierViewall">A final handbook model was designed, including the justification, the methodology, and the adaptation of the baseline clinical practice guidelines, according to the expert recommendations under the participative method. The team that prepared the handbook developed the final document.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Disclosures</span><p id="par0225" class="elsevierStylePara elsevierViewall">All of the participants in the working group and in the expert consensus affirmed, completed, and signed the disclosures document.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Copyright</span><p id="par0230" class="elsevierStylePara elsevierViewall">Consultations were made and authorizations secured for using and translating part of the contents of the guidelines to prepare the handbook. The partial translation and reproduction of the material was authorized by Lippincott Williams and Wilkins/Wolters Kluwer Health, Association of Anesthetists of Great Britain &#38; Ireland &#38; the AAGBI Foundation y Institute of Clinical Systems Improvement. Copyright belongs to the authors of the guidelines and protocols that are duly referenced in the document.</p></span></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Clinical contents</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Approach</span><p id="par0235" class="elsevierStylePara elsevierViewall">The handbook focuses on the postoperative management of the patient, emphasizing the reduction in the number of adverse events through a standardized evaluation of the recovery process, leading to improved quality of life during the post-anesthesia phase and a rationalization of postoperative care and discharge criteria.</p><p id="par0240" class="elsevierStylePara elsevierViewall">This handbook is applicable to patients receiving general or regional anesthesia, profound or moderate sedation and may be amended (or a complementary protocol be designed) to adapt it to the needs of a particular type of patients or populations such as children and the elderly. It is not applicable to patients receiving local anesthesia without sedation, minimal sedation or patients admitted to the ICU.</p><p id="par0245" class="elsevierStylePara elsevierViewall">This handbook is not intended to replace individualized patient care or the particular protocols of the institution. Neither is it expected to predict patient outcomes.</p><p id="par0250" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> illustrates the sequence of activities under this handbook.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conditions or requirements of the postoperative care unit</span><p id="par0255" class="elsevierStylePara elsevierViewall">The postoperative care unit shall preferably be located centrally to the operating rooms, allowing easy access and transit to and from the unit. Monitors, medicines, equipment and enough trained nursing staff shall all be available for managing patients during the postoperative phase and to deal with any complications.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">An anesthesiologist in charge of the patients transferred to the postoperative care unit shall be available.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> A user-friendly communications and alarms system shall be available and the staff should be trained to use it properly.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Patient admission to the postoperative care unit</span><p id="par0270" class="elsevierStylePara elsevierViewall">The anesthesiologist in charge of the patient shall personally hand-off the patient to the postoperative care unit staff.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">The anesthesiologist is required to give a verbal report of the patient&#39;s pre-surgical and surgical medical record, including any adverse event that may have occurred in the course of the surgical procedure.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0280" class="elsevierStylePara elsevierViewall">The anesthesiologist shall report on all the general indications for postoperative care in accordance with the medical record, the type of surgery and the anesthesia received by the patient.</p><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Indications</span><p id="par0285" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0290" class="elsevierStylePara elsevierViewall">An anesthesiologist shall be responsible for delivering the patient at the postoperative care unit, the ICU or any other unit in charge of admitting the patient for his/her immediate postoperative phase.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0295" class="elsevierStylePara elsevierViewall">In the event of an anesthesia-related complication during surgery, or in the course of anesthesia recovery, the anesthesiologist that administered the anesthesia, or the anesthesiologist in charge of the postoperative care unit &#8211; or else the anesthesiologist that was formally entrusted with the care of the patient &#8211; shall notify the patient or his/her representative about the type of complication and how it was managed.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0300" class="elsevierStylePara elsevierViewall">Any complication arising during surgery shall be reported by the surgeon responsible for the procedure.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0305" class="elsevierStylePara elsevierViewall">It is highly advisable that the surgical team, the anesthesiologist and the surgeon report to the patient or accompanying person the result of the surgical procedure.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0310" class="elsevierStylePara elsevierViewall">An anesthesiologist responsible for the patient&#39;s recovery at the postoperative care unit shall be available.</p></li></ul></p><p id="par0315" class="elsevierStylePara elsevierViewall">The team of practitioners and staff assistants in charge of the postoperative care unit are required to record every evaluation based on monitoring, clinical observation, reading of diagnostic follow-up tests, intervention, therapeutic or prophylactic prescription done during the emergency care and anesthesia recovery, including the prevention and treatment of complications.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Evaluation and monitoring of the patient at the postoperative care unit</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Respiratory function</span><p id="par0320" class="elsevierStylePara elsevierViewall">The periodic evaluation and monitoring of the airway patency, the respiratory rate, and oxygen saturation (SpO<span class="elsevierStyleSup">2</span>) shall be done during anesthesia recovery to reduce the number of adverse outcomes (Evidence A2-B).</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Cardiovascular function</span><p id="par0325" class="elsevierStylePara elsevierViewall">ASA experts<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> considered that blood pressure, pulse and EKG monitoring identify complications, reduce the number of adverse outcomes and shall be implemented during anesthesia recovery (insufficient evidence). They were of the opinion that EKG monitoring may be unnecessary in certain types of patients or depending on the anesthetic procedure.</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Neuromuscular function</span><p id="par0330" class="elsevierStylePara elsevierViewall">The evaluation of the neuromuscular function is deemed to reduce the number of adverse events and should be carried out during post-anesthesia recovery.</p><p id="par0335" class="elsevierStylePara elsevierViewall">The neuromuscular evaluation begins with a physical exam and may include neuromuscular block monitoring (Evidence B2-B).</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Mental status</span><p id="par0340" class="elsevierStylePara elsevierViewall">According to the experts&#8217; opinion,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> every institution should have a scale to assess the mental status of the patient in the postoperative care unit. This will help to reduce the number of post-anesthetic complications (insufficient evidence).</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Temperature</span><p id="par0345" class="elsevierStylePara elsevierViewall">Experts agree that measuring the patient&#39;s temperature is associated with less postoperative complications and that temperature should be measured during the anesthesia recovery phase (insufficient evidence).</p><p id="par0350" class="elsevierStylePara elsevierViewall">Ideally the patient shall be kept under normal temperature keeping in mind the changes in temperature self-regulation following anesthesia and surgery.</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Pain</span><p id="par0360" class="elsevierStylePara elsevierViewall">Experts believe that pain assessment during recovery reduces the number of postoperative adverse events (insufficient evidence).</p><p id="par0365" class="elsevierStylePara elsevierViewall">Pain management may be started during the surgical procedure and be part of the anesthetic procedure selected for the particular patient. Pain management may be continued and evaluated during the postoperative phase.</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Nausea and vomiting</span><p id="par0370" class="elsevierStylePara elsevierViewall">The opinion of experts about the evaluation of nausea and vomiting to reduce any adverse effects is ambiguous; however, they say that such evaluation shall be performed during anesthesia recovery (insufficient evidence).</p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Fluids</span><p id="par0375" class="elsevierStylePara elsevierViewall">Experts agree on the benefits of monitoring hydration and fluid management. This reduces the adverse effects and improves the patient&#39;s wellbeing and satisfaction (insufficient evidence).</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Urine output and micturition</span><p id="par0380" class="elsevierStylePara elsevierViewall">The evaluation of urine output identifies urine retention (Evidence B3-B), but the evidence is ambiguous for other complications (insufficient evidence). In the opinion of experts,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> the evaluation of urine output identifies potential complications and reduces the number of adverse effects. Depending on the particular case, such evaluation may not be on a routine basis.</p><p id="par0385" class="elsevierStylePara elsevierViewall">There is insufficient evidence and ambiguous opinions of experts regarding the assessment of micturition for the identification of adverse events, though they consider it may be assessed during the recovery phase.</p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Drainage and bleeding</span><p id="par0395" class="elsevierStylePara elsevierViewall">Experts agree that the evaluation of bleeding and drainage identifies complications, reduces the number of adverse effects and may be a routine when caring for postoperative patients (insufficient evidence).</p></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">Indications</span><p id="par0400" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0405" class="elsevierStylePara elsevierViewall">The periodic evaluation of the airway, the respiratory rate, oxygen saturation, pulse, heart rate and blood pressure is a requirement during anesthesia recovery.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0410" class="elsevierStylePara elsevierViewall">EKG monitoring should be available at the postoperative care units for patients that need to be monitored.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0415" class="elsevierStylePara elsevierViewall">The evaluation of the neuromuscular function shall be done during the post-anesthesia recovery phase in all patients receiving neuromuscular block with non-depolarizing agents or in patients with neuromuscular dysfunction-related medical conditions.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0420" class="elsevierStylePara elsevierViewall">The level of hydration should be assessed depending on the particular patient, particularly if the surgical procedure entailed a significant blood or fluids loss and required additional fluid management.</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8226;</span><p id="par0425" class="elsevierStylePara elsevierViewall">Urine output and micturition shall be assessed in particular patients undergoing specific procedures.</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8226;</span><p id="par0430" class="elsevierStylePara elsevierViewall">The mental status, body temperature, pain, nausea, vomiting, and drainage and bleeding may be assessed during the recovery phase.</p></li></ul></p></span></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0235">Pharmacological management at the postoperative care unit</span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0240">Nausea and vomiting</span><p id="par0435" class="elsevierStylePara elsevierViewall">The groups of drugs evaluated were 5-HT3 antiemetics, tranquilizers, and neuroleptics, metoclopramide and dexamethasone.</p></span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0245">5HT3 antiemetics</span><p id="par0440" class="elsevierStylePara elsevierViewall">A meta-analysis of the new ECCs confirmed that 5HT3 agents versus placebo were effective in the postoperative prophylaxis of nausea and vomiting and reduces the use of rescue antiemetic use (Evidence A1-B). The specific drugs are: dolasetron (reduces vomiting),<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;27</span></a> granisetron (reduces vomiting)<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#8211;32</span></a> and ondansetron (reduces vomiting and the use of rescue antiemetics).<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28,33&#8211;45</span></a></p></span><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0250">Tranquilizers</span><p id="par0445" class="elsevierStylePara elsevierViewall">The meta-analysis of the new CCTs ratifies that droperidol reduces postoperative nausea and vomiting and the use of rescue antiemetics (Evidence A3-B).<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38,46&#8211;50</span></a> Several CCTs evidenced that haloperidol is also effective (Evidence A2-B).<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34,47,49,51</span></a></p></span><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0255">Metoclopramide</span><p id="par0450" class="elsevierStylePara elsevierViewall">The meta-analysis of CCTs comparing metoclopramide (10<span class="elsevierStyleHsp" style=""></span>mg) against placebo do not report any statistically significant differences in nausea and vomiting during the immediate postoperative period (Evidence A1-E), but show efficacy in reducing vomiting during the first twenty four hours into the postoperative period (Evidence category A1-B).<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35,39,44,52&#8211;55</span></a></p></span><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0260">Dexamethasone</span><p id="par0455" class="elsevierStylePara elsevierViewall">The meta-analysis of CCTs reports that this antiemetic is effective in the prophylaxis of postoperative vomiting, reduces the use of rescue antiemetics; at higher doses dexamethasone was effective as prophylactic treatment for nausea (Evidence category A1-B).<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29,33,45,48,49,51,52,54&#8211;67</span></a></p></span><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0265">Combinations</span><p id="par0460" class="elsevierStylePara elsevierViewall">The combination of two antiemetic agents is effective for prophylaxis against postoperative nausea and vomiting (Evidence category A2-B); there were no differences in terms of side effects such as headache, dizziness, drowsiness and restlessness.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,31,32,48,53,56,68&#8211;77</span></a></p></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0270">Update</span><p id="par0465" class="elsevierStylePara elsevierViewall">A systematic review<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">78</span></a> on the treatment of postoperative nausea and vomiting considers a similar evidence for medicines that may be effective for the prophylaxis and treatment of these events. The review favors ondansentron as the first pharmacological choice.</p></span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0275">Indications</span><p id="par0470" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8226;</span><p id="par0475" class="elsevierStylePara elsevierViewall">Anesthesia-related nausea and vomiting prophylaxis improves patient satisfaction and wellbeing, reducing the time to discharge of the postoperative care unit.</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0480" class="elsevierStylePara elsevierViewall">Anesthesia-related nausea and vomiting prophylaxis improves with ondansentron, droperidol or dexamethasone, that also reduce the need for rescue antiemetics.</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">&#8226;</span><p id="par0485" class="elsevierStylePara elsevierViewall">Ondansentron is considered a first line treatment.</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">&#8226;</span><p id="par0490" class="elsevierStylePara elsevierViewall">There is no conclusive evidence regarding the use of multiple drugs for the treatment of nausea and vomiting during recovery.</p></li></ul></p></span></span><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0280">Antagonism of sedative and analgesic effects and of neuromuscular blocking agents</span><span id="sec0200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0285">Benzodiazepines antagonistic activity</span><p id="par0495" class="elsevierStylePara elsevierViewall">A recent CCT<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a> reaffirmed the findings of the 2002 guidelines<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> regarding the efficacy of flumazenil&#39;s antagonistic activity on the residual effects of benzodiazepines following general anesthesia versus placebo (Evidence A3-B). The 2002 Guidelines<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> claimed that flumazenil reduced the time to emergence following sedation (Evidence A1-B).</p><p id="par0500" class="elsevierStylePara elsevierViewall">Experts<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> disagree on the routine use of flumazenil to reduce the number of adverse events or improving patient comfort and satisfaction.</p></span><span id="sec0205" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0290">Opioids antagonistic activity</span><p id="par0505" class="elsevierStylePara elsevierViewall">The 2002 Guidelines<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> indicated that naloxone reduced the time to emergence and recovery of spontaneous breathing (Evidence A3-B). Experts disagree about the routine use of naloxone to reduce the number of adverse events or improving the patient&#39;s comfort or satisfaction.</p></span><span id="sec0210" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0295">Reversal of neuromuscular relaxants</span><p id="par0510" class="elsevierStylePara elsevierViewall">The 2002 Guidelines<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> stated that neostigmine is effective for antagonizing the residual effect of muscle relaxants (Evidence A1-B), although it showed increasing number of postoperative emetic episodes (Evidence A1-H).</p><p id="par0515" class="elsevierStylePara elsevierViewall">No expert consensus has been reached about the fact that the anesthetic regimes designed to avoid the use of neuromuscular block antagonism reduce the adverse outcomes and improve patient satisfaction and wellbeing.</p></span><span id="sec0215" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0300">Indications</span><p id="par0520" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">&#8226;</span><p id="par0525" class="elsevierStylePara elsevierViewall">Flumazenil shall not be administered routinely, though it may be an option in the presence of respiratory depression and sedation in patients with benzodiazepines use as the underlying cause. Following the administration of the antagonistic drug, patients must be under observation for a long time to prevent the relapse of respiratory depression.</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">&#8226;</span><p id="par0530" class="elsevierStylePara elsevierViewall">Opioid antagonists (naloxone) are not recommended for routine use. However, opioid antagonists may be administered in the presence of respiratory depression attributable to opioid use. Following the administration of the antagonistic drug, patients must be under observation for a long time to prevent the relapse of respiratory depression. The acute antagonism of opioids may trigger pain, hypertension, tachycardia and pulmonary edema.</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">&#8226;</span><p id="par0535" class="elsevierStylePara elsevierViewall">Specific antagonists must be administered to revert the residual neuromuscular block if indicated.</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">&#8226;</span><p id="par0540" class="elsevierStylePara elsevierViewall">Flumazenil, naloxone, or neuromuscular block antagonists shall be available for administration as needed.</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">&#8226;</span><p id="par0545" class="elsevierStylePara elsevierViewall">Specific neuromuscular block antagonists shall be available to revert the block when appropriate.</p></li></ul></p></span></span><span id="sec0220" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0305">Postoperative care unit treatment</span><span id="sec0225" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0310">Administration of supplemental oxygen</span><p id="par0550" class="elsevierStylePara elsevierViewall">A CCT<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">80</span></a> showed that the administration of supplemental oxygen during transfer and at the postoperative care unit reduces the incidence of hypoxemia (Evidence A3B).</p></span><span id="sec0230" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0315">Temperature</span><p id="par0555" class="elsevierStylePara elsevierViewall">The 2002 Guidelines<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> included evidence that active warming of the patient is associated to temperature normalization (Evidence A2-B). There is evidence that the use of normal forced air warming devices normalize the patient&#39;s temperature (Evidence category A3-B). This latter finding was reaffirmed at a recent CCT, but there is no evidence of a reduction of shivering (Evidence A3-E).<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a></p></span><span id="sec0235" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0320">Use of pharmacological agents to reduce postoperative shivering</span><p id="par0560" class="elsevierStylePara elsevierViewall">The 2002 Guidelines<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> state that meperidine is effective in the management of postoperative shivering as compared to other opioid antagonists and placebo (Evidence A1-B). A recent CCT<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">82</span></a> found that meperidine decreased shivering as compared to other drugs (Evidence A3-B).</p><p id="par0565" class="elsevierStylePara elsevierViewall">The effects of dexmedetomidine have helped in controlling shivering in children (Evidence B3) as well as regional anesthesia-related chills (Evidence A3).<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">83,84</span></a></p></span><span id="sec0240" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0325">Indications</span><p id="par0570" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">&#8226;</span><p id="par0575" class="elsevierStylePara elsevierViewall">The administration of supplemental oxygen during transfer and postoperative anesthesia care is a requirement for patients at risk of developing hypoxemia.</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">&#8226;</span><p id="par0580" class="elsevierStylePara elsevierViewall">Normal body temperature shall be one of the goals of perioperative care. When available, forced air warming devices shall be used.</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">&#8226;</span><p id="par0585" class="elsevierStylePara elsevierViewall">Meperidine may be used to control shivering during the postoperative phase, if clinically indicated and in the absence of contraindications.</p></li></ul></p></span></span><span id="sec0245" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0330">Patient discharge from the postoperative care unit</span><span id="sec0250" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0335">Spontaneous voiding before for discharge</span><p id="par0590" class="elsevierStylePara elsevierViewall">This may extend the length of stay and should be required only in selected patients. It is not considered a requirement for discharge.</p></span><span id="sec0255" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0340">Requirement for the patient to drink clear fluids prior to discharge</span><p id="par0595" class="elsevierStylePara elsevierViewall">This may extend the length of stay of the patient in the unit. It is not considered an absolute requirement that the patient drinks clear fluids prior to discharge. The 2002 Guidelines rated this item as Evidence A2-E. Experts do not feel that this improves patient comfort or satisfaction.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0260" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0345">Requirement for the patient to have a responsible companion prior to home discharge</span><p id="par0600" class="elsevierStylePara elsevierViewall">It has been considered that the need to have a responsible companion at discharge of the outpatient reduces the risk of complications and improves patient satisfaction and wellbeing. In the opinion of experts his should be a compulsory requirement. However, scientific evidence is insufficient.</p></span><span id="sec0265" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0350">Need for minimum length of stay at the post-anesthetic care unit</span><p id="par0605" class="elsevierStylePara elsevierViewall">Evidence is insufficient and experts do not feel that a minimum length of stay is required. The LOS shall be determined on a case-by-case basis. There is no consensus regarding whether a minimum length of stay reduces the number of adverse events or complications.</p></span><span id="sec0270" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0355">Motor activity assessment following regional anesthesia</span><p id="par0610" class="elsevierStylePara elsevierViewall">According to S.C.A.R.E&#39;s minimum anesthesia safety rules 2013,<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a> the use of a scale to measure the recovery of motor activity is suggested. Bromage scale<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">86</span></a> is the most widely used (<a class="elsevierStyleCrossRef" href="#tbl0035">Table 5</a>).</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></span><span id="sec0275" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0360">Evaluation of discharge criteria</span><p id="par0615" class="elsevierStylePara elsevierViewall">A systematic review concluded that every discharge evaluation should include the awareness status, blood pressure, pain, and nausea/vomiting assessment.<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">87</span></a> Aldrete&#39;s scale covers all these aspects and hence could be considered the scale of choice for this purpose<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">88</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0040">Table 6</a>).</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia></span><span id="sec0280" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0365">Update</span><p id="par0620" class="elsevierStylePara elsevierViewall">The consensus group advices to have an institution staff member accompany the patient to the exit.</p></span></span><span id="sec0285" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0370">Indications</span><p id="par0625" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">&#8226;</span><p id="par0630" class="elsevierStylePara elsevierViewall">The requirement to void or drink fluids prior to discharge may be obligatory for particular patients.</p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">&#8226;</span><p id="par0635" class="elsevierStylePara elsevierViewall">As part of the discharge protocols at every institution, all patients discharged must have a responsible companion at the time of discharge.</p></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">&#8226;</span><p id="par0640" class="elsevierStylePara elsevierViewall">A minimum length of stay at the postoperative care unit is not recommended as a routine. The length of stay shall be determined on a patient-by-patient basis.</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">&#8226;</span><p id="par0645" class="elsevierStylePara elsevierViewall">Consider checking the patency of the airway, drains and catheters and needed.</p></li><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">&#8226;</span><p id="par0650" class="elsevierStylePara elsevierViewall">Check the complete records.</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">&#8226;</span><p id="par0655" class="elsevierStylePara elsevierViewall">Use an Aldrete type scale to assess every patient prior to discharge from the postoperative care unit.</p></li></ul></p></span><span id="sec0290" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0375">Information given to patients</span><p id="par0660" class="elsevierStylePara elsevierViewall">If the patient is discharged home from the postoperative care unit, all the surgery-related recommendations, the alarm signs and unexpected adverse events shall be submitted to the patient in writing.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,20</span></a></p></span></span><span id="sec0295" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0380">Funding sources</span><p id="par0665" class="elsevierStylePara elsevierViewall">This project was <span class="elsevierStyleGrantSponsor" id="gs1">Colombian society of Anesthesiology and Resuscitation &#8211; S.C.A.R.E.</span> in collaboration agreement with the School of Medicine, Universidad Nacional de Colombia.</p></span><span id="sec0335" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0385">Conflicts of interest</span><p id="par0685" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:2 [
          "identificador" => "xres412676"
          "titulo" => array:6 [
            0 => "Abstract"
            1 => "Introduction"
            2 => "Objective"
            3 => "Methodology"
            4 => "Result"
            5 => "Conclusions"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec388400"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres412675"
          "titulo" => array:6 [
            0 => "Resumen"
            1 => "Introducci&oacute;n"
            2 => "Objetivo"
            3 => "Metodolog&iacute;a"
            4 => "Resultado"
            5 => "Conclusiones"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec388401"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Definitions"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Methodology"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0315"
              "titulo" => "1. Make up of the handbook development team"
            ]
            1 => array:3 [
              "identificador" => "sec0320"
              "titulo" => "2. Systematic review of secondary literature"
              "secciones" => array:6 [
                0 => array:2 [
                  "identificador" => "sec0020"
                  "titulo" => "Search strategy"
                ]
                1 => array:2 [
                  "identificador" => "sec0325"
                  "titulo" => "Search strategies design and implementation"
                ]
                2 => array:2 [
                  "identificador" => "sec0025"
                  "titulo" => "Results of the search strategies"
                ]
                3 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "Selection of evidence"
                ]
                4 => array:2 [
                  "identificador" => "sec0035"
                  "titulo" => "Quality assessment"
                ]
                5 => array:2 [
                  "identificador" => "sec0040"
                  "titulo" => "Availability and power of evidence under the baseline clinical practice guidelines"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "sec0330"
              "titulo" => "3. Participative method"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "Preparation and drafting of the final document"
                ]
                1 => array:2 [
                  "identificador" => "sec0050"
                  "titulo" => "Disclosures"
                ]
                2 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "Copyright"
                ]
              ]
            ]
          ]
        ]
        7 => array:3 [
          "identificador" => "sec0060"
          "titulo" => "Clinical contents"
          "secciones" => array:10 [
            0 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Approach"
            ]
            1 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Conditions or requirements of the postoperative care unit"
            ]
            2 => array:3 [
              "identificador" => "sec0075"
              "titulo" => "Patient admission to the postoperative care unit"
              "secciones" => array:1 [
                0 => array:2 [
                  "identificador" => "sec0080"
                  "titulo" => "Indications"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "sec0085"
              "titulo" => "Evaluation and monitoring of the patient at the postoperative care unit"
              "secciones" => array:11 [
                0 => array:2 [
                  "identificador" => "sec0095"
                  "titulo" => "Respiratory function"
                ]
                1 => array:2 [
                  "identificador" => "sec0100"
                  "titulo" => "Cardiovascular function"
                ]
                2 => array:2 [
                  "identificador" => "sec0105"
                  "titulo" => "Neuromuscular function"
                ]
                3 => array:2 [
                  "identificador" => "sec0110"
                  "titulo" => "Mental status"
                ]
                4 => array:2 [
                  "identificador" => "sec0115"
                  "titulo" => "Temperature"
                ]
                5 => array:2 [
                  "identificador" => "sec0120"
                  "titulo" => "Pain"
                ]
                6 => array:2 [
                  "identificador" => "sec0125"
                  "titulo" => "Nausea and vomiting"
                ]
                7 => array:2 [
                  "identificador" => "sec0130"
                  "titulo" => "Fluids"
                ]
                8 => array:2 [
                  "identificador" => "sec0135"
                  "titulo" => "Urine output and micturition"
                ]
                9 => array:2 [
                  "identificador" => "sec0140"
                  "titulo" => "Drainage and bleeding"
                ]
                10 => array:2 [
                  "identificador" => "sec0145"
                  "titulo" => "Indications"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "sec0150"
              "titulo" => "Pharmacological management at the postoperative care unit"
              "secciones" => array:8 [
                0 => array:2 [
                  "identificador" => "sec0155"
                  "titulo" => "Nausea and vomiting"
                ]
                1 => array:2 [
                  "identificador" => "sec0160"
                  "titulo" => "5HT3 antiemetics"
                ]
                2 => array:2 [
                  "identificador" => "sec0165"
                  "titulo" => "Tranquilizers"
                ]
                3 => array:2 [
                  "identificador" => "sec0170"
                  "titulo" => "Metoclopramide"
                ]
                4 => array:2 [
                  "identificador" => "sec0175"
                  "titulo" => "Dexamethasone"
                ]
                5 => array:2 [
                  "identificador" => "sec0180"
                  "titulo" => "Combinations"
                ]
                6 => array:2 [
                  "identificador" => "sec0185"
                  "titulo" => "Update"
                ]
                7 => array:2 [
                  "identificador" => "sec0190"
                  "titulo" => "Indications"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "sec0195"
              "titulo" => "Antagonism of sedative and analgesic effects and of neuromuscular blocking agents"
              "secciones" => array:4 [
                0 => array:2 [
                  "identificador" => "sec0200"
                  "titulo" => "Benzodiazepines antagonistic activity"
                ]
                1 => array:2 [
                  "identificador" => "sec0205"
                  "titulo" => "Opioids antagonistic activity"
                ]
                2 => array:2 [
                  "identificador" => "sec0210"
                  "titulo" => "Reversal of neuromuscular relaxants"
                ]
                3 => array:2 [
                  "identificador" => "sec0215"
                  "titulo" => "Indications"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "sec0220"
              "titulo" => "Postoperative care unit treatment"
              "secciones" => array:4 [
                0 => array:2 [
                  "identificador" => "sec0225"
                  "titulo" => "Administration of supplemental oxygen"
                ]
                1 => array:2 [
                  "identificador" => "sec0230"
                  "titulo" => "Temperature"
                ]
                2 => array:2 [
                  "identificador" => "sec0235"
                  "titulo" => "Use of pharmacological agents to reduce postoperative shivering"
                ]
                3 => array:2 [
                  "identificador" => "sec0240"
                  "titulo" => "Indications"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "sec0245"
              "titulo" => "Patient discharge from the postoperative care unit"
              "secciones" => array:7 [
                0 => array:2 [
                  "identificador" => "sec0250"
                  "titulo" => "Spontaneous voiding before for discharge"
                ]
                1 => array:2 [
                  "identificador" => "sec0255"
                  "titulo" => "Requirement for the patient to drink clear fluids prior to discharge"
                ]
                2 => array:2 [
                  "identificador" => "sec0260"
                  "titulo" => "Requirement for the patient to have a responsible companion prior to home discharge"
                ]
                3 => array:2 [
                  "identificador" => "sec0265"
                  "titulo" => "Need for minimum length of stay at the post-anesthetic care unit"
                ]
                4 => array:2 [
                  "identificador" => "sec0270"
                  "titulo" => "Motor activity assessment following regional anesthesia"
                ]
                5 => array:2 [
                  "identificador" => "sec0275"
                  "titulo" => "Evaluation of discharge criteria"
                ]
                6 => array:2 [
                  "identificador" => "sec0280"
                  "titulo" => "Update"
                ]
              ]
            ]
            8 => array:2 [
              "identificador" => "sec0285"
              "titulo" => "Indications"
            ]
            9 => array:2 [
              "identificador" => "sec0290"
              "titulo" => "Information given to patients"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0295"
          "titulo" => "Funding sources"
        ]
        9 => array:2 [
          "identificador" => "sec0335"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-10-10"
    "fechaAceptado" => "2014-10-19"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec388400"
          "palabras" => array:5 [
            0 => "Postoperative Care"
            1 => "Anesthesia"
            2 => "Manuals as Topic"
            3 => "Evidence-Based Medicine"
            4 => "Anesthesia Recovery Period"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec388401"
          "palabras" => array:5 [
            0 => "Cuidados Postoperatorios"
            1 => "Anestesia"
            2 => "Manuales como Asunto"
            3 => "Medicina Basada en Evidencia"
            4 => "Periodo de Recuperación de la Anestesia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Post-anesthetic care reduces the anesthesia-related postoperative complications and mortality, shortens the length of stay at the postoperative care units and improves patient satisfaction.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To establish a set of recommendations for immediate post-anesthetic care of patients that received general/regional anesthesia or profound/moderate sedation at the postoperative care units.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methodology</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This is a process of &#8220;rapid&#8221; clinical practice guidelines adaptation, including systematic search. The illegible guidelines for adaptation were rated using AGREE II. The guideline selected to be adapted as the clinical practice handbook was <span class="elsevierStyleItalic">Practice guidelines for post-anesthetic care</span> of the <span class="elsevierStyleItalic">American Society of Anesthesiologists</span>. The manual was evaluated in terms of implementation ability, up-to-date information, relevancy, ethical considerations and patient safety by the group of anesthesiologists and epidemiologists based on Delphi.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Result</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The manual kept the recommendations on evaluation and monitoring, pharmacological management of postoperative nausea and vomiting, antagonistic actions for sedatives and analgesics and neuromuscular block agents, emergency management and anesthesia recovery, as well as the criteria for discharge from the unit. Indications about the conditions and requirements of the unit and patient admission were also included.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This handbook comprises the basic guidelines for primary management of patients at the postoperative care unit. It may be amended or adapted according to the institutional requirements and for specific patient groups and is not intended to replace the existing protocols at the particular institution and does not define outcomes or prognosis.</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introducci&oacute;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El cuidado posanest&eacute;sico disminuye las complicaciones y mortalidad posoperatorias inmediatas relacionadas con la anestesia, acorta la estancia en las unidades de cuidado posoperatoro y mejora la satisfacci&oacute;n de los pacientes.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Establecer un conjunto de recomendaciones para el cuidado posantest&eacute;sico inmediato de los pacientes que recibieron anestesia general/regional o sedaci&oacute;n profunda/moderada en la unidades de cuidado posoperatorio.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Metodolog&iacute;a</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Un proceso de adaptaci&oacute;n &#8220;r&aacute;pida&#8221; de gu&iacute;as de pr&aacute;ctica cl&iacute;nica, que incluy&oacute; b&uacute;squeda sistem&aacute;tica. Se calificaron las gu&iacute;as elegibles a adaptar, mediante AGREE II. La gu&iacute;a seleccionada para su adaptaci&oacute;n como manual de pr&aacute;ctica cl&iacute;nica fue <span class="elsevierStyleItalic">Practice guidelines for postanesthetic care</span> de la <span class="elsevierStyleItalic">American Society of Anesthesiologists</span>. El manual fue evaluado por un grupo de anestesi&oacute;logos y epidemi&oacute;logos mediante Delphi, en t&eacute;rminos de implementabilidad, actualizaci&oacute;n, pertinencia, consideraciones &eacute;tica y seguridad del paciente.</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultado</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El manual mantuvo las recomendaciones sobre evaluaci&oacute;n y monitorizaci&oacute;n, manejo farmacol&oacute;gico de n&aacute;useas y v&oacute;mito posoperatorio, antagonismo de los efectos de sedantes, analg&eacute;sicos y agentes de bloqueo neuromuscular, el manejo de la emergencia y recuperaci&oacute;n anest&eacute;sica, y los criterios para egreso de la unidad. Se incluyeron indicaciones sobre condiciones y requisitos de la unidad y el ingreso del paciente a esta.</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Este manual es una gu&iacute;a b&aacute;sica sobre el manejo primario de los pacientes en la unidad de cuidado posoperatorio, puede ser modificado o adaptado seg&uacute;n los requerimientos institucionales y para grupos espec&iacute;ficos de pacientes; no pretende reemplazar los protocolos existentes en cada instituci&oacute;n ni puede definir desenlaces ni pron&oacute;sticos.</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Caro CAB, Alvarado FEP, Torres M, Buitrago G, Duarte HG, Garc&iacute;a C, et al. Manual de pr&aacute;ctica cl&iacute;nica basado en la evidencia: controles posquir&uacute;rgicos. Rev Colomb Anestesiol. 2015;43:20&#8211;31.</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0820" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0345"
          ]
        ]
      ]
    ]
    "multimedia" => array:9 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 431
            "Ancho" => 2540
            "Tamanyo" => 56549
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Rating scale for real-time use during the Delphi exercise.</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 956
            "Ancho" => 1638
            "Tamanyo" => 80245
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Results related to the manual presented.</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Source: Authors.</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Source: Authors.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Protocol compilers&nbsp;\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">Meta-browsers&nbsp;\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">National Guidelines Clearinghouse &#8211; USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tripdatabase&nbsp;\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">Institute for Clinical Systems Improvement &#8211; USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Evidence Search (NICE)&nbsp;\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">National Institute for Health and Clinical Excellence (NICE) &#8211; United Kingdom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Data Bases&nbsp;\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">Gu&iacute;a Salud &#8211; Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medline&nbsp;\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">Canadian Medical Association Infobase &#8211; Canada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Embase&nbsp;\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">Hunter &#38; New England Health Pathways &#8211; Australia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Google Scholar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab642074.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Sources of information used for searching clinical practice guidelines.</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Source: Authors.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Source&nbsp;\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">Phase One&nbsp;\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">Phase Two&nbsp;\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">Embase/Medline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">864&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">123&nbsp;\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">Google Scholar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134&nbsp;\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">National Guidelines Clearinghouse &#8211; USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\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">Institute for Clinical Systems Improvement &#8211; USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\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">National Institute for Health and Clinical Excellence (NICE) &#8211; United Kingdom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\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">Gu&iacute;a Salud &#8211; Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\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">Canadian Medical Association Infobase &#8211; Canada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\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">Hunter &#38; New England Health Pathways &#8211; Australia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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">Tripdatabase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">723&nbsp;\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">Evidence Search (NICE)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab642070.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Search results of clinical practice guidelines for post-anesthetic care.</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Source: Authors.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inclusion criteria&nbsp;\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">Exclusion criteria&nbsp;\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">Guidelines containing recommendations relating to relevant questions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not having a complete version&nbsp;\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">Title or abstract including the words: &#8220;Guideline&#8221; &#8220;Clinical Practice Guidelines&#8221;, &#8220;Recommendations&#8221; or &#8220;Consensus&#8221;, whether in Spanish, English or Portuguese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inconsistent with the general surgical population&nbsp;\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">Not more than 5 years old.&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Being specific for a particular type of surgery or surgical specialty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab642073.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Inclusion and exclusion criteria for the clinical practice guidelines found.</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Source: Authors.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Level&nbsp;\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">A &#8211; Controlled Clinical Trials (CCT) reporting comparative results of clinical interventions for specific outcomes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#8211; The literature contains enough CCTs to undertake a meta-analysis and the meta-analytic results of such aggregate are reported as evidence2 &#8211; The literature contains multiple CCTs but not enough to undertake a meta-analysis. The CCTs findings are reported as evidence.3 &#8211; There is one CCT in the literature and its findings are reported as evidence&nbsp;\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">B &#8211; Observational trials that allow draw conclusions about the beneficial or harmful effects of the clinical interventions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#8211; The literature includes observational comparisons (cohort trials or cases and controls) among the clinical interventions for a particular outcome.2 &#8211; There are observational trials in the literature with associative statistics (RR, correlation, sensitivity or specificity)3 &#8211; There are non-comparative observational trials in the literature with descriptive statistics (frequencies, percentages)4 &#8211; The literature includes case reports&nbsp;\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">Insufficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">When evidence is not available (not relevant studies found) or inadequate (affected by bias or confounding). It was considered insufficient when it didn&#8217;t correspond to the Questions and purpose of the guidelines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab642072.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Scientific evidence rating.</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0035"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Source: Authors.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Rating&nbsp;\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">Description&nbsp;\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">3 &#8211; Complete&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unable to move feet and knees&nbsp;\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">2 &#8211; Almost complete&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Only able to move feet&nbsp;\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">1 &#8211; Partial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Able to move knees&nbsp;\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">0 &#8211; Null&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total flexion of knees and feet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab642075.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Bromage scale ratings for evaluating the motor block following central regional anesthesia.</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0040"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Source: Authors.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Rating&nbsp;\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">Description&nbsp;\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  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Activity: able to move around voluntarily or following instructions</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 extremities&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 extremities&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 extremities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Breathing</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Able to take a deep breath and cough freely&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dyspnea, shallow or limited breathing&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Circulation</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Blood pressure &plusmn;20<span class="elsevierStyleHsp" style=""></span>mm of the pre-surgery level&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Blood pressure &plusmn;20&#8211;50<span class="elsevierStyleHsp" style=""></span>mm of the pre-surgery level&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Blood pressure &plusmn;50<span class="elsevierStyleHsp" style=""></span>mm of the pre-surgery level&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Level of awareness</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fully awake&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alert to being called&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Irresponsive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Oxygen saturation</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Able to keep the O<span class="elsevierStyleInf">2</span> saturation &#62;92% on room air&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Needs to inhale O<span class="elsevierStyleInf">2</span> to maintain O<span class="elsevierStyleInf">2</span> saturation &#62;90%&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">O<span class="elsevierStyleInf">2</span> saturation is kept below 90% despite supplemental O<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab642071.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Modified Aldrete score for authorizing postoperative care unit discharge.</p>"
        ]
      ]
      8 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.pdf"
          "ficheroTamanyo" => 87663
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:88 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "Committee on Quality of Health Care in America, Institute of Medicine, To err is human: building a safer health system"
                        "serieFecha" => "2000"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(12)60990-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2012"
                        "volumen" => "380"
                        "paginaInicial" => "1075"
                        "paginaFinal" => "1081"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality in anesthesia: a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clinics (Sao Paulo)"
                        "fecha" => "2009"
                        "volumen" => "64"
                        "paginaInicial" => "999"
                        "paginaFinal" => "1006"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Major incidents and complications in otherwise healthy patients undergoing elective procedures: results based on 1.37 million anaesthetic procedures"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aeu094"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2014"
                        "volumen" => "113"
                        "paginaInicial" => "109"
                        "paginaFinal" => "121"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A factorial trial of six interventions for the prevention of postoperative nausea and vomiting"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa032196"
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2004"
                        "volumen" => "350"
                        "paginaInicial" => "2441"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications occurring in the postanesthesia care unit: a survey"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "1992"
                        "volumen" => "74"
                        "paginaInicial" => "503"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications in the postanesthetic care unit"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Middle East J Anesthesiol"
                        "fecha" => "1992"
                        "volumen" => "11"
                        "paginaInicial" => "525"
                        "paginaFinal" => "547"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Determinants of long-term survival after major surgery and the adverse effect of postoperative complications"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2005"
                        "volumen" => "242"
                        "paginaInicial" => "326"
                        "paginaFinal" => "341"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic significance of postoperative in-hospital complications in elderly patients. I. Long-term survival"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2003"
                        "volumen" => "96"
                        "paginaInicial" => "583"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temporal patterns of postoperative complications"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archsurg.138.6.596"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "2003"
                        "volumen" => "138"
                        "paginaInicial" => "596"
                        "paginaFinal" => "603"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and preventability of adverse events requiring intensive care admission: a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2753.2010.01612.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eval Clin Pract"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "485"
                        "paginaFinal" => "497"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "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 [ …2]
                      ]
                    ]
                  ]
                  "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 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postoperative care"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.anclin.2012.07.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiol Clin"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "xi"
                        "paginaFinal" => "xii"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Task Force on Postanesthetic Care. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e31827773e9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2013"
                        "volumen" => "118"
                        "paginaInicial" => "291"
                        "paginaFinal" => "307"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "U.S. news best hospitals 2014&#8211;15. Available from: <a href="http://health.usnews.com/best-hospitals/rankings?int=a01008">http://health.usnews.com/best-hospitals/rankings?int=a01008</a> [accessed 28.08.14]."
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The AGREE Collaboration Writing Group: development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Qual Saf Health Care"
                        "fecha" => "2003"
                        "volumen" => "12"
                        "paginaInicial" => "18"
                        "paginaFinal" => "23"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice guidelines for postanesthetic care: a report by the American Society of Anesthesiologists Task Force on Postanesthetic Care"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2002"
                        "volumen" => "96"
                        "paginaInicial" => "742"
                        "paginaFinal" => "752"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immediate post-anaesthesia recovery 2013: Association of Anaesthetists of Great Britain and Ireland"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/anae.12146"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "2013"
                        "volumen" => "68"
                        "paginaInicial" => "288"
                        "paginaFinal" => "297"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postoperative management in adults"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2004"
                        "editorial" => "SIGN"
                        "editorialLocalizacion" => "Edimburgo"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Delphi technique: a methodological discussion"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Adv Nurs"
                        "fecha" => "1994"
                        "volumen" => "19"
                        "paginaInicial" => "180"
                        "paginaFinal" => "186"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The RAND/UCLA appropriateness method"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2001"
                        "editorial" => "RAND"
                        "editorialLocalizacion" => "Santa Monica"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality and safety guidelines of postanaesthesia care: Working Party on Post Anaesthesia Care (approved by the European Board and Section of Anaesthesiology, Union Europ&eacute;enne des M&eacute;decins Sp&eacute;cialistes)"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/EJA.0b013e32832bb68f"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Anaesthesiol"
                        "fecha" => "2009"
                        "volumen" => "26"
                        "paginaInicial" => "715"
                        "paginaFinal" => "721"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dolasetron prophylaxis reduces nausea and postanaesthesia recovery time after remifentanil infusion during monitored anaesthesia care for extracorporeal shock wave lithotripsy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2003"
                        "volumen" => "90"
                        "paginaInicial" => "194"
                        "paginaFinal" => "198"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Droperidol and dolasetron alone or in combination for prevention of postoperative nausea and vomiting after vitrectomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ophtha.2004.01.031"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology"
                        "fecha" => "2004"
                        "volumen" => "111"
                        "paginaInicial" => "1569"
                        "paginaFinal" => "1575"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prophylactic intravenous ondansetron and dolasetron in intrathecal morphine-induced pruritus: a randomized, double-blinded, placebo-controlled study"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/01.ANE.0000181338.35454.6A"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2005"
                        "volumen" => "101"
                        "paginaInicial" => "1516"
                        "paginaFinal" => "1520"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ondansetron and dolasetron provide equivalent postoperative vomiting control after ambulatory tonsillectomy in dexamethasone-pretreated children"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2002"
                        "volumen" => "95"
                        "paginaInicial" => "1230"
                        "paginaFinal" => "1235"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dolasetron for the prevention of postoperative vomiting in children undergoing strabismus surgery"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Paediatr Anaesth"
                        "fecha" => "2003"
                        "volumen" => "13"
                        "paginaInicial" => "522"
                        "paginaFinal" => "526"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Granisetron and ondansetron for prevention of nausea and vomiting in patients undergoing modified radical mastectomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesth Intensive Care"
                        "fecha" => "2004"
                        "volumen" => "32"
                        "paginaInicial" => "761"
                        "paginaFinal" => "764"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a randomized placebo-controlled study"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00464-007-9656-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Endosc"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "paginaInicial" => "1487"
                        "paginaFinal" => "1492"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized, double-blinded comparison of ondansetron, granisetron, and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ANA.0b013e3181a7beaa"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg Anesthesiol"
                        "fecha" => "2009"
                        "volumen" => "21"
                        "paginaInicial" => "226"
                        "paginaFinal" => "230"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery &#8211; granisetron alone vs granisetron combined with dexamethasone/droperidol"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Middle East J Anesthesiol"
                        "fecha" => "2007"
                        "volumen" => "19"
                        "paginaInicial" => "357"
                        "paginaFinal" => "367"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized blinded study of the incidence of postoperative nausea and vomiting in women after major gynecologic laparoscopic surgery"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jmig.2006.05.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Minim Invasive Gynecol"
                        "fecha" => "2006"
                        "volumen" => "13"
                        "paginaInicial" => "413"
                        "paginaFinal" => "417"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimization of anesthesia antiemetic measures versus combination therapy using dexamethasone or ondansetron for the prevention of postoperative nausea and vomiting"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00464-009-0567-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Endosc"
                        "fecha" => "2010"
                        "volumen" => "24"
                        "paginaInicial" => "353"
                        "paginaFinal" => "358"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Haloperidol vs. ondansetron for the prevention of postoperative nausea and vomiting following gynaecological surgery"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0265021506001323"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Anaesthesiol"
                        "fecha" => "2007"
                        "volumen" => "24"
                        "paginaInicial" => "171"
                        "paginaFinal" => "178"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized comparison of droperidol, metoclopramide, tropisetron, and ondansetron for the prevention of postoperative nausea and vomiting"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000320747"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gynecol Obstet Invest"
                        "fecha" => "2011"
                        "volumen" => "71"
                        "paginaInicial" => "59"
                        "paginaFinal" => "65"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dexamethasone 8<span class="elsevierStyleHsp" style=""></span>mg in combination with ondansetron 4<span class="elsevierStyleHsp" style=""></span>mg appears to be the optimal dose for the prevention on nausea and vomiting after laparoscopic cholecystectomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF03016875"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Anaesth"
                        "fecha" => "2002"
                        "volumen" => "49"
                        "paginaInicial" => "922"
                        "paginaFinal" => "926"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of orally disintegrating ondansentron in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: a randomised, double blind placebo controlled study"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2044.2008.05860.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "2009"
                        "volumen" => "64"
                        "paginaInicial" => "595"
                        "paginaFinal" => "600"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of prophylactic ondansentron on post-operative nausea and vomiting after elective craniotomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Neurosurg Anesthesiol"
                        "fecha" => "2001"
                        "volumen" => "13"
                        "paginaInicial" => "2007"
                        "paginaFinal" => "2012"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Anesth"
                        "fecha" => "2001"
                        "volumen" => "13"
                        "paginaInicial" => "430"
                        "paginaFinal" => "435"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ondansetron or droperidol for prophylaxis of nausea and vomiting after intrathecal morphine"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0265021506000482"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Anaesthesiol"
                        "fecha" => "2006"
                        "volumen" => "23"
                        "paginaInicial" => "670"
                        "paginaFinal" => "675"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ondasentron, orally disintegrating tablets versus intravenous injection for prevention or intrathecal morphine-induced nausea, vomiting, and pruritus in young males"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/01.ANE.0000180830.12355.D9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2005"
                        "volumen" => "101"
                        "paginaInicial" => "1330"
                        "paginaFinal" => "1336"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prophylactic iv ondansentron reduces nausea, vomiting and pruritus following epidural morphine for postoperative pain control"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Can J Anaesth"
                        "fecha" => "2003"
                        "volumen" => "40"
                        "paginaInicial" => "1023"
                        "paginaFinal" => "1026"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of prophylactic ondansentron on post-operative nausea and vomiting in patients on preoperative steroids undergoing craniotomy for supratentorial tumors"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ANA.0b013e3181557471"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg Anesthesiol"
                        "fecha" => "2007"
                        "volumen" => "19"
                        "paginaInicial" => "239"
                        "paginaFinal" => "242"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metoclopramide versus ondansetron in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg"
                        "fecha" => "2001"
                        "volumen" => "181"
                        "paginaInicial" => "138"
                        "paginaFinal" => "141"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of prophylactic anti-emetic effects of ondansetron and dexamethasone in women undergoing day-case gynaecological laparoscopic surgery"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Int Med Res"
                        "fecha" => "2003"
                        "volumen" => "31"
                        "paginaInicial" => "481"
                        "paginaFinal" => "488"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Droperidol has comparable clinical efficacy against both nausea and vomiting"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aep177"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2009"
                        "volumen" => "103"
                        "paginaInicial" => "359"
                        "paginaFinal" => "363"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prophylactic effect of haloperidol plus dexamethasone on postoperative nausea and vomiting in patients undergoing laparoscopically assisted vaginal hysterectomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ane.0b013e3181609424"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2008"
                        "volumen" => "106"
                        "paginaInicial" => "1402"
                        "paginaFinal" => "1406"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dexamethasone for preventing nausea and vomiting associated with epidural morphine: a dose-ranging study"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2001"
                        "volumen" => "92"
                        "paginaInicial" => "745"
                        "paginaFinal" => "748"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low-dose haloperidol prevents post-operative nausea and vomiting after ambulatory laparoscopic surgery"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-6576.2007.01525.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Scand"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "280"
                        "paginaFinal" => "284"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of postoperative nausea and vomiting after intrathecal morphine for Cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijoa.2006.11.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Obstet Anesth"
                        "fecha" => "2007"
                        "volumen" => "16"
                        "paginaInicial" => "122"
                        "paginaFinal" => "127"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Single-dose haloperidol for the prophylaxis of postoperative nausea and vomiting after intrathecal morphine"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2004"
                        "volumen" => "98"
                        "paginaInicial" => "1072"
                        "paginaFinal" => "1076"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low-dose dexamethasone effectively prevents postoperative nausea and vomiting after ambulatory laparoscopic surgery"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF03016586"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Anaesth"
                        "fecha" => "2001"
                        "volumen" => "48"
                        "paginaInicial" => "973"
                        "paginaFinal" => "977"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prophylactic antiemetics for laparoscopic cholecystectomy: droperidol, metoclopramide, and droperidol plus metoclopramide"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/lap.2004.14.212"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Laparoendosc Adv Surg Tech A"
                        "fecha" => "2004"
                        "volumen" => "14"
                        "paginaInicial" => "212"
                        "paginaFinal" => "218"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of dexamethasone, metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00464-006-9122-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Endosc"
                        "fecha" => "2007"
                        "volumen" => "21"
                        "paginaInicial" => "607"
                        "paginaFinal" => "612"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low-dose dexamethasone reduces nausea and vomiting after epidural morphine: a comparison of metoclopramide with saline"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Anesth"
                        "fecha" => "2002"
                        "volumen" => "14"
                        "paginaInicial" => "19"
                        "paginaFinal" => "23"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anti-emetic prophylaxis with oral tropisetron and/or dexamethasone"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2362.2006.01671.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Invest"
                        "fecha" => "2006"
                        "volumen" => "36"
                        "paginaInicial" => "580"
                        "paginaFinal" => "587"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Small-dose dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy: a comparison of tropisetron with saline"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2002"
                        "volumen" => "95"
                        "paginaInicial" => "229"
                        "paginaFinal" => "232"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postoperative vomiting reduction after laparoscopic cholecystectomy with single dose of dexamethasone"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Minerva Anestesiol"
                        "fecha" => "2007"
                        "volumen" => "73"
                        "paginaInicial" => "343"
                        "paginaFinal" => "346"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dexamethasone facilitates discharge after outpatient anorectal surgery"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2001"
                        "volumen" => "92"
                        "paginaInicial" => "85"
                        "paginaFinal" => "88"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized clinical trial of the effect of preoperative dexamethasone on nausea and vomiting after laparoscopic cholecystectomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/bjs.5252"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2006"
                        "volumen" => "93"
                        "paginaInicial" => "295"
                        "paginaFinal" => "299"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2407-10-692"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Cancer"
                        "fecha" => "2010"
                        "volumen" => "10"
                        "paginaInicial" => "692"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The preoperative use of gabapentin, dexamethasone, and their combination in varicocele surgery: a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/01.ane.0000278869.00918.b7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2007"
                        "volumen" => "105"
                        "paginaInicial" => "1137"
                        "paginaFinal" => "1142"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A dose ranging study of dexamethasone for preventing patient-controlled analgesia-related nausea and vomiting: a comparison of droperidol with saline"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2004"
                        "volumen" => "98"
                        "paginaInicial" => "1066"
                        "paginaFinal" => "1071"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of PONV with dexamethasone in female patients undergoing desflurane anesthesia for thyroidectomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Sin"
                        "fecha" => "2001"
                        "volumen" => "39"
                        "paginaInicial" => "151"
                        "paginaFinal" => "62003"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2003"
                        "volumen" => "90"
                        "paginaInicial" => "665"
                        "paginaFinal" => "670"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dexamethasone for postoperative nausea and vomiting prophylaxis: effect on glycaemia in obese patients with impaired glucose tolerance"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/EJA.0b013e328319c09b"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Anaesthesiol"
                        "fecha" => "2009"
                        "volumen" => "26"
                        "paginaInicial" => "318"
                        "paginaFinal" => "321"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of dexamethasone on postoperative symptoms in patients undergoing elective laparoscopic cholecystectomy: randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00268-010-0457-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg"
                        "fecha" => "2010"
                        "volumen" => "34"
                        "paginaInicial" => "895"
                        "paginaFinal" => "900"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of the effects of droperidol and the combination of droperidol and ondansetron on postoperative nausea and vomiting for patients undergoing laparoscopic cholecystectomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Anesth"
                        "fecha" => "2002"
                        "volumen" => "14"
                        "paginaInicial" => "481"
                        "paginaFinal" => "485"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of combined haloperidol and dexamethasone versus dexamethasone only for postoperative nausea and vomiting in high-risk day surgery patients: a randomized blinded trial"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/EJA.0b013e32832fce15"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Anaesthesiol"
                        "fecha" => "2010"
                        "volumen" => "27"
                        "paginaInicial" => "192"
                        "paginaFinal" => "195"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            69 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dexamethasone in combination with dolasetron for prophylaxis in the ambulatory setting: effect on outcome after laparoscopic cholecystectomy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2002"
                        "volumen" => "96"
                        "paginaInicial" => "1346"
                        "paginaFinal" => "1350"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            70 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Haloperidol versus haloperidol plus ondansetron for the prophylaxis of postoperative nausea and vomiting after ophthalmologic surgery"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000196812"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pharmacology"
                        "fecha" => "2009"
                        "volumen" => "83"
                        "paginaInicial" => "205"
                        "paginaFinal" => "210"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            71 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Haloperidol plus ondansetron versus ondansetron alone for prophylaxis of postoperative nausea and vomiting"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ane.0b013e31816091f0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2008"
                        "volumen" => "106"
                        "paginaInicial" => "1410"
                        "paginaFinal" => "1413"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            72 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of transdermal scopolamine on the incidence and severity of postoperative nausea and vomiting in a group of high-risk patients given prophylactic intravenous ondansetron"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AANA J"
                        "fecha" => "2006"
                        "volumen" => "74"
                        "paginaInicial" => "127"
                        "paginaFinal" => "132"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            73 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "74"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of nausea and vomiting after middle ear surgery: combination of ondansetron and dexamethasone is the right choice"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Otolaryngol"
                        "fecha" => "2004"
                        "volumen" => "33"
                        "paginaInicial" => "88"
                        "paginaFinal" => "92"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            74 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "75"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of vomiting after strabismus surgery in children: dexamethasone alone versus dexamethasone plus low-dose ondansetron"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Paediatr Anaesth"
                        "fecha" => "2001"
                        "volumen" => "11"
                        "paginaInicial" => "591"
                        "paginaFinal" => "595"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            75 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "76"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2003"
                        "volumen" => "97"
                        "paginaInicial" => "259"
                        "paginaFinal" => "263"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            76 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "77"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomised double blind multicentre trial"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.38903.419549.80"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2006"
                        "volumen" => "333"
                        "paginaInicial" => "324"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            77 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "78"
              "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 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ANE.0000000000000002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2014"
                        "volumen" => "118"
                        "paginaInicial" => "85"
                        "paginaFinal" => "111"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            78 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "79"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of flumazenil on recovery from sevoflurane anesthesia in children premedicated with oral midazolam before undergoing herniorrhaphy with or without caudal analgesia"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00540-005-0314-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Anesth"
                        "fecha" => "2005"
                        "volumen" => "19"
                        "paginaInicial" => "204"
                        "paginaFinal" => "207"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            79 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "80"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ambulatory surgery: room air versus nasal cannula oxygen during transport after general anesthesia"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2001"
                        "volumen" => "93"
                        "paginaInicial" => "917"
                        "paginaFinal" => "921"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            80 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "81"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative hypothermia and postoperative opioid requirements"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Anaesthesiol"
                        "fecha" => "2001"
                        "volumen" => "18"
                        "paginaInicial" => "679"
                        "paginaFinal" => "686"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            81 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "82"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison between meperidine, clonidine and urapidil in the treatment of postanesthetic shivering"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2001"
                        "volumen" => "92"
                        "paginaInicial" => "257"
                        "paginaFinal" => "260"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            82 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "83"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dexmedetomidine for the treatment of postanesthesia shivering in children"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1460-9592.2006.02100.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Paediatr Anaesth"
                        "fecha" => "2007"
                        "volumen" => "17"
                        "paginaInicial" => "341"
                        "paginaFinal" => "346"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            83 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "84"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dexmedetomidine for the prevention of shivering during spinal anesthesia"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clinics (Sao Paulo)"
                        "fecha" => "2011"
                        "volumen" => "66"
                        "paginaInicial" => "1187"
                        "paginaFinal" => "1191"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            84 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "85"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normas m&iacute;nimas de seguridad en Anestesiolog&iacute;a CLASA &#8211; SCARE 2006"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Colomb Anestesiol"
                        "fecha" => "2006"
                        "volumen" => "34"
                        "paginaInicial" => "185"
                        "paginaFinal" => "190"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            85 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "86"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "titulo" => "Epidural analgesia"
                        "paginaInicial" => "144"
                        "serieFecha" => "1978"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            86 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "87"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Post-anaesthetic discharge scoring criteria: a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JBI Library Syst Rev"
                        "fecha" => "2011"
                        "volumen" => "9"
                        "paginaInicial" => "1679"
                        "paginaFinal" => "1713"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            87 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "88"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The post anesthesia recovery score revisited"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Anesth"
                        "fecha" => "1995"
                        "volumen" => "7"
                        "paginaInicial" => "89"
                        "paginaFinal" => "91"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22562087/0000004300000001/v1_201501210932/S2256208714001266/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/S2256208714001266/v1_201501210932/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208714001266?idApp=UINPBA00004N"
]
Article information
ISSN: 22562087
Original language: English
DOI:10.1016/j.rcae.2014.11.001
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 13 0 13
2024 October 100 12 112
2024 September 122 22 144
2024 August 79 13 92
2024 July 68 7 75
2024 June 51 4 55
2024 May 73 4 77
2024 April 82 11 93
2024 March 199 13 212
2024 February 129 15 144
2024 January 94 16 110
2023 December 94 18 112
2023 November 95 10 105
2023 October 98 6 104
2023 September 83 8 91
2023 August 66 3 69
2023 July 62 5 67
2023 June 27 4 31
2023 May 95 4 99
2023 April 77 4 81
2023 March 58 8 66
2023 February 45 7 52
2023 January 41 9 50
2022 December 38 4 42
2022 November 50 6 56
2022 October 34 10 44
2022 September 63 19 82
2022 August 34 6 40
2022 July 29 7 36
2022 June 27 5 32
2022 May 19 8 27
2022 April 31 5 36
2022 March 42 8 50
2022 February 64 2 66
2022 January 39 11 50
2021 December 24 9 33
2021 November 38 15 53
2021 October 64 17 81
2021 September 37 9 46
2021 August 18 7 25
2021 July 21 7 28
2021 June 33 7 40
2021 May 37 5 42
2021 April 42 39 81
2021 March 33 27 60
2021 February 19 22 41
2021 January 24 18 42
2020 December 26 14 40
2020 November 29 12 41
2020 October 18 17 35
2020 September 19 27 46
2020 August 16 19 35
2020 July 13 22 35
2020 June 7 15 22
2020 May 13 7 20
2020 April 9 1 10
2020 March 17 4 21
2020 February 17 4 21
2020 January 13 2 15
2019 December 15 5 20
2019 November 7 1 8
2019 October 9 0 9
2019 September 7 3 10
2019 August 2 0 2
2019 July 1 3 4
2019 June 4 1 5
2019 May 2 8 10
2018 December 1 0 1
2018 September 1 0 1
2018 June 6 1 7
2018 May 43 6 49
2018 April 76 6 82
2018 March 74 13 87
2018 February 40 9 49
2018 January 58 8 66
2017 December 36 6 42
2017 November 61 5 66
2017 October 71 8 79
2017 September 75 12 87
2017 August 74 8 82
2017 July 73 7 80
2017 June 75 9 84
2017 May 74 7 81
2017 April 71 12 83
2017 March 68 6 74
2017 February 58 6 64
2017 January 34 8 42
2016 December 58 10 68
2016 November 56 7 63
2016 October 66 12 78
2016 September 83 5 88
2016 August 91 14 105
2016 July 42 8 50
2016 June 0 15 15
2016 May 2 0 2
2016 April 0 17 17
2016 March 4 21 25
2016 February 5 27 32
2015 December 43 11 54
2015 November 151 17 168
2015 October 166 16 182
2015 September 141 6 147
2015 August 140 12 152
2015 July 141 9 150
2015 June 74 7 81
2015 May 68 8 76
2015 April 107 10 117
2015 March 103 21 124
2015 February 70 13 83
2015 January 48 11 59
Show all

Follow this link to access the full text of the article

Subscribe to our newsletter

es en pt

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

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

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