Etilefrine vs. phenylephrine for hypotension during spinal anesthesia for cesarean section: Multicenter, randomized, double blind controlled clinical trial

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SBP: Systolic Blood Pressure." ] ] ] "textoCompleto" => "IntroductionIn the last few years there has been an increasing incidence of cesarean sections worldwide, with rates ranging from 25 to 30%.<a class="elsevierStyleCrossRef" href="#bib0205">1</a> Regional anesthesia is considered superior to general anesthesia for cesarean delivery because it reduces maternal morbidity, although mortality and neonatal outcomes are similar as compared to general anesthesia.<a class="elsevierStyleCrossRefs" href="#bib0210">2,3</a> Spinal anesthesia has become the technique of choice for this procedure because it is safer and simpler to use, is administer in a shorter time, has a quick onset of action, and is more comfortable for the patient.Maternal hypotension is an unwanted consequence of spinal block. Its incidence ranges from 55 to 90%,<a class="elsevierStyleCrossRefs" href="#bib0220">4–6</a> and is more frequent in patients scheduled for elective cesarean section and no labor.<a class="elsevierStyleCrossRef" href="#bib0235">7</a>Hypotension during spinal anesthesia – regardless of how mild or short duration – results in deleterious effects for both the mother and the fetus. There is decreased utero-placental blood flow (UBF) causing hypoxia and fetal acidosis, as well as neonatal depression.<a class="elsevierStyleCrossRefs" href="#bib0205">1,8</a> The mother experiences low cardiac output symptoms, including nausea, vomiting, dizziness, and decreased consciousness. Several interventions have been studied and implemented to reduce the incidence of hypotension; i.e., uterine displacement, intravascular volume expansion with intravenous fluids, and the use of vasopressors.<a class="elsevierStyleCrossRefs" href="#bib0245">9,4</a>Despite the use of pre-load or co-load of intravenous fluids, there is still a high frequency of hypotension and vasopressors are required in a high proportion of patients.<a class="elsevierStyleCrossRef" href="#bib0250">10</a>Though most studies have shown that the incidence of fetal acidosis following spinal anesthesia is secondary to hypotension, others feel that acidosis may be associated to the transfer of the vasopressor across the placenta.<a class="elsevierStyleCrossRefs" href="#bib0240">8,11–14</a>Phenylephrine is one of the most studied vasopressors and is the drug of choice in obstetrics because of its high transfer rate across the placental barrier, increased fetal metabolism due to direct stimulation of the α and β receptors, and because it increases catecholamines and PaCO2. Phenylephrine has shown less transfer across the placenta with enhanced utero-placental blood flow and improved acid–base fetal status.<a class="elsevierStyleCrossRefs" href="#bib0260">12–15</a>Etilefrine is the most frequently used vasopressor in Colombia for the treatment of hypotension from spinal anesthesia during cesarean section.<a class="elsevierStyleCrossRef" href="#bib0280">16</a> Etilefrine is a direct action sympathomimetic agent that stimulates the α-1 and β-2 receptors.<a class="elsevierStyleCrossRef" href="#bib0285">17</a> We have not been unable to find any studies comparing these two vasopressors.The purpose of this study is to compare the fetal outcomes as evidenced by the pH of the umbilical artery and the Apgar score, and maternal outcomes, measured in terms of the dose of vasopressor, hypotension time and the incidence of nausea and vomiting, following the administration of etilefrine vs. phenylephrine for the management of hypotension secondary to the administration of spinal anesthesia for cesarean section.Materials and methodsA randomized, double blind, controlled clinical trial was undertaken in two clinics in Medellin: Clínica Universitaria Bolivariana and Clínica del Prado. The trial was approved by the Institute of Ethics and Bioethics of the Pontificia Bolivariana University.A random allocation in blocks of three was performed, classified in accordance with the institution, using RALLOC version 3.5.2 statistical software. The trial was initially planned for three institutions but when data collection was initiated, only two participated. The blinding process was done in opaque envelopes containing the study group to which the patient was allocated. The envelopes for the third institution were distributed between the other two.All pregnant women who underwent elective or programmed cesarean section according to the Lucas and Yentis classification<a class="elsevierStyleCrossRef" href="#bib0290">18</a>, under spinal anesthesia, with a gestational age of ≥36 and <42 weeks, aged over 18 years old, single pregnancy and ASA physical condition 1–2<a class="elsevierStyleCrossRef" href="#bib0295">19</a> who accepted to participate in the study were included. Patients with congenital and clinical fetal abnormalities – including nonreassuring fetal status or episodes of resolved fetal bradycardia, patients with pregnancy-associated hypertensive disorders, diabetes mellitus, gestational diabetes, and patients with known allergy to any of the vasopressors, were excluded.The patients were included upon understanding, accepting and signing of the informed consent. Once the patient was accepted, a head nurse from each department who was not a member of the research group and was not in charge of the patient's care, consecutively opened an opaque envelope from the study group and prepared the corresponding mixture. The medications were prepared in 10ml of 0.9% saline solution in identical syringes; there were no differential characteristics to indicate the medication used. The syringe labeled with each patient's random number was then delivered to the anesthetist in charge of the procedure and the anesthetist was not aware of the medication prepared.The anesthetic technique was identical for every patient. Spinal anesthesia was administered in the sitting position with a pencil tip needle. A 7.5mg hyperbaric bupivacaine solution was used, in addition to fentanyl 25μg plus morphine 100μg, with the aim of blocking up to T4 level. Simultaneously with the drug, a co-load of 500ml of 0.9% saline solution was administered. After the spinal anesthesia was administered, the patients were placed in supine position with the uterus deviated to the left and a wedge under the right pelvis.The patients joined the study only after presenting an episode of hypotension following spinal anesthesia, identified by serial non-invasive blood pressure measurements using an automatic blood pressure device, at one-minute intervals for the first 10min. The patients who did not become hypotensive at the end of the 10min were excluded.Hypotension was defined as a systolic blood pressure (SBP) below 100mmHg and/or a mean blood pressure (MBP) of less than 60mmHg. When hypotension developed, 2ml boluses of vasopressor were administered every minute, corresponding to 2mg of etilefrine or 50μg of phenylephrine, until the SBP and/or MBP values were above the limits established to join the trial.In the case of non-responders that required over 10ml of the vasopressor's solution, the patient was unblinded so that the anesthesiologist could continue managing the patient appropriately to avoid unfavorable maternal or fetal consequences.At the time of birth, a 15cm double clamped cord segment was obtained before the baby's first breath. Before the next 60min an arterial blood sample was taken and processed to measure the pH value, using an i-STAT® (The i-STAT® System- Point of Care Testing) blood gas analyzer supplied by Arrow Laboratories.The anesthetist entered the data into a form designed by the research team. The initial protocol was registered with the Latin American Trial Registry “Latin American Ongoing Clinical Trials Register – LATINREC-” COL101. The study was presented as an abstract at the annual meeting of the “Society for Obstetric Anesthesia and Perinatology (SOAP)” in 2012. Abstract Number: TW-2.Statistical analysisAs primary outcome we assessed the average pH difference of the fetuses’ umbilical vein. A total of 98 patients were programmed for each group's sample in order to identify a 0.03 difference in pH among the groups, with a 0.05 standard deviation considering an alpha error of 0.05, a beta error of 0.2 and a 10% loss in each group. These numbers were based on a previous study by Cooper et al., which found a 2.08% incidence of fetal acidosis with phenylephrine.<a class="elsevierStyleCrossRef" href="#bib0260">12</a>The secondary outcomes for the newborn babies were: fetal acidosis defined as an umbilical vein pH<7.20; low Apgar score at minutes 1 and 5, established at <7; need to intubate and NICU admission. The secondary outcomes for mothers were: time of hypotension, total dose of vasopressor, need to use atropine, total intravenous fluids volume during the intraoperative period, and the incidence of nausea and vomiting. Additionally, a graphical representation and a comparison of the systolic blood pressure, the mean blood pressure, and the heart rate during the first 10min in both groups were developed.The quantitative variables were evaluated with the Kolmogorov–Smirnov test to verify the hypothesis of normality. The continuous variables with normal distribution are presented as means±standard deviation and the non-normal distribution variables as medians with interquartile range. The categorical variables are presented as percentages. The comparison of the continuous variables between both study groups was made with the student-t test when the distribution was normal, and with Mann–Whitney's when the distribution was not normal. The comparison of the categorical variables was done using chi square, or Fisher's exact test when required based on the magnitude of the result. The intention-to-treat analysis was performed. A two-tailed P value of less than 0.05 was considered statistically significant. The statistical analysis was done under the SPSS software, version 15.0.ResultsA total of 422 patients were evaluated to participate in the trial from July 2009 through November 2010. 196 were included, of which 98 received etilefrine and 98 received phenylephrine. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> illustrates the flow of participants.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Although there was a statistically significant difference in the gestational age between the two study groups, such difference was not clinically relevant. All other baseline characteristics were similar (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The most frequent indication for cesarean section was cephalopelvic disproportion, which occurred in 37.8 and 38.8% of the patients in each group (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>No statistically significant difference was found in the primary outcome – umbilical arterial pH – between the etilefrine and phenylephrine groups (7.27±0.07 vs. 7.28±0.07 respectively. P=0.493). Neither were there any differences in most of the secondary outcomes. There were no statistically significant differences in the PaCO2 and PaO2 values of the umbilical cord samples (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The incidence of fetal acidosis in the etilefrine group was 11.2% vs. 12.2% in the phenylephrine group, with no evidence of statistical significance (RR: 0.88; CI 95%: 0.41–1.91; P=0.93). Only one of all the neonates examined had to be admitted to the NICU and he was from the phenylephrine group (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>There were significant differences in terms of time of hypotension between the two groups, with shorter times in the etilefrine group (2.78±1.32min vs. 3.25±1.45min, P=0.021) and in the total dose of vasopressor which was also lower in the etilefrine group (5.66±2.93ml vs. 6.6±2.90ml; P=0.024) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Two patients from the phenylephrine group and one from the etilefrine group had to be unblinded, but treatment remained unchanged in all three; just additional doses were given and none developed fetal acidosis.The hemodynamic behavior of both SBP and MBP in both groups during the first 10min following the first episode of hypotension showed no significant differences, though the heart rate was higher in the patients receiving etilefrine (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2–4</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>The remaining secondary outcomes including Apgar score, incidence of nausea and vomiting, atropine requirement and need for neonatal intubation were low and there were no differences between the two groups (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).DiscussionThis study shows that etilefrine and phenylephrine are equally effective and safe vasopressors for the treatment of spinal anesthesia hypotension during cesarean delivery. There were no differences in the fetal or maternal outcomes in pregnancies between 36 and 42 weeks, in women undergoing elective or programmed cesarean section.The recommendation to achieve adequate anesthesia for cesarean section is to deliver a sensory block up to dermatome T5 as a minimum. This trial used an anesthetic technique with hyperbaric bupivacaine, fentanyl, and morphine aimed at obtaining a block up to level T4. This results in a sympathetic block that leads to a reduction in the systemic vascular resistance causing hypotension in 55–90% of the patients.<a class="elsevierStyleCrossRefs" href="#bib0225">5,6</a>Toward the end of pregnancy, the uterine-placental vessels exhibit maximum dilatation and low resistance, resulting in loss of self-regulation. Maternal hypotension may lead to utero-placental hypoperfusion and fetal distress.<a class="elsevierStyleCrossRef" href="#bib0220">4</a> Different approaches have been considered to prevent and to quickly treat such event.<a class="elsevierStyleCrossRefs" href="#bib0225">5,20,21</a> Our group used the concomitant administration of a co-load of 500ml of 0.9% saline solution following spinal anesthesia, since it has been established that the result is the same using crystalloids or colloids and that it is better to do co-load rather than pre-load.<a class="elsevierStyleCrossRefs" href="#bib0220">4,21,22</a> We also did left uterine displacement placing a wedge below the pelvis, although this approach has not been useful<a class="elsevierStyleCrossRefs" href="#bib0315">23,24</a> but is part of the routine management in our setting.To offset the drop in vascular resistance caused by spinal anesthesia, which leads to hypotension, the use of vasopressors to preserve the α and β adrenergic activity is a logical approach. The two vasopressors most commonly used and researched are ephedrine (an α and β adrenergic agonist) and phenylephrine, a α-1 receptor agonist and with β-agonist action only at high doses.<a class="elsevierStyleCrossRef" href="#bib0230">6</a> Phenylephrine is currently considered the vasopressor of choice since it has been associated with improved fetal acid-base status as compared to ephedrine.<a class="elsevierStyleCrossRef" href="#bib0275">15</a> Notwithstanding the fact that a meta-analysis including 142 trials failed to acknowledge the superiority of phenylephrine over ephedrine when comparing the results of the Apgar scores in neonates,<a class="elsevierStyleCrossRef" href="#bib0325">25</a> it has been proven that ephedrine can cross the placenta and result in lower fetal pH due to its metabolic effects from stimulation of the fetal β-adrenergic receptors<a class="elsevierStyleCrossRef" href="#bib0270">14</a> and that fetal acidosis – defined as a pH in the umbilical cord artery <7.20 – is associated with a two and four-fold increase in morbidity and mortality, respectively.<a class="elsevierStyleCrossRef" href="#bib0330">26</a>The most popular vasopressor in Colombia is etilefrine, which being an isomer of phenylephrine could have similar effects. We failed to find a trial comparing the maternal-fetal effects of these two vasopressors and only found two trials comparing etilefrine with efedrine. Belzarena reported that there were no differences in the Apgar scores of newborn babies when comparing these two drugs for the treatment of hypotension.<a class="elsevierStyleCrossRef" href="#bib0335">27</a> Räsänen et al., showed that etilefrine caused no detectable changes in the fetal hemodynamic behavior or myocardial function, whilst ephedrine reduced the renal and cerebral artery flow rate and led to increased ventricular contractility and a reduction in the left ventricular dimension at the end of diastole.<a class="elsevierStyleCrossRef" href="#bib0285">17</a>Although Valli et al. reported an increase in the uterine vascular resistance during the prophylactic administration of etilefrine infusion to maintain the blood pressure in patients under spinal anesthesia, no adverse medical neonatal effects were shown as measured by the Apgar score and the acid-base status of the arterial and venous blood of the umbilical cord.<a class="elsevierStyleCrossRef" href="#bib0340">28</a> No significant difference was found in this study between the arterial pH values of the umbilical cord among the neonates born from mothers receiving etilefrine or phenylephrine; hence, as shown in previous studies, the medications did not cross the placenta. Neither did this study find statistically significant differences between the two groups in terms of the incidence of fetal acidosis; however, the incidence in the phenylephrine group was higher than the incidence reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0260">12,29,30</a> This could be explained by the use of a smaller volume of intravenous fluids as compared to other studies, or because our group included a neonate with non-previously diagnosed heart disease and another one with macrosomia (4110g). The latter neonate experienced a difficult and prolonged uterine extraction (>3min).As far as the neonatal results are concerned, Casey et al.,<a class="elsevierStyleCrossRef" href="#bib0355">31</a> claim that the Apgar score is a better predictor of the neonatal outcome than the umbilical cord pH measurement. There were no statistically significant differences in the Apgar score measurement between the two groups in this trial. There were only three neonates with a score <7 at the first minute, two from the phenylephrine group and one from the etilefrine group. The Apgar score at 5min of every neonate in both groups was >7, none of them required tracheal intubation and only one from the phenylephrine group – the same baby who developed acidosis – had to be admitted to the NICU and was diagnosed with congenital heart disease that was not identified in the prenatal period.The intravenous dose of phenylephrine has an immediate onset of action and lasts for 5–10min. There is yet no agreement among the anesthetists about the proper administration regime for phenylephrine<a class="elsevierStyleCrossRef" href="#bib0355">31</a>; our group used bolus doses because although some advocate infusion, it has been proven that the total bolus dose used is less, pressure control is adequate, simpler and no pumps or perfusion syringes are needed.<a class="elsevierStyleCrossRefs" href="#bib0365">32,33</a>Several studies suggest that the effective dose of phenylephrine is 122–147μg<a class="elsevierStyleCrossRefs" href="#bib0375">34,35</a>; however, a 50μg dose (2ml) was chosen because the 40μg and 100μg bolus doses continue to be the usual practice<a class="elsevierStyleCrossRef" href="#bib0360">36</a> and because we use the same dose used in other studies.<a class="elsevierStyleCrossRefs" href="#bib0365">32–39</a>The 2mg dose (2ml) of etilefrine was chosen on the basis of the management protocols used by the local work groups and by the Belzarena trial<a class="elsevierStyleCrossRef" href="#bib0335">27</a> since no bioequivalence data comparing both drugs are available.LaPorta and Thomas documented that the development of bradycardia was more likely in women receiving phenylephrine than in those treated with ephedrine. This is a side effect and a reflex mechanism due to increased vascular resistance without stimulation of the β receptors.<a class="elsevierStyleCrossRefs" href="#bib0390">38,40</a> The etilefrine group in this trial developed a higher heart rate, though not clinically significant, probably because of a stronger stimulating effect over the β-adrenergic receptors.Although there was a statistically significant difference in the time of hypotension, such difference was not clinically relevant. There was also a difference in the dose of vasopressor used measured in ml, but we cannot make any claims about an actual difference since the bioequivalence of these drugs is yet unknown.Spinal anesthesia induces nausea and vomiting through various mechanisms such as intestinal ischemia, cerebral ischemia or via a reflex mechanism in response to a decreased venous return.<a class="elsevierStyleCrossRef" href="#bib0245">9</a> There were no differences in the incidence of vomiting between both groups in this trial and it was similar to other reports.<a class="elsevierStyleCrossRefs" href="#bib0335">27,38</a>This trial has several limitations: 205 patients that could have been included in the randomization were not evaluated because the researchers were not available at the institutions throughout the trial and, although there could have been an equitable distribution based on the methodological design, the impact on the results cannot be ruled out, and neither is it possible to indicate how that effect would have been since their behavior is unpredictable. Furthermore, the trial was carried out at only two institutions and the results cannot be generalized to other institutions using different doses, different block levels, pre-loads or other co-load volumes. Etilefrine is a very popular vasopressor in our country, but this is not necessarily the case in other regions.There are still many unanswered questions about vasopressors used for the management of hypotension in patients undergoing cesarean section that require further research. Currently there is no clear evidence about the adequate vasopressor for non-elective surgery; the bioequivalent doses of phenylephrine and etilefrine are unknown; and the specific vasopressor that can be safely used in mothers of nonreassuring fetal status babies has not been identified.The conclusion from the results of this trial are that etilefrine may be safely used in mothers during the 36 and 42 weeks of pregnancy undergoing elective or programmed cesarean section, following the protocol recommendations, and develop spinal anesthesia-associated hypotension.FundingCentro de Investigación para el Desarrollo y la Innovación – CIDI de la Universidad Pontificia Bolivariana. Número de radicado: 379A-12/08-40.Conflicts of interestNone of the authors has conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres631168" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec644021" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres631169" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec644022" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack212733" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-04-20" "fechaAceptado" => "2016-01-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec644021" "palabras" => array:5 [ 0 => "Phenylephrine" 1 => "Spinal, anesthesia" 2 => "Cesárean section" 3 => "Etilefrine" 4 => "Hypotension" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec644022" "palabras" => array:5 [ 0 => "Fenilefrina" 1 => "Anestesia raquídea" 2 => "Cesárea" 3 => "Etilefrina" 4 => "Hipotensión" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionHypotension after spinal anesthesia in cesarean section should be minimized. The use of vasopressors is an effective measure to treat hypotension. The objective of this paper is to compare the safety and effectiveness of etilefrine vs. phenylephrine in the management of this condition. MethodsThis multicenter, double-blind trial between August 2009 and November 2010 included 196 patients with hypotension during spinal anesthesia for cesarean delivery; the patients were randomized to receive etilefrine or phenylephrine as vasopressor. The primary outcome was the fetal umbilical arterial pH. The secondary outcomes were: fetal acidosis (umbilical arterial pH<7.20), Apgar score at 1 and 5min, need for intubation and admission to the neonatal intensive care unit for newborns, and time of hypotension, total dose of vasopressor, atropine requirement, intravenous fluids volume and incidence of nausea and vomiting in mothers. Results98 patients received etilefrine and 98 phenylephrine. There were no differences in umbilical arterial pH (7.27 vs. 7.28, respectively, P=0.493). The total dose of vasopressor (5.66 vs. 6.51ml, respectively, P=0.024) and total time of hypotension (2.78 vs. 3.25min, respectively, P=0.021) were lower in the etilefrine group. Other outcomes studied showed no statistically significant differences. ConclusionEtilefrine and phenylephrine are equally effective for the treatment of hypotension during spinal anesthesia for cesarean delivery. This study found no difference in the maternal or fetal outcomes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa hipotensión que ocurre luego de anestesia espinal para cesárea debe minimizarse. El uso de vasopresores es una medida eficaz para su tratamiento. El objetivo de este trabajo es comparar la seguridad y efectividad de etilefrina vs fenilefrina para manejo de esta condición. MétodosEn este estudio multicéntrico y doble ciego, entre agosto de 2009 y noviembre de 2010, 196 pacientes con hipotensión durante anestesia espinal para cesárea, fueron asignadas aleatoriamente para recibir etilefrina o fenilefrina como vasopresor. El resultado primario fue el pH arterial umbilical fetal. Los resultados secundarios fueron: acidosis fetal (pH arterial umbilical<7,20), puntaje Apgar al 1 y 5 minutos, necesidad de intubación e ingreso a la unidad de cuidados intensivos neonatal para los recién nacidos; y tiempo de hipotensión, dosis total de vasopresor, necesidad de uso de atropina, líquidos endovenosos totales e incidencia de nausea y vómito para las madres. Resultados98 pacientes recibieron etilefrina y 98 fenilefrina. No se encontraron diferencias en el pH arterial umbilical (7,27 vs 7,28 respectivamente; p=0,493). La dosis total de vasopresor (5,66 vs. 6,6ml, respectivamente; P=0,024) y el tiempo total de hipotensión (2,78 vs. 3,25min, respectivamente; p=0,021), fueron menores en el grupo de etilefrina. Los demás desenlaces estudiados no presentaron diferencia estadísticamente significativa. ConclusiónLa etilefrina y la fenilefrina son igualmente efectivas para el tratamiento de la hipotensión por anestesia espinal para cesárea. Este estudio no encontró diferencia en los resultados fetales ni maternos." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Bolaños-Arboleda D, Fonseca-Ruiz NJ, Socha-García NI, García-Peñuela E, Monsalve-Mejía G. Etilefrina vs. fenilefrina en hipotensión por anestesia espinal para cesárea: ensayo clínico multicéntrico, controlado, aleatorizado y doble ciego. Rev Colomb Anestesiol. 2016;44:89–96." ] ] "multimedia" => array:7 [ 0 => array:9 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1564 "Ancho" => 1628 "Tamanyo" => 113221 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flow of participants." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1398 "Ancho" => 1554 "Tamanyo" => 157984 ] ] "descripcion" => array:1 [ "en" => "Systolic Blood Pressure comparison between both groups. SBP: Systolic Blood Pressure." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1305 "Ancho" => 1541 "Tamanyo" => 108792 ] ] "descripcion" => array:1 [ "en" => "Mean blood pressure comparison between both groups. MBP: Mean Blood Pressure." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1328 "Ancho" => 1554 "Tamanyo" => 94109 ] ] "descripcion" => array:1 [ "en" => "Heart rate comparison between both groups. HR: heart rate." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "tabla" => array:2 [ "leyenda" => "IQR, interquartile range; SD, standard deviation; kg, kilograms; SBP, systolic blood pressure; mmHg, millimeters of Mercury; DBP, diastolic blood pressure; MAP, mean arterial pressure; g, grams; SIET, skin incision extraction time." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Etilefrine, n=98 \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">Phenylephrine, n=98 \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">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age in years, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.2 (5.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.48 (5.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.355 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Parity, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.616 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gestational age in weeks, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (38–39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (38–39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maternal body weight in Kg, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (65–77.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.5 (67–78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.112 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline SBP, mmHg (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119.11 (9.11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119.64 (9.90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.697 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline DBP, mmHg (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.9 (9.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.42 (8.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.224 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP admission, mmHg (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.21 (10.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.98 (11.62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.331 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MBP admission, mmHg (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.39 (10.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.22 (11.11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.443 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fetal weight, g (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3265.6 (420.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3233.5 (440.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.973 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fasting hours, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (8–14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (8–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.603 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SIET in minutes, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (6–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (6–14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.826 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035457.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of the study population." ] ] 5 => array:9 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CPD, cephalo-pelvic disproportion; g, grams; Others, non-favorable cervix (4); human immunodeficiency virus (1); congenital hip dislocation (1); hip dysplasia (1); giant myomas (2); hip fracture (2); thin uterine segment (1)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Etilefrine, n=98 \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">Phenylephrine, n=98 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CPD, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (37.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (38.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prior C-section, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (24.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (22.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breech, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (20.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (17.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fetal macrosomia (≥4000g), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (10.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035458.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Indications for cesarean delivery in the study population." ] ] 6 => array:9 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "SD, standard deviation; mmHg, millimeters of mercury; TH, total hypotension time; ml, milliliters; IVF, total intravenous fluids in the intraoperative period; RR, relative risk; CI, confidence interval; min, minute; ICU, intensive care unit; (–), O value variables where RR, CI or P cannot be calculated. NA, not applicable." "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">Variable \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">Etilefrine, n=98 \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">Phenylephrine, n=98 \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">RR \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">CI 95% \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">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Umbilical artery pH<7.20, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (11.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (12.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.41–1.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apgar score at 1min<7, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.04–5.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nausea or vomiting, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (18.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (17.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.58–1.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Need for atropine, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apgar score 5min<7, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neonatal ICU, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neonatal intubation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Umbilical vein pH, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.27 (0.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.28 (0.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.493 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PaCO2 umbilical in mmHg, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.17 (9.79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.83 (9.66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.349 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PaO2 umbilical in mmHg, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.91 (6.50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.66 (6.95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.059 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TH in minutes, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.78 (1.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.25 (1.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.021<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vasopressor dose in ml, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.66 (2.93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6 (2.90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.024<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVF in ml, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1277.55 (402.96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1288.27 (470.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.984 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035459.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Statistically significant." ] ] ] "descripcion" => array:1 [ "en" => "Final results." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0205" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anesthesia for cesarean delivery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Tsen" 1 => "C. Lawrence" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "60th Annual meeting of the American Society of Anesthesiologists" "paginaInicial" => "1" "paginaFinal" => "6" "conferencia" => "New Orleans" "serieFecha" => "2009" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0210" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anesthesia-related deaths during obstetric delivery in the United States, 1979–1990" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.L. Awkins" 1 => "L.M. Koonin" 2 => "S.K. Palmer" 3 => "C.P. Gibbs" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1997" "volumen" => "86" "paginaInicial" => "277" "paginaFinal" => "284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9054245" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0215" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anestesia regional versus general para parto por cesárea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Páez" 1 => "J. Navarro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Colomb Anestesiol" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "203" "paginaFinal" => "206" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0220" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal hypotension during spinal anesthesia for caesarean delivery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.J. Mercier" 1 => "M. Augè" 2 => "C. Hoffmann" 3 => "C. Fischer" 4 => "A. Le Gouez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Minerva Anestesiol" "fecha" => "2013" "volumen" => "79" "paginaInicial" => "62" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23135692" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0225" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: continuing professional development" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Loubert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12630-012-9705-9" "Revista" => array:6 [ "tituloSerie" => "Can J Anaesth" "fecha" => "2012" "volumen" => "59" "paginaInicial" => "604" "paginaFinal" => "619" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22528166" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0230" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasopressors in obstetric anesthesia: a current perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.S. Nag" 1 => "D.P. Samaddar" 2 => "A. Chatterjee" 3 => "H. Kumar" 4 => "A. Dembla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12998/wjcc.v3.i1.58" "Revista" => array:6 [ "tituloSerie" => "World J Clin Cases" "fecha" => "2015" "volumen" => "3" "paginaInicial" => "58" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25610851" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0235" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anesthesia for obstetrics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Birnbach" 1 => "I. Browne" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "Miller's anesthesia" "edicion" => "7th ed." "serieFecha" => "2009" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0240" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fetal academia associated with regional anesthesia for elective cesarean delivery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.W. Roberts" 1 => "K.J. Leveno" 2 => "J.E. Sidawi" 3 => "M.J. Lucas" 4 => "M.A. Kelly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "1995" "volumen" => "85" "paginaInicial" => "79" "paginaFinal" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7800330" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0245" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Caesarean delivery vasopressor management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.W. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0b013e3283530d62" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2012" "volumen" => "25" "paginaInicial" => "300" "paginaFinal" => "308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22473212" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0250" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Banerjee" 1 => "R.M. Stocche" 2 => "P. Angle" 3 => "S.H. Halpern" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12630-009-9206-7" "Revista" => array:6 [ "tituloSerie" => "Can J Anaesth" "fecha" => "2010" "volumen" => "57" "paginaInicial" => "24" "paginaFinal" => "31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19859776" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0255" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.D. Mueller" 1 => "H. Brühwiler" 2 => "G.K. Schüpfer" 3 => "K.P. Lüscher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0029-7844(97)00210-X" "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "1997" "volumen" => "90" "paginaInicial" => "131" "paginaFinal" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9207827" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0260" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.W. Cooper" 1 => "M. Carpenter" 2 => "P. Mowbray" 3 => "W.R. Desira" 4 => "D.M. Ryall" 5 => "M.S. Kokri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2002" "volumen" => "97" "paginaInicial" => "1582" "paginaFinal" => "1590" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12459688" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0265" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of maternal administration of ephedrine on fetal heart rate and variability" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.G. Wright" 1 => "S.M. Shnider" 2 => "G. Levinson" 3 => "S.H. Rolbin" 4 => "J.T. Parer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "1981" "volumen" => "57" "paginaInicial" => "734" "paginaFinal" => "738" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7231826" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0270" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.D. Ngan Kee" 1 => "K.S. Khaw" 2 => "P.E. Tan" 3 => "F.F. Ng" 4 => "M.K. Karmakar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e3181b160a3" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2009" "volumen" => "111" "paginaInicial" => "506" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19672175" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0275" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Veeser" 1 => "T. Hofmann" 2 => "R. Roth" 3 => "S. Klöhr" 4 => "R. Rossaint" 5 => "M. Heesen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-6576.2011.02646.x" "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "2012" "volumen" => "56" "paginaInicial" => "810" "paginaFinal" => "816" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22313496" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0280" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Líquidos y vasopresores en prevención y manejo de hipotensión inducida por anestesia espinal durante cesárea programada en mujeres colombianas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Marrugo" 1 => "L. Granados" 2 => "J. Marrugo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Cienc Biomed" "fecha" => "2014" "volumen" => "5" "paginaInicial" => "263" "paginaFinal" => "271" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0285" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of ephedrine and etilefrine on uterine and fetal blood flow and on fetal myocardial function during spinal anaesthesia for caesarean section" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Räsänen" 1 => "S. Alahuhta" 2 => "T. Kangas-Saarela" 3 => "R. Jouppila" 4 => "P. Jouppila" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Obstet Anesth" "fecha" => "1991" "volumen" => "1" "paginaInicial" => "3" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15636788" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0290" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgency of caesarean section: a new classification" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.N. Lucas" 1 => "S.M. Yentis" 2 => "S.M. Kinsella" 3 => "A. Holdcroft" 4 => "A.E. May" 5 => "M. Wee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J R Soc Med" "fecha" => "2000" "volumen" => "93" "paginaInicial" => "346" "paginaFinal" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10928020" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0295" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optimizing postoperative outcomes with efficient preoperative assessment and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.M. Halaszynski" 1 => "R. Juda" 2 => "D.G. Silverman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2004" "volumen" => "32" "paginaInicial" => "S76" "paginaFinal" => "S86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15064666" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0300" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Managing hypotension induced by spinal anesthesia for caesarean section" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.H. Montoya" 1 => "C.I. Oliveros" 2 => "D.A. Moreno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Col Anest Mayo-Julio" "fecha" => "2009" "volumen" => "37" "paginaInicial" => "131" "paginaFinal" => "140" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0305" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid loading for cesarean delivery under spinal anesthesia: have we studied all the options?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.J. Mercier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e3182245af4" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2011" "volumen" => "113" "paginaInicial" => "677" "paginaFinal" => "680" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21948275" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0310" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cesarean delivery fluid management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.J. Mercier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0b013e3283530dab" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2012" "volumen" => "25" "paginaInicial" => "286" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22459983" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0315" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal position during caesarean section for preventing maternal and neonatal complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Cluver" 1 => "N. Novikova" 2 => "G.J. Hofmeyr" 3 => "D.R. Hall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD007623.pub3" "Revista" => array:2 [ "tituloSerie" => "Cochrane Database of Systematic Reviews" "fecha" => "2013" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0320" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemodynamic effects of a right lumbar pelvic wedge during spinal anesthesia for caesarean section" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Calvache" 1 => "M.F. Muñoz" 2 => "F.J. Baron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijoa.2011.06.010" "Revista" => array:6 [ "tituloSerie" => "Int J Obstet Anesth" "fecha" => "2011" "volumen" => "20" "paginaInicial" => "307" "paginaFinal" => "311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21852106" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0325" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "To press or not to press, and if so, with what? A single question-focused meta-analysis of vasopressor choice during regional anesthesia in obstetrics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Biddle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AANA J" "fecha" => "2013" "volumen" => "81" "paginaInicial" => "261" "paginaFinal" => "264" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24133847" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0330" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.L. Malin" 1 => "R.K. Morris" 2 => "K.S. Khan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2010" "volumen" => "340" "paginaInicial" => "c1471" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20466789" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0335" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Ephedrine and etilefrine as vasopressor to correct maternal arterial hypotension during elective cesarean section under spinal anesthesia. Comparative study]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.D. Belzarena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Bras Anestesiol" "fecha" => "2006" "volumen" => "56" "paginaInicial" => "223" "paginaFinal" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19468568" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0340" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of regional anaesthesia for caesarean section on maternal and fetal blood flow velocities measured by Doppler ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Valli" 1 => "J. Pirhonen" 2 => "R. Aantaa" 3 => "R. Erkkola" 4 => "J. Kanto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "1994" "volumen" => "38" "paginaInicial" => "165" "paginaFinal" => "169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7909642" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0345" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal and neonatal effects of bolus administration of ephedrine and phenylephrine during spinal anaesthesia for caesarean delivery: a randomized study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Prakash" 1 => "V. Pramanik" 2 => "H. Chellani" 3 => "S. Salhan" 4 => "A.R. Gogia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijoa.2009.02.007" "Revista" => array:6 [ "tituloSerie" => "Int J Obstet Anesth" "fecha" => "2010" "volumen" => "19" "paginaInicial" => "24" "paginaFinal" => "30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19665364" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0350" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ephedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Magalhães" 1 => "C.S. Govêia" 2 => "L.C. de Araújo Ladeira" 3 => "B.G. Nascimento" 4 => "S.M. Kluthcouski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Bras Anestesiol" "fecha" => "2009" "volumen" => "59" "paginaInicial" => "11" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19374211" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0355" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The continuing value of the Apgar score for the assessment of newborn infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.M. Casey" 1 => "D.D. McIntire" 2 => "K.J. Leveno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200102153440701" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2001" "volumen" => "344" "paginaInicial" => "467" "paginaFinal" => "471" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172187" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0365" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phenylephrine infusion versus bolus regimens during cesarean delivery under spinal anesthesia: a double-blind randomized clinical trial to assess hemodynamic changes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Doherty" 1 => "Y. Ohashi" 2 => "K. Downey" 3 => "J.C. Carvalho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e31826ac3db" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2012" "volumen" => "115" "paginaInicial" => "1343" "paginaFinal" => "1350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23011562" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0370" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phenylephrine infusions for maintaining blood pressure during spinal anesthesia for cesarean delivery: finding the shoe that fits" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.D. Ngan Kee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000000111" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2014" "volumen" => "118" "paginaInicial" => "496" "paginaFinal" => "498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24557093" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0375" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ED95 of phenylephrine to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Tanaka" 1 => "M. Balki" 2 => "R.K. Parkes" 3 => "J.C. Carvalho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijoa.2008.09.008" "Revista" => array:6 [ "tituloSerie" => "Int J Obstet Anesth" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "125" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19162468" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0380" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Up-down determination of the 90% effective dose of phenylephrine for the treatment of spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.B. George" 1 => "D. McKeen" 2 => "M.O. Columb" 3 => "A.S. Habib" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e3181c30b72" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2010" "volumen" => "110" "paginaInicial" => "154" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19910625" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0360" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.S. Habib" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e3182373a3e" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2012" "volumen" => "114" "paginaInicial" => "377" "paginaFinal" => "390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22104076" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0385" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of ephedrine and phenylephrine on maternal and fetal atrial natriuretic peptide levels during elective cesarean section" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.T. Pierce" 1 => "D.B. Carr" 2 => "S. Datta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "1994" "volumen" => "38" "paginaInicial" => "48" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8140873" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0390" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phenylephrine in treating maternal hypotension due to spinal anaesthesia for caesarean delivery: effects on neonatal catecholamine concentrations, acid base status and Apgar scores" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.F. LaPorta" 1 => "G.R. Arthur" 2 => "S. Datta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "1995" "volumen" => "39" "paginaInicial" => "901" "paginaFinal" => "905" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8848889" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0395" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W.D. Ngan Kee" 1 => "K.S. Khaw" 2 => "F.F. Ng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aeh088" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2004" "volumen" => "92" "paginaInicial" => "469" "paginaFinal" => "474" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14977792" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0400" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.G. Thomas" 1 => "S.C. Robson" 2 => "N. Redfern" 3 => "D. Hughes" 4 => "R.J. Boys" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "1996" "volumen" => "76" "paginaInicial" => "61" "paginaFinal" => "65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8672382" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack212733" "titulo" => "Acknowledgments" "texto" => "The authors express their gratitude to:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Clínica Universitaria Bolivariana.</li><li class="elsevierStyleListItem" id="lsti0010">•Clínica del Prado.</li><li class="elsevierStyleListItem" id="lsti0015">•Anesthesiologists and obstetricians that collaborated with the collection of information.</li><li class="elsevierStyleListItem" id="lsti0020">•All students graduate in anesthesiology who collaborated with the collection of information.</li><li class="elsevierStyleListItem" id="lsti0025">•Diarlen Milene Arboleda B. from Laboratorios Arrow Medical de Occidente S.A.</li><li class="elsevierStyleListItem" id="lsti0030">•Hernando Muñoz P. from Laboratorios SUN Pharmaceutical Service.</li></ul>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/22562087/0000004400000002/v1_201604260026/S2256208716300037/v1_201604260026/en/main.assets" "Apartado" => array:4 [ "identificador" => "951" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific and Technological Research" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22562087/0000004400000002/v1_201604260026/S2256208716300037/v1_201604260026/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208716300037?idApp=UINPBA00004N"]

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Scientific and Technological Research

Etilefrina vs fenilefrina en hipotensión por anestesia espinal para cesárea: ensayo clínico multicéntrico, controlado, aleatorizado y doble ciego

Diana Bolaños-Arboledaa, Nelson Javier Fonseca-Ruizb,

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nelson.fonseca@upb.edu.co

Corresponding author at: Calle 78b No. 72a-109, Medellín, Colombia.

, Nury Isabel Socha-Garcíac, Edward García-Peñuelaa, Germán Monsalve-Mejíad

a Anesthesiologist, Universidad Pontificia Bolivariana, Medellín, Colombia

b Anesthesiologist, Intensivist, Master of Clinical Epidemiology, Universidad Pontificia Bolivariana, Medellín, Colombia

c Anesthesiologist, Maternal and Child Health Unit, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia

d Clínica del Prado, Medellín, Colombia

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Its incidence ranges from 55 to 90&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4&#8211;6</span></a> and is more frequent in patients scheduled for elective cesarean section and no labor&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Hypotension during spinal anesthesia &#8211; regardless of how mild or short duration &#8211; results in deleterious effects for both the mother and the fetus&#46; There is decreased utero-placental blood flow &#40;UBF&#41; causing hypoxia and fetal acidosis&#44; as well as neonatal depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;8</span></a> The mother experiences low cardiac output symptoms&#44; including nausea&#44; vomiting&#44; dizziness&#44; and decreased consciousness&#46; Several interventions have been studied and implemented to reduce the incidence of hypotension&#59; i&#46;e&#46;&#44; uterine displacement&#44; intravascular volume expansion with intravenous fluids&#44; and the use of vasopressors&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the use of pre-load or co-load of intravenous fluids&#44; there is still a high frequency of hypotension and vasopressors are required in a high proportion of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Though most studies have shown that the incidence of fetal acidosis following spinal anesthesia is secondary to hypotension&#44; others feel that acidosis may be associated to the transfer of the vasopressor across the placenta&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;11&#8211;14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Phenylephrine is one of the most studied vasopressors and is the drug of choice in obstetrics because of its high transfer rate across the placental barrier&#44; increased fetal metabolism due to direct stimulation of the &#945; and &#946; receptors&#44; and because it increases catecholamines and PaCO<span class="elsevierStyleInf">2</span>&#46; Phenylephrine has shown less transfer across the placenta with enhanced utero-placental blood flow and improved acid&#8211;base fetal status&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12&#8211;15</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Etilefrine is the most frequently used vasopressor in Colombia for the treatment of hypotension from spinal anesthesia during cesarean section&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> Etilefrine is a direct action sympathomimetic agent that stimulates the &#945;-1 and &#946;-2 receptors&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> We have not been unable to find any studies comparing these two vasopressors&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The purpose of this study is to compare the fetal outcomes as evidenced by the pH of the umbilical artery and the Apgar score&#44; 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at one-minute intervals for the first 10<span class="elsevierStyleHsp" style=""></span>min&#46; The patients who did not become hypotensive at the end of the 10<span class="elsevierStyleHsp" style=""></span>min were excluded&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Hypotension was defined as a systolic blood pressure &#40;SBP&#41; below 100<span class="elsevierStyleHsp" style=""></span>mmHg and&#47;or a mean blood pressure &#40;MBP&#41; of less than 60<span class="elsevierStyleHsp" style=""></span>mmHg&#46; When hypotension developed&#44; 2<span class="elsevierStyleHsp" style=""></span>ml boluses of vasopressor were administered every minute&#44; corresponding to 2<span class="elsevierStyleHsp" style=""></span>mg of etilefrine or 50<span class="elsevierStyleHsp" style=""></span>&#956;g of phenylephrine&#44; until the SBP and&#47;or MBP values were above the limits established to join the trial&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the case of non-responders that required over 10<span class="elsevierStyleHsp" style=""></span>ml of the vasopressor&#39;s solution&#44; the patient was unblinded so that the anesthesiologist could continue managing the patient appropriately to avoid unfavorable maternal or fetal consequences&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">At the time of birth&#44; a 15<span class="elsevierStyleHsp" style=""></span>cm double clamped cord segment was obtained before the baby&#39;s first breath&#46; Before the next 60<span class="elsevierStyleHsp" style=""></span>min an arterial blood sample was taken and processed to measure the pH value&#44; using an i-STAT<span class="elsevierStyleSup">&#174;</span> &#40;The i-STAT<span class="elsevierStyleSup">&#174;</span> System- Point of Care Testing&#41; blood gas analyzer supplied by Arrow Laboratories&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The anesthetist entered the data into a form designed by the research team&#46; The initial protocol was registered with the Latin American Trial Registry &#8220;Latin American Ongoing Clinical Trials Register &#8211; LATINREC-&#8221; COL101&#46; The study was presented as an abstract at the annual meeting of the &#8220;Society for Obstetric Anesthesia and Perinatology &#40;SOAP&#41;&#8221; in 2012&#46; Abstract Number&#58; TW-2&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">As primary outcome we assessed the average pH difference of the fetuses&#8217; umbilical vein&#46; A total of 98 patients were programmed for each group&#39;s sample in order to identify a 0&#46;03 difference in pH among the groups&#44; with a 0&#46;05 standard deviation considering an alpha error of 0&#46;05&#44; a beta error of 0&#46;2 and a 10&#37; loss in each group&#46; These numbers were based on a previous study by Cooper et al&#46;&#44; which found a 2&#46;08&#37; incidence of fetal acidosis with phenylephrine&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The secondary outcomes for the newborn babies were&#58; fetal acidosis defined as an umbilical vein pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#46;20&#59; low Apgar score at minutes 1 and 5&#44; established at &#60;7&#59; need to intubate and NICU admission&#46; The secondary outcomes for mothers were&#58; time of hypotension&#44; total dose of vasopressor&#44; need to use atropine&#44; total intravenous fluids volume during the intraoperative period&#44; and the incidence of nausea and vomiting&#46; Additionally&#44; a graphical representation and a comparison of the systolic blood pressure&#44; the mean blood pressure&#44; and the heart rate during the first 10<span class="elsevierStyleHsp" style=""></span>min in both groups were developed&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The quantitative variables were evaluated with the Kolmogorov&#8211;Smirnov test to verify the hypothesis of normality&#46; The continuous variables with normal distribution are presented as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation and the non-normal distribution variables as medians with interquartile range&#46; The categorical variables are presented as percentages&#46; The comparison of the continuous variables between both study groups was made with the student-<span class="elsevierStyleItalic">t</span> test when the distribution was normal&#44; and with Mann&#8211;Whitney&#39;s when the distribution was not normal&#46; The comparison of the categorical variables was done using chi square&#44; or Fisher&#39;s exact test when required based on the magnitude of the result&#46; The intention-to-treat analysis was performed&#46; A two-tailed <span class="elsevierStyleItalic">P</span> value of less than 0&#46;05 was considered statistically significant&#46; The statistical analysis was done under the SPSS software&#44; version 15&#46;0&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0110" class="elsevierStylePara elsevierViewall">A total of 422 patients were evaluated to participate in the trial from July 2009 through November 2010&#46; 196 were included&#44; of which 98 received etilefrine and 98 received phenylephrine&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> illustrates the flow of participants&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Although there was a statistically significant difference in the gestational age between the two study groups&#44; such difference was not clinically relevant&#46; All other baseline characteristics were similar &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The most frequent indication for cesarean section was cephalopelvic disproportion&#44; which occurred in 37&#46;8 and 38&#46;8&#37; of the patients in each group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">No statistically significant difference was found in the primary outcome &#8211; umbilical arterial pH &#8211; between the etilefrine and phenylephrine groups &#40;7&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;07 vs&#46; 7&#46;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;07 respectively&#46; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;493&#41;&#46; Neither were there any differences in most of the secondary outcomes&#46; There were no statistically significant differences in the PaCO<span class="elsevierStyleInf">2</span> and PaO<span class="elsevierStyleInf">2</span> values of the umbilical cord samples &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The incidence of fetal acidosis in the etilefrine group was 11&#46;2&#37; vs&#46; 12&#46;2&#37; in the phenylephrine group&#44; with no evidence of statistical significance &#40;RR&#58; 0&#46;88&#59; CI 95&#37;&#58; 0&#46;41&#8211;1&#46;91&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;93&#41;&#46; Only one of all the neonates examined had to be admitted to the NICU and he was from the phenylephrine group &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">There were significant differences in terms of time of hypotension between the two groups&#44; with shorter times in the etilefrine group &#40;2&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;32<span class="elsevierStyleHsp" style=""></span>min vs&#46; 3&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;45<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41; and in the total dose of vasopressor which was also lower in the etilefrine group &#40;5&#46;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;93<span class="elsevierStyleHsp" style=""></span>ml vs&#46; 6&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;90<span class="elsevierStyleHsp" style=""></span>ml&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Two patients from the phenylephrine group and one from the etilefrine group had to be unblinded&#44; but treatment remained unchanged in all three&#59; just additional doses were given and none developed fetal acidosis&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The hemodynamic behavior of both SBP and MBP in both groups during the first 10<span class="elsevierStyleHsp" style=""></span>min following the first episode of hypotension showed no significant differences&#44; though the heart rate was higher in the patients receiving etilefrine &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2&#8211;4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">The remaining secondary outcomes including Apgar score&#44; incidence of nausea and vomiting&#44; atropine requirement and need for neonatal intubation were low and there were no differences between the two groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">This study shows that etilefrine and phenylephrine are equally effective and safe vasopressors for the treatment of spinal anesthesia hypotension during cesarean delivery&#46; There were no differences in the fetal or maternal outcomes in pregnancies between 36 and 42 weeks&#44; in women undergoing elective or programmed cesarean section&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The recommendation to achieve adequate anesthesia for cesarean section is to deliver a sensory block up to dermatome T5 as a minimum&#46; This trial used an anesthetic technique with hyperbaric bupivacaine&#44; fentanyl&#44; and morphine aimed at obtaining a block up to level T4&#46; This results in a sympathetic block that leads to a reduction in the systemic vascular resistance causing hypotension in 55&#8211;90&#37; of the patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Toward the end of pregnancy&#44; the uterine-placental vessels exhibit maximum dilatation and low resistance&#44; resulting in loss of self-regulation&#46; Maternal hypotension may lead to utero-placental hypoperfusion and fetal distress&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> Different approaches have been considered to prevent and to quickly treat such event&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;20&#44;21</span></a> Our group used the concomitant administration of a co-load of 500<span class="elsevierStyleHsp" style=""></span>ml of 0&#46;9&#37; saline solution following spinal anesthesia&#44; since it has been established that the result is the same using crystalloids or colloids and that it is better to do co-load rather than pre-load&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4&#44;21&#44;22</span></a> We also did left uterine displacement placing a wedge below the pelvis&#44; although this approach has not been useful<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#44;24</span></a> but is part of the routine management in our setting&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">To offset the drop in vascular resistance caused by spinal anesthesia&#44; which leads to hypotension&#44; the use of vasopressors to preserve the &#945; and &#946; adrenergic activity is a logical approach&#46; The two vasopressors most commonly used and researched are ephedrine &#40;an &#945; and &#946; adrenergic agonist&#41; and phenylephrine&#44; a &#945;-1 receptor agonist and with &#946;-agonist action only at high doses&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> Phenylephrine is currently considered the vasopressor of choice since it has been associated with improved fetal acid-base status as compared to ephedrine&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Notwithstanding the fact that a meta-analysis including 142 trials failed to acknowledge the superiority of phenylephrine over ephedrine when comparing the results of the Apgar scores in neonates&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> it has been proven that ephedrine can cross the placenta and result in lower fetal pH due to its metabolic effects from stimulation of the fetal &#946;-adrenergic receptors<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> and that fetal acidosis &#8211; defined as a pH in the umbilical cord artery &#60;7&#46;20 &#8211; is associated with a two and four-fold increase in morbidity and mortality&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The most popular vasopressor in Colombia is etilefrine&#44; which being an isomer of phenylephrine could have similar effects&#46; We failed to find a trial comparing the maternal-fetal effects of these two vasopressors and only found two trials comparing etilefrine with efedrine&#46; Belzarena reported that there were no differences in the Apgar scores of newborn babies when comparing these two drugs for the treatment of hypotension&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> R&#228;s&#228;nen et al&#46;&#44; showed that etilefrine caused no detectable changes in the fetal hemodynamic behavior or myocardial function&#44; whilst ephedrine reduced the renal and cerebral artery flow rate and led to increased ventricular contractility and a reduction in the left ventricular dimension at the end of diastole&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Although Valli et al&#46; reported an increase in the uterine vascular resistance during the prophylactic administration of etilefrine infusion to maintain the blood pressure in patients under spinal anesthesia&#44; no adverse medical neonatal effects were shown as measured by the Apgar score and the acid-base status of the arterial and venous blood of the umbilical cord&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> No significant difference was found in this study between the arterial pH values of the umbilical cord among the neonates born from mothers receiving etilefrine or phenylephrine&#59; hence&#44; as shown in previous studies&#44; the medications did not cross the placenta&#46; Neither did this study find statistically significant differences between the two groups in terms of the incidence of fetal acidosis&#59; however&#44; the incidence in the phenylephrine group was higher than the incidence reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12&#44;29&#44;30</span></a> This could be explained by the use of a smaller volume of intravenous fluids as compared to other studies&#44; or because our group included a neonate with non-previously diagnosed heart disease and another one with macrosomia &#40;4110<span class="elsevierStyleHsp" style=""></span>g&#41;&#46; The latter neonate experienced a difficult and prolonged uterine extraction &#40;&#62;3<span class="elsevierStyleHsp" style=""></span>min&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">As far as the neonatal results are concerned&#44; Casey et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> claim that the Apgar score is a better predictor of the neonatal outcome than the umbilical cord pH measurement&#46; There were no statistically significant differences in the Apgar score measurement between the two groups in this trial&#46; There were only three neonates with a score &#60;7 at the first minute&#44; two from the phenylephrine group and one from the etilefrine group&#46; The Apgar score at 5<span class="elsevierStyleHsp" style=""></span>min of every neonate in both groups was &#62;7&#44; none of them required tracheal intubation and only one from the phenylephrine group &#8211; the same baby who developed acidosis &#8211; had to be admitted to the NICU and was diagnosed with congenital heart disease that was not identified in the prenatal period&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The intravenous dose of phenylephrine has an immediate onset of action and lasts for 5&#8211;10<span class="elsevierStyleHsp" style=""></span>min&#46; There is yet no agreement among the anesthetists about the proper administration regime for phenylephrine<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&#59; our group used bolus doses because although some advocate infusion&#44; it has been proven that the total bolus dose used is less&#44; pressure control is adequate&#44; simpler and no pumps or perfusion syringes are needed&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">32&#44;33</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Several studies suggest that the effective dose of phenylephrine is 122&#8211;147<span class="elsevierStyleHsp" style=""></span>&#956;g<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">34&#44;35</span></a>&#59; however&#44; a 50<span class="elsevierStyleHsp" style=""></span>&#956;g dose &#40;2<span class="elsevierStyleHsp" style=""></span>ml&#41; was chosen because the 40<span class="elsevierStyleHsp" style=""></span>&#956;g and 100<span class="elsevierStyleHsp" style=""></span>&#956;g bolus doses continue to be the usual practice<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> and because we use the same dose used in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">32&#8211;39</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">The 2<span class="elsevierStyleHsp" style=""></span>mg dose &#40;2<span class="elsevierStyleHsp" style=""></span>ml&#41; of etilefrine was chosen on the basis of the management protocols used by the local work groups and by the Belzarena trial<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> since no bioequivalence data comparing both drugs are available&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">LaPorta and Thomas documented that the development of bradycardia was more likely in women receiving phenylephrine than in those treated with ephedrine&#46; This is a side effect and a reflex mechanism due to increased vascular resistance without stimulation of the &#946; receptors&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">38&#44;40</span></a> The etilefrine group in this trial developed a higher heart rate&#44; though not clinically significant&#44; probably because of a stronger stimulating effect over the &#946;-adrenergic receptors&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Although there was a statistically significant difference in the time of hypotension&#44; such difference was not clinically relevant&#46; There was also a difference in the dose of vasopressor used measured in ml&#44; but we cannot make any claims about an actual difference since the bioequivalence of these drugs is yet unknown&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Spinal anesthesia induces nausea and vomiting through various mechanisms such as intestinal ischemia&#44; cerebral ischemia or via a reflex mechanism in response to a decreased venous return&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> There were no differences in the incidence of vomiting between both groups in this trial and it was similar to other reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">27&#44;38</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">This trial has several limitations&#58; 205 patients that could have been included in the randomization were not evaluated because the researchers were not available at the institutions throughout the trial and&#44; although there could have been an equitable distribution based on the methodological design&#44; the impact on the results cannot be ruled out&#44; and neither is it possible to indicate how that effect would have been since their behavior is unpredictable&#46; Furthermore&#44; the trial was carried out at only two institutions and the results cannot be generalized to other institutions using different doses&#44; different block levels&#44; pre-loads or other co-load volumes&#46; Etilefrine is a very popular vasopressor in our country&#44; but this is not necessarily the case in other regions&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">There are still many unanswered questions about vasopressors used for the management of hypotension in patients undergoing cesarean section that require further research&#46; Currently there is no clear evidence about the adequate vasopressor for non-elective surgery&#59; the bioequivalent doses of phenylephrine and etilefrine are unknown&#59; and the specific vasopressor that can be safely used in mothers of nonreassuring fetal status babies has not been identified&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The conclusion from the results of this trial are that etilefrine may be safely used in mothers during the 36 and 42 weeks of pregnancy undergoing elective or programmed cesarean section&#44; following the protocol recommendations&#44; and develop spinal anesthesia-associated hypotension&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleGrantSponsor" id="gs1">Centro de Investigaci&#243;n para el Desarrollo y la Innovaci&#243;n</span> &#8211; CIDI de la Universidad Pontificia Bolivariana&#46; N&#250;mero de radicado&#58; <span class="elsevierStyleGrantNumber" refid="gs1">379A-12&#47;08-40</span>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">None of the authors has conflicts of interest&#46;</p></span></span>"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypotension after spinal anesthesia in cesarean section should be minimized&#46; The use of vasopressors is an effective measure to treat hypotension&#46; The objective of this paper is to compare the safety and effectiveness of etilefrine vs&#46; phenylephrine in the management of this condition&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This multicenter&#44; double-blind trial between August 2009 and November 2010 included 196 patients with hypotension during spinal anesthesia for cesarean delivery&#59; the patients were randomized to receive etilefrine or phenylephrine as vasopressor&#46; The primary outcome was the fetal umbilical arterial pH&#46; The secondary outcomes were&#58; fetal acidosis &#40;umbilical arterial pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#46;20&#41;&#44; Apgar score at 1 and 5<span class="elsevierStyleHsp" style=""></span>min&#44; need for intubation and admission to the neonatal intensive care unit for newborns&#44; and time of hypotension&#44; total dose of vasopressor&#44; atropine requirement&#44; intravenous fluids volume and incidence of nausea and vomiting in mothers&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">98 patients received etilefrine and 98 phenylephrine&#46; There were no differences in umbilical arterial pH &#40;7&#46;27 vs&#46; 7&#46;28&#44; respectively&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;493&#41;&#46; The total dose of vasopressor &#40;5&#46;66 vs&#46; 6&#46;51<span class="elsevierStyleHsp" style=""></span>ml&#44; respectively&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41; and total time of hypotension &#40;2&#46;78 vs&#46; 3&#46;25<span class="elsevierStyleHsp" style=""></span>min&#44; respectively&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41; were lower in the etilefrine group&#46; Other outcomes studied showed no statistically significant differences&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Etilefrine and phenylephrine are equally effective for the treatment of hypotension during spinal anesthesia for cesarean delivery&#46; This study found no difference in the maternal or fetal outcomes&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La hipotensi&#243;n que ocurre luego de anestesia espinal para ces&#225;rea debe minimizarse&#46; El uso de vasopresores es una medida eficaz para su tratamiento&#46; El objetivo de este trabajo es comparar la seguridad y efectividad de etilefrina vs fenilefrina para manejo de esta condici&#243;n&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En este estudio multic&#233;ntrico y doble ciego&#44; entre agosto de 2009 y noviembre de 2010&#44; 196 pacientes con hipotensi&#243;n durante anestesia espinal para ces&#225;rea&#44; fueron asignadas aleatoriamente para recibir etilefrina o fenilefrina como vasopresor&#46; El resultado primario fue el pH arterial umbilical fetal&#46; Los resultados secundarios fueron&#58; acidosis fetal &#40;pH arterial umbilical<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20&#41;&#44; puntaje Apgar al 1 y 5 minutos&#44; necesidad de intubaci&#243;n e ingreso a la unidad de cuidados intensivos neonatal para los reci&#233;n nacidos&#59; y tiempo de hipotensi&#243;n&#44; dosis total de vasopresor&#44; necesidad de uso de atropina&#44; l&#237;quidos endovenosos totales e incidencia de nausea y v&#243;mito para las madres&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">98 pacientes recibieron etilefrina y 98 fenilefrina&#46; No se encontraron diferencias en el pH arterial umbilical &#40;7&#44;27 vs 7&#44;28 respectivamente&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;493&#41;&#46; La dosis total de vasopresor &#40;5&#44;66 vs&#46; 6&#44;6<span class="elsevierStyleHsp" style=""></span>ml&#44; respectivamente&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41; y el tiempo total de hipotensi&#243;n &#40;2&#44;78 vs&#46; 3&#44;25<span class="elsevierStyleHsp" style=""></span>min&#44; respectivamente&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#44; fueron menores en el grupo de etilefrina&#46; Los dem&#225;s desenlaces estudiados no presentaron diferencia estad&#237;sticamente significativa&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La etilefrina y la fenilefrina son igualmente efectivas para el tratamiento de la hipotensi&#243;n por anestesia espinal para ces&#225;rea&#46; Este estudio no encontr&#243; diferencia en los resultados fetales ni maternos&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Introducci&#243;n"
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            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
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        ]
      ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Bola&#241;os-Arboleda D&#44; Fonseca-Ruiz NJ&#44; Socha-Garc&#237;a NI&#44; Garc&#237;a-Pe&#241;uela E&#44; Monsalve-Mej&#237;a G&#46; Etilefrina vs&#46; fenilefrina en hipotensi&#243;n por anestesia espinal para ces&#225;rea&#58; ensayo cl&#237;nico multic&#233;ntrico&#44; controlado&#44; aleatorizado y doble ciego&#46; Rev Colomb Anestesiol&#46; 2016&#59;44&#58;89&#8211;96&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">IQR&#44; interquartile range&#59; SD&#44; standard deviation&#59; kg&#44; kilograms&#59; SBP&#44; systolic blood pressure&#59; mmHg&#44; millimeters of Mercury&#59; DBP&#44; diastolic blood pressure&#59; MAP&#44; mean arterial pressure&#59; g&#44; grams&#59; SIET&#44; skin incision extraction time&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Etilefrine&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&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">Phenylephrine&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&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"><span class="elsevierStyleItalic">P</span>&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age in years&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;2 &#40;5&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;48 &#40;5&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;355&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Parity&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;616&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gestational age in weeks&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;38&#8211;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;38&#8211;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maternal body weight in Kg&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;65&#8211;77&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;5 &#40;67&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline SBP&#44; mmHg &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119&#46;11 &#40;9&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119&#46;64 &#40;9&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;697&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline DBP&#44; mmHg &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;9 &#40;9&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#46;42 &#40;8&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;224&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP admission&#44; mmHg &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;21 &#40;10&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;98 &#40;11&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;331&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MBP admission&#44; mmHg &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;39 &#40;10&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;22 &#40;11&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;443&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fetal weight&#44; g &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3265&#46;6 &#40;420&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3233&#46;5 &#40;440&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;973&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fasting hours&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;8&#8211;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;8&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;603&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SIET in minutes&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;6&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;6&#8211;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;826&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">CPD&#44; cephalo-pelvic disproportion&#59; g&#44; grams&#59; Others&#44; non-favorable cervix &#40;4&#41;&#59; human immunodeficiency virus &#40;1&#41;&#59; congenital hip dislocation &#40;1&#41;&#59; hip dysplasia &#40;1&#41;&#59; giant myomas &#40;2&#41;&#59; hip fracture &#40;2&#41;&#59; thin uterine segment &#40;1&#41;&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Etilefrine&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&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">Phenylephrine&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CPD&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;37&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;38&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prior C-section&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;24&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;22&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breech&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;20&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fetal macrosomia &#40;&#8805;4000<span class="elsevierStyleHsp" style=""></span>g&#41;&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Indications for cesarean delivery in the study population&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">SD&#44; standard deviation&#59; mmHg&#44; millimeters of mercury&#59; TH&#44; total hypotension time&#59; ml&#44; milliliters&#59; IVF&#44; total intravenous fluids in the intraoperative period&#59; RR&#44; relative risk&#59; CI&#44; confidence interval&#59; min&#44; minute&#59; ICU&#44; intensive care unit&#59; &#40;&#8211;&#41;&#44; O value variables where RR&#44; CI or <span class="elsevierStyleItalic">P</span> cannot be calculated&#46; NA&#44; not applicable&#46;</p>"
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                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">Variable&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">Etilefrine&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&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">Phenylephrine&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&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">RR&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">CI 95&#37;&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"><span class="elsevierStyleItalic">P</span>&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Umbilical artery pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#46;20&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;12&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;41&#8211;1&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apgar score at 1<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;04&#8211;5&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nausea or vomiting&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;18&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;58&#8211;1&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Need for atropine&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apgar score 5<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neonatal ICU&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neonatal intubation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Umbilical vein pH&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;27 &#40;0&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;28 &#40;0&#46;07&#41;&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="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">0&#46;493&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PaCO<span class="elsevierStyleInf">2</span> umbilical in mmHg&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;17 &#40;9&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;83 &#40;9&#46;66&#41;&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="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">0&#46;349&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PaO<span class="elsevierStyleInf">2</span> umbilical in mmHg&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;91 &#40;6&#46;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;66 &#40;6&#46;95&#41;&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="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">0&#46;059&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TH in minutes&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;78 &#40;1&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;25 &#40;1&#46;45&#41;&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="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">0&#46;021<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vasopressor dose in ml&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;66 &#40;2&#46;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;6 &#40;2&#46;90&#41;&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="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">0&#46;024<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVF in ml&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1277&#46;55 &#40;402&#46;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1288&#46;27 &#40;470&#46;0&#41;&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="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">0&#46;984&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Statistically significant&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Final results&#46;</p>"
        ]
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anesthesia for cesarean delivery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Tsen"
                            1 => "C&#46; Lawrence"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "60th Annual meeting of the American Society of Anesthesiologists"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "conferencia" => "New Orleans"
                        "serieFecha" => "2009"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0210"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anesthesia-related deaths during obstetric delivery in the United States&#44; 1979&#8211;1990"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; Awkins"
                            1 => "L&#46;M&#46; Koonin"
                            2 => "S&#46;K&#46; Palmer"
                            3 => "C&#46;P&#46; Gibbs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "1997"
                        "volumen" => "86"
                        "paginaInicial" => "277"
                        "paginaFinal" => "284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9054245"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anestesia regional versus general para parto por ces&#225;rea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; P&#225;ez"
                            1 => "J&#46; Navarro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Colomb Anestesiol"
                        "fecha" => "2012"
                        "volumen" => "40"
                        "paginaInicial" => "203"
                        "paginaFinal" => "206"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal hypotension during spinal anesthesia for caesarean delivery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46;J&#46; Mercier"
                            1 => "M&#46; Aug&#232;"
                            2 => "C&#46; Hoffmann"
                            3 => "C&#46; Fischer"
                            4 => "A&#46; Le Gouez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Minerva Anestesiol"
                        "fecha" => "2013"
                        "volumen" => "79"
                        "paginaInicial" => "62"
                        "paginaFinal" => "73"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23135692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid and vasopressor management for Cesarean delivery under spinal anesthesia&#58; continuing professional development"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Loubert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12630-012-9705-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Anaesth"
                        "fecha" => "2012"
                        "volumen" => "59"
                        "paginaInicial" => "604"
                        "paginaFinal" => "619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22528166"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vasopressors in obstetric anesthesia&#58; a current perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;S&#46; Nag"
                            1 => "D&#46;P&#46; Samaddar"
                            2 => "A&#46; Chatterjee"
                            3 => "H&#46; Kumar"
                            4 => "A&#46; Dembla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.12998/wjcc.v3.i1.58"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Clin Cases"
                        "fecha" => "2015"
                        "volumen" => "3"
                        "paginaInicial" => "58"
                        "paginaFinal" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25610851"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anesthesia for obstetrics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Birnbach"
                            1 => "I&#46; Browne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "titulo" => "Miller&#39;s anesthesia"
                        "edicion" => "7th ed&#46;"
                        "serieFecha" => "2009"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fetal academia associated with regional anesthesia for elective cesarean delivery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;W&#46; Roberts"
                            1 => "K&#46;J&#46; Leveno"
                            2 => "J&#46;E&#46; Sidawi"
                            3 => "M&#46;J&#46; Lucas"
                            4 => "M&#46;A&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "1995"
                        "volumen" => "85"
                        "paginaInicial" => "79"
                        "paginaFinal" => "83"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7800330"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Caesarean delivery vasopressor management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;W&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACO.0b013e3283530d62"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2012"
                        "volumen" => "25"
                        "paginaInicial" => "300"
                        "paginaFinal" => "308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22473212"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preload or coload for spinal anesthesia for elective Cesarean delivery&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Banerjee"
                            1 => "R&#46;M&#46; Stocche"
                            2 => "P&#46; Angle"
                            3 => "S&#46;H&#46; Halpern"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12630-009-9206-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Anaesth"
                        "fecha" => "2010"
                        "volumen" => "57"
                        "paginaInicial" => "24"
                        "paginaFinal" => "31"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19859776"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;D&#46; Mueller"
                            1 => "H&#46; Br&#252;hwiler"
                            2 => "G&#46;K&#46; Sch&#252;pfer"
                            3 => "K&#46;P&#46; L&#252;scher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0029-7844(97)00210-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "1997"
                        "volumen" => "90"
                        "paginaInicial" => "131"
                        "paginaFinal" => "134"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9207827"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;W&#46; Cooper"
                            1 => "M&#46; Carpenter"
                            2 => "P&#46; Mowbray"
                            3 => "W&#46;R&#46; Desira"
                            4 => "D&#46;M&#46; Ryall"
                            5 => "M&#46;S&#46; Kokri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2002"
                        "volumen" => "97"
                        "paginaInicial" => "1582"
                        "paginaFinal" => "1590"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12459688"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of maternal administration of ephedrine on fetal heart rate and variability"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;G&#46; Wright"
                            1 => "S&#46;M&#46; Shnider"
                            2 => "G&#46; Levinson"
                            3 => "S&#46;H&#46; Rolbin"
                            4 => "J&#46;T&#46; Parer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "1981"
                        "volumen" => "57"
                        "paginaInicial" => "734"
                        "paginaFinal" => "738"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7231826"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46;D&#46; Ngan Kee"
                            1 => "K&#46;S&#46; Khaw"
                            2 => "P&#46;E&#46; Tan"
                            3 => "F&#46;F&#46; Ng"
                            4 => "M&#46;K&#46; Karmakar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e3181b160a3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2009"
                        "volumen" => "111"
                        "paginaInicial" => "506"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19672175"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0275"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section&#46; Systematic review and cumulative meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Veeser"
                            1 => "T&#46; Hofmann"
                            2 => "R&#46; Roth"
                            3 => "S&#46; Kl&#246;hr"
                            4 => "R&#46; Rossaint"
                            5 => "M&#46; Heesen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-6576.2011.02646.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Scand"
                        "fecha" => "2012"
                        "volumen" => "56"
                        "paginaInicial" => "810"
                        "paginaFinal" => "816"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22313496"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "L&#237;quidos y vasopresores en prevenci&#243;n y manejo de hipotensi&#243;n inducida por anestesia espinal durante ces&#225;rea programada en mujeres colombianas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Marrugo"
                            1 => "L&#46; Granados"
                            2 => "J&#46; Marrugo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Cienc Biomed"
                        "fecha" => "2014"
                        "volumen" => "5"
                        "paginaInicial" => "263"
                        "paginaFinal" => "271"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of ephedrine and etilefrine on uterine and fetal blood flow and on fetal myocardial function during spinal anaesthesia for caesarean section"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; R&#228;s&#228;nen"
                            1 => "S&#46; Alahuhta"
                            2 => "T&#46; Kangas-Saarela"
                            3 => "R&#46; Jouppila"
                            4 => "P&#46; Jouppila"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Obstet Anesth"
                        "fecha" => "1991"
                        "volumen" => "1"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15636788"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urgency of caesarean section&#58; a new classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;N&#46; Lucas"
                            1 => "S&#46;M&#46; Yentis"
                            2 => "S&#46;M&#46; Kinsella"
                            3 => "A&#46; Holdcroft"
                            4 => "A&#46;E&#46; May"
                            5 => "M&#46; Wee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J R Soc Med"
                        "fecha" => "2000"
                        "volumen" => "93"
                        "paginaInicial" => "346"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10928020"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimizing postoperative outcomes with efficient preoperative assessment and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;M&#46; Halaszynski"
                            1 => "R&#46; Juda"
                            2 => "D&#46;G&#46; Silverman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2004"
                        "volumen" => "32"
                        "paginaInicial" => "S76"
                        "paginaFinal" => "S86"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15064666"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Managing hypotension induced by spinal anesthesia for caesarean section"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;H&#46; Montoya"
                            1 => "C&#46;I&#46; Oliveros"
                            2 => "D&#46;A&#46; Moreno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Col Anest Mayo-Julio"
                        "fecha" => "2009"
                        "volumen" => "37"
                        "paginaInicial" => "131"
                        "paginaFinal" => "140"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid loading for cesarean delivery under spinal anesthesia&#58; have we studied all the options&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46;J&#46; Mercier"
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                      "doi" => "10.1213/ANE.0b013e3182245af4"
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                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2011"
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                        "paginaInicial" => "677"
                        "paginaFinal" => "680"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21948275"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cesarean delivery fluid management"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46;J&#46; Mercier"
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                      "doi" => "10.1097/ACO.0b013e3283530dab"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2012"
                        "volumen" => "25"
                        "paginaInicial" => "286"
                        "paginaFinal" => "291"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22459983"
                            "web" => "Medline"
                          ]
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                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal position during caesarean section for preventing maternal and neonatal complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Cluver"
                            1 => "N&#46; Novikova"
                            2 => "G&#46;J&#46; Hofmeyr"
                            3 => "D&#46;R&#46; Hall"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
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                      "Revista" => array:2 [
                        "tituloSerie" => "Cochrane Database of Systematic Reviews"
                        "fecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0320"
              "etiqueta" => "24"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemodynamic effects of a right lumbar pelvic wedge during spinal anesthesia for caesarean section"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Calvache"
                            1 => "M&#46;F&#46; Mu&#241;oz"
                            2 => "F&#46;J&#46; Baron"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijoa.2011.06.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Obstet Anesth"
                        "fecha" => "2011"
                        "volumen" => "20"
                        "paginaInicial" => "307"
                        "paginaFinal" => "311"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21852106"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0325"
              "etiqueta" => "25"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "To press or not to press&#44; and if so&#44; with what&#63; A single question-focused meta-analysis of vasopressor choice during regional anesthesia in obstetrics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Biddle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AANA J"
                        "fecha" => "2013"
                        "volumen" => "81"
                        "paginaInicial" => "261"
                        "paginaFinal" => "264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24133847"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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            25 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Strength of association between umbilical cord pH and perinatal and long term outcomes&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;L&#46; Malin"
                            1 => "R&#46;K&#46; Morris"
                            2 => "K&#46;S&#46; Khan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2010"
                        "volumen" => "340"
                        "paginaInicial" => "c1471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20466789"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Ephedrine and etilefrine as vasopressor to correct maternal arterial hypotension during elective cesarean section under spinal anesthesia&#46; Comparative study&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;D&#46; Belzarena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Bras Anestesiol"
                        "fecha" => "2006"
                        "volumen" => "56"
                        "paginaInicial" => "223"
                        "paginaFinal" => "229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19468568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of regional anaesthesia for caesarean section on maternal and fetal blood flow velocities measured by Doppler ultrasound"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Valli"
                            1 => "J&#46; Pirhonen"
                            2 => "R&#46; Aantaa"
                            3 => "R&#46; Erkkola"
                            4 => "J&#46; Kanto"
                          ]
                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Scand"
                        "fecha" => "1994"
                        "volumen" => "38"
                        "paginaInicial" => "165"
                        "paginaFinal" => "169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7909642"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal and neonatal effects of bolus administration of ephedrine and phenylephrine during spinal anaesthesia for caesarean delivery&#58; a randomized study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Prakash"
                            1 => "V&#46; Pramanik"
                            2 => "H&#46; Chellani"
                            3 => "S&#46; Salhan"
                            4 => "A&#46;R&#46; Gogia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijoa.2009.02.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Obstet Anesth"
                        "fecha" => "2010"
                        "volumen" => "19"
                        "paginaInicial" => "24"
                        "paginaFinal" => "30"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19665364"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ephedrine versus phenylephrine&#58; prevention of hypotension during spinal block for cesarean section and effects on the fetus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Magalh&#227;es"
                            1 => "C&#46;S&#46; Gov&#234;ia"
                            2 => "L&#46;C&#46; de Ara&#250;jo Ladeira"
                            3 => "B&#46;G&#46; Nascimento"
                            4 => "S&#46;M&#46; Kluthcouski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Bras Anestesiol"
                        "fecha" => "2009"
                        "volumen" => "59"
                        "paginaInicial" => "11"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19374211"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0355"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The continuing value of the Apgar score for the assessment of newborn infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;M&#46; Casey"
                            1 => "D&#46;D&#46; McIntire"
                            2 => "K&#46;J&#46; Leveno"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200102153440701"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2001"
                        "volumen" => "344"
                        "paginaInicial" => "467"
                        "paginaFinal" => "471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172187"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0365"
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Phenylephrine infusion versus bolus regimens during cesarean delivery under spinal anesthesia&#58; a double-blind randomized clinical trial to assess hemodynamic changes"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            2 => "K&#46; Downey"
                            3 => "J&#46;C&#46; Carvalho"
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                        ]
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                      "doi" => "10.1213/ANE.0b013e31826ac3db"
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                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2012"
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                        "paginaFinal" => "1350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23011562"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0370"
              "etiqueta" => "33"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Phenylephrine infusions for maintaining blood pressure during spinal anesthesia for cesarean delivery&#58; finding the shoe that fits"
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                          "etal" => false
                          "autores" => array:1 [
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                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2014"
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                        "paginaInicial" => "496"
                        "paginaFinal" => "498"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24557093"
                            "web" => "Medline"
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                ]
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              "identificador" => "bib0375"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "ED95 of phenylephrine to prevent spinal-induced hypotension and&#47;or nausea at elective cesarean delivery"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            2 => "R&#46;K&#46; Parkes"
                            3 => "J&#46;C&#46; Carvalho"
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                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.ijoa.2008.09.008"
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                        "tituloSerie" => "Int J Obstet Anesth"
                        "fecha" => "2009"
                        "volumen" => "18"
                        "paginaInicial" => "125"
                        "paginaFinal" => "130"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19162468"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0380"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Up-down determination of the 90&#37; effective dose of phenylephrine for the treatment of spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "M&#46;O&#46; Columb"
                            3 => "A&#46;S&#46; Habib"
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                    0 => array:2 [
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                        "paginaInicial" => "154"
                        "paginaFinal" => "158"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19910625"
                            "web" => "Medline"
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              ]
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              "identificador" => "bib0360"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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                    0 => array:2 [
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                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2012"
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                        "paginaInicial" => "377"
                        "paginaFinal" => "390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22104076"
                            "web" => "Medline"
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                  ]
                ]
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              "identificador" => "bib0385"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of ephedrine and phenylephrine on maternal and fetal atrial natriuretic peptide levels during elective cesarean section"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "D&#46;B&#46; Carr"
                            2 => "S&#46; Datta"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Scand"
                        "fecha" => "1994"
                        "volumen" => "38"
                        "paginaInicial" => "48"
                        "paginaFinal" => "51"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8140873"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Phenylephrine in treating maternal hypotension due to spinal anaesthesia for caesarean delivery&#58; effects on neonatal catecholamine concentrations&#44; acid base status and Apgar scores"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            1 => "G&#46;R&#46; Arthur"
                            2 => "S&#46; Datta"
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                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Scand"
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                        "paginaInicial" => "901"
                        "paginaFinal" => "905"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8848889"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0395"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aeh088"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2004"
                        "volumen" => "92"
                        "paginaInicial" => "469"
                        "paginaFinal" => "474"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14977792"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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            39 => array:3 [
              "identificador" => "bib0400"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section"
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                        0 => array:2 [
                          "etal" => false
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                            1 => "S&#46;C&#46; Robson"
                            2 => "N&#46; Redfern"
                            3 => "D&#46; Hughes"
                            4 => "R&#46;J&#46; Boys"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "1996"
                        "volumen" => "76"
                        "paginaInicial" => "61"
                        "paginaFinal" => "65"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8672382"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack212733"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0230" class="elsevierStylePara elsevierViewall">The authors express their gratitude to&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0235" class="elsevierStylePara elsevierViewall">Cl&#237;nica Universitaria Bolivariana&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0240" class="elsevierStylePara elsevierViewall">Cl&#237;nica del Prado&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0245" class="elsevierStylePara elsevierViewall">Anesthesiologists and obstetricians that collaborated with the collection of information&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0250" class="elsevierStylePara elsevierViewall">All students graduate in anesthesiology who collaborated with the collection of information&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0255" class="elsevierStylePara elsevierViewall">Diarlen Milene Arboleda B&#46; from Laboratorios Arrow Medical de Occidente S&#46;A&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Hernando Mu&#241;oz P&#46; from Laboratorios SUN Pharmaceutical Service&#46;</p></li></ul></p>"
        "vista" => "all"
      ]
    ]
  ]
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  "url" => "/22562087/0000004400000002/v1_201604260026/S2256208716300037/v1_201604260026/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "951"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Scientific and Technological Research"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22562087/0000004400000002/v1_201604260026/S2256208716300037/v1_201604260026/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
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]

Article information

ISSN: 22562087
Original language: English

DOI:10.1016/j.rcae.2016.03.009

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Year/Month	Html	Pdf	Total

2024 November	7	0	7
2024 October	50	16	66
2024 September	45	8	53
2024 August	68	2	70
2024 July	57	3	60
2024 June	57	5	62
2024 May	58	5	63
2024 April	77	12	89
2024 March	78	12	90
2024 February	68	9	77
2024 January	46	3	49
2023 December	58	12	70
2023 November	82	20	102
2023 October	70	3	73
2023 September	63	4	67
2023 August	79	7	86
2023 July	60	9	69
2023 June	66	12	78
2023 May	83	6	89
2023 April	39	1	40
2023 March	50	7	57
2023 February	45	9	54
2023 January	47	1	48
2022 December	34	5	39
2022 November	47	9	56
2022 October	37	10	47
2022 September	29	11	40
2022 August	29	18	47
2022 July	22	17	39
2022 June	15	10	25
2022 May	22	10	32
2022 April	15	4	19
2022 March	22	15	37
2022 February	14	10	24
2022 January	18	10	28
2021 December	16	19	35
2021 November	22	11	33
2021 October	24	5	29
2021 September	16	16	32
2021 August	16	6	22
2021 July	9	3	12
2021 June	11	9	20
2021 May	12	6	18
2021 April	29	20	49
2021 March	17	10	27
2021 February	6	5	11
2021 January	9	9	18
2020 December	14	10	24
2020 November	17	12	29
2020 October	7	6	13
2020 September	8	6	14
2020 August	10	11	21
2020 July	13	9	22
2020 June	9	6	15
2020 May	8	8	16
2020 April	3	3	6
2020 March	7	3	10
2020 February	9	4	13
2020 January	12	3	15
2019 December	10	13	23
2019 November	4	2	6
2019 October	10	2	12
2019 September	1	2	3
2019 August	3	1	4
2019 July	1	18	19
2019 June	0	14	14
2019 May	0	12	12
2019 April	1	0	1
2018 September	1	0	1
2018 June	6	2	8
2018 May	31	8	39
2018 April	42	5	47
2018 March	27	7	34
2018 February	20	11	31
2018 January	30	6	36
2017 December	17	7	24
2017 November	17	4	21
2017 October	19	11	30
2017 September	18	9	27
2017 August	15	5	20
2017 July	15	3	18
2017 June	26	8	34
2017 May	43	13	56
2017 April	44	17	61
2017 March	18	11	29
2017 February	31	1	32
2017 January	19	4	23
2016 December	38	15	53
2016 November	39	14	53
2016 October	30	10	40
2016 September	53	32	85
2016 August	31	10	41
2016 July	26	18	44
2016 May	5	28	33

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