Hypothermia in elective surgery: The hidden enemy | Colombian Journal of Anesthesiology

array:25 ["pii" => "S2256208716300736" "issn" => "22562087" "doi" => "10.1016/j.rcae.2016.11.003" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "320" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-sa/4.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2017;45:48-53" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1099 "formatos" => array:3 [ "EPUB" => 113 "HTML" => 730 "PDF" => 256 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0120334716301174" "issn" => "01203347" "doi" => "10.1016/j.rca.2016.08.003" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "320" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2017;45:48-53" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5873 "formatos" => array:3 [ "EPUB" => 141 "HTML" => 5082 "PDF" => 650 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "Revisión" "titulo" => "Hipotermia en cirugía electiva. El enemigo oculto" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "48" "paginaFinal" => "53" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Hypothermia in elective surgery. The hidden enemy" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jorge Enrique Bayter-Marín, Jorge Rubio, Arnaldo Valedón, Álvaro Andrés Macías" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Jorge Enrique" "apellidos" => "Bayter-Marín" ] 1 => array:2 [ "nombre" => "Jorge" "apellidos" => "Rubio" ] 2 => array:2 [ "nombre" => "Arnaldo" "apellidos" => "Valedón" ] 3 => array:2 [ "nombre" => "Álvaro Andrés" "apellidos" => "Macías" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2256208716300736" "doi" => "10.1016/j.rcae.2016.11.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208716300736?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334716301174?idApp=UINPBA00004N" "url" => "/01203347/0000004500000001/v2_201701100131/S0120334716301174/v2_201701100131/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2256208716300803" "issn" => "22562087" "doi" => "10.1016/j.rcae.2016.11.010" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "323" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2017;45:54-61" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1226 "formatos" => array:3 [ "EPUB" => 102 "HTML" => 871 "PDF" => 253 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Review" "titulo" => "The basic principles of anesthesia for the neonate" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "54" "paginaFinal" => "61" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Principios básicos de la anestesia neonatal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Reproduced with permission from LeDez and Lerman.<a class="elsevierStyleCrossRef" href="#bib0495">41</a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1333 "Ancho" => 1464 "Tamanyo" => 72438 ] ] "descripcion" => array:1 [ "en" => "The minimum alveolar concentration (MAC) of isoflurane and post-conceptual age." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lynn D. Martin" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Lynn D." "apellidos" => "Martin" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0120334716301204" "doi" => "10.1016/j.rca.2016.07.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334716301204?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208716300803?idApp=UINPBA00004N" "url" => "/22562087/0000004500000001/v1_201701060057/S2256208716300803/v1_201701060057/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2256208716300785" "issn" => "22562087" "doi" => "10.1016/j.rcae.2016.11.008" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "327" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Colomb Anestesiol. 2017;45:46-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1106 "formatos" => array:3 [ "EPUB" => 110 "HTML" => 760 "PDF" => 236 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Brief Academy" "titulo" => "Commentary on “Reflections about euthanasia in Colombia”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "46" "paginaFinal" => "47" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario sobre “Reflexiones acerca de la eutanasia en Colombia”" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Álvaro Sanz-Rubiales, María Luisa del Valle" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Álvaro" "apellidos" => "Sanz-Rubiales" ] 1 => array:2 [ "nombre" => "María Luisa" "apellidos" => "del Valle" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0120334716301289" "doi" => "10.1016/j.rca.2016.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334716301289?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208716300785?idApp=UINPBA00004N" "url" => "/22562087/0000004500000001/v1_201701060057/S2256208716300785/v1_201701060057/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Review" "titulo" => "Hypothermia in elective surgery: The hidden enemy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "48" "paginaFinal" => "53" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jorge Enrique Bayter-Marín, Jorge Rubio, Arnaldo Valedón, Álvaro Andrés Macías" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Jorge Enrique" "apellidos" => "Bayter-Marín" "email" => array:1 [ 0 => "jokibay@yahoo.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "◊" "identificador" => "fn1" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jorge" "apellidos" => "Rubio" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "◊" "identificador" => "fn1" ] ] ] 2 => array:3 [ "nombre" => "Arnaldo" "apellidos" => "Valedón" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "◊" "identificador" => "fn1" ] ] ] 3 => array:3 [ "nombre" => "Álvaro Andrés" "apellidos" => "Macías" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] 1 => array:2 [ "etiqueta" => "◊" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Medical director, Clínica El Pinar, Bucaramanga, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anesthesia Committee Coordinator for Plastic Surgery, Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), Bogotá, D.C., Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Anesthesiologist, Centro Quirúrgico Ambulatorio, Salud SURA, Medellin, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Committee Coordinator of Ambulatory Anesthesia, Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), Bogotá, D.C., Colombia" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Chief Ambulatory Division and Managing Partner, First Colonies Anesthesia Associates, Baltimore, USA" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Staff Anesthesiologist, Brigham and Womens Hospital, Department of Anesthesiology, Massachusetts Eye and Ear, Boston, USA" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Clínica El Pinar, Centro Empresarial Natura, Km 2 Anillo vial Autopista Floridablanca – Girón, Torre 2, Floridablanca, Santander, Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipotermia en cirugía electiva. El enemigo oculto" ] ] "textoCompleto" => "IntroductionHypothermia is the hidden enemy in most elective surgery procedures. Very few anesthesiologists and surgeons take into account this problem intraoperatively despite all the adverse effects caused in the postoperative period. It is considered that 70–90% of patients undergoing surgery develop hypothermia even if surgery only takes 1h. The restoration of normothermia can take up to 4h if measures for preventing hypothermia are not taken. Both general and regional anesthesia, contribute to deteriorate protective mechanisms of hypothermia. In addition to the known effects of hypothermia such as increased infection rate, impairment of clotting mechanisms and major bleeding, there are adverse events due to the inevitable tremors that cause great discomfort and unpleasant feeling.MethodologyA non-systematic literature review was performed in databases such as PubMed and Medline, entering keywords in English: hypothermia in plastic surgery, complications of hypothermia, prevention of hypothermia, maintaining normothermia. The articles were read, those referring to the subject were consulted and according to this methodology 52 references were selected. The results of this review are presented below.ReviewThermoregulation in humansHuman being is homeothermic and endothermic. This means that, in addition to maintaining its temperature in narrow ranges, can produce heat by itself. In simple terms, the human body is divided into two compartments, one central that produces heat and one peripheral that regulates heat loss. Our tight regulatory mechanisms are made to protect our central compartment at the expense of the peripheral. Thus, the core temperature, and especially the temperature in the brain, is regulated close to 37°C, with an almost perfect thermoregulation, but at the expense of the skin, which is actually poikilothermic and its temperature resembles the ambient temperature about 33°C. Under normal conditions, the production of body heat is the result of the basal metabolic rate of internal organs such as the brain and those of the thoracic and abdominal cavity as heart, lung, liver, intestine and kidney. Blood passes through these organs is heated and then is distributed by the cardiovascular system by convection from the central region to skin region.<a class="elsevierStyleCrossRefs" href="#bib0260">1–4</a>The core that integrates and regulates body temperature and actually acts as a thermostat is in the posterior hypothalamus. Thus the blood temperature that reaches the hypothalamus is the major determinant of the body's response to climate change and is responsible for maintaining a balance between heat production and heat transfer processes (gain and loss).These transfer processes between our body and the external medium is produced in two ways: by evaporation and no evaporative mechanisms (radiation, conduction and convection).According to the second law of thermodynamics heat can only flow by temperature gradient from the body that is warmer toward the periphery or the environment that is colder, therefore, the body never can be heated from the periphery to the core which is usually warmer than the outside.Body temperature regulation mechanismsBody temperature is regulated exclusively by nervous mechanisms of negative feedback operating in the thermoregulatory centers in the hypothalamus. In few cases, body temperature can only be altered by internal heat generation, regularly is by cooling or heating of the environment. For its part, transient receptor potential (TRP) channels in the skin are widely present in sensory neurons. TRPM8 subtype exhibits activation at a room temperature <27°C that is when there is a slight cold. The central thermoreceptors are located in the brain, spinal cord and abdomen. Lateral parabrachial nucleus neurons are activated by cooling signal, which promotes an excitatory influx aimed at GABAergic interneurons. This GABA influx inhibits inhibitory neurons in the preoptic area in the hypothalamus, which is the area in charge of temperature control, among other functions. The result is the disinhibition of thermogenesis-promoting neurons in the hypothalamus. The spinal sympathetic influx and somatic motor circuits are activated by these fibers to trigger thermogenesis.<a class="elsevierStyleCrossRefs" href="#bib0280">5–7</a> Thus, the coordination of a thermoregulatory response with a perfect hierarchical organization takes place from the preoptic area of the anterior hypothalamus, coordination that goes far beyond a simple spinal cord response as vasoconstriction.A symphatic spinal flow is triggered with a large release of adrenaline and noradrenaline due to hypothermia, which produces an extensive peripheral vasoconstriction with arteriovenous shunts that reduce the blood flow to these cold peripheral areas and, in turn, keeps the warm blood in the central compartment. Thus we have a gradient between the central and peripheral temperature, which can be 2–4° with peripheral temperatures of 32°C and centrals of 36°C or lower.<a class="elsevierStyleCrossRef" href="#bib0295">8</a>Anesthetics effects on the heat conservation mechanismsAll inhaled anesthetics impaired deeply the autonomic responses that defend us from hypothermia. These responses are given in therapeutic ranges, thus interthreshold range may increase 10–20 times (4°C), meaning that the response of peripheral vasoconstriction, usually given at 37°C with inhaled anesthesia, can be given at 34°C or 35°C. It means being totally exposed to hypothermia during surgery; regional anesthesia may increase the range only 3 or 4 times, but also has a direct vasodilator effect that deteriorates the response to cold.<a class="elsevierStyleCrossRef" href="#bib0300">9</a>Hypothermia phases during general anesthesiaTemperature changes occur in three phases during anesthesia.<a class="elsevierStyleCrossRef" href="#bib0305">10</a> The greatest decline takes place during the first phase; temperature drops from 1°C to 1.5°C in the first hour due to a redistribution of heat from the center to the periphery. Heat loss in this phase is the result of the normal gradient, from 2°C to 4°C, between the core to the periphery and the vasodilatation that exists at the peripheral level due to the loss of the mechanisms of vasoconstriction by anesthesia.<a class="elsevierStyleCrossRefs" href="#bib0310">11–13</a>During the second phase (second and third hour) occurs a slow linear reduction of temperature due to central heat loss by decreased of basal metabolism. Hypothermia is also exacerbated by the low temperatures in the operating room, the body sites exposed (for example in liposuction) and the amount of cold liquids infiltrated subcutaneously.In the third phase (third and fourth hour) or plateau, temperature maintains a relatively stable state. In this phase, normally between 34°C and 35°C, the mechanisms of protection against lost hypothermia such as vasoconstriction and the closure of shunts in hands and feet, are activated again. At this stage the heat loss is minimized, but it never gets to reheat the body.Regional anesthesia and hypothermiaHypothermia is frequent in both general and regional anesthesia. Some studies may show that the loss of temperature may be slightly lower in the first hour with regional anesthesia (0.8°C) versus general anesthesia (1.2°C)<a class="elsevierStyleCrossRefs" href="#bib0325">14–16</a> while others have shown no difference. Phases 1 and 2 are almost equal to the general anesthesia ones, but the phase 3 has complications. Vasoconstriction is not activated at 34°C with regional anesthesia, therefore, in this third phase (phase Plateau in general anesthesia) heat loss may continue in the patient, after 3 or 4h. Thus, hypothermia can become even more serious with regional anesthesia, especially during lengthy surgery.<a class="elsevierStyleCrossRefs" href="#bib0340">17,18</a> Hypothermia is more severe, depending on the dermatomes blocked and hence of the sympathetic blockade. Some studies have shown a decrease in 0.15°C per dermatome blocked.<a class="elsevierStyleCrossRef" href="#bib0350">19</a> In plastic surgery this is a matter of great concern since very extensive blockages are performed that might include the thoracolumbar system in cases of tummy tucks and breast procedures with double puncture.Hemodynamic and autonomic effects in response to coldEven mild hypothermia (1–2°C), Norepinephrine values increase up to 7 times that generate a considerable hyperdynamic response. It has been proved that this can cause morbid cardiac events in susceptible individuals.<a class="elsevierStyleCrossRefs" href="#bib0355">20–22</a>According to a study published by Frank (1993),<a class="elsevierStyleCrossRef" href="#bib0370">23</a> which compares normothermic patients versus hypothermic patients intraoperatively, it was found the latter was three times more risk of myocardial infarction and 12 times more risk of angina.Hematologic effectsHypothermia increases blood viscosity which can lead to a deterioration of perfusion. Hematocrit levels rises by 2% per 1°C decline in temperature. This false hematocrit increase can be misleading in a hypothermic patient with blood loss.<a class="elsevierStyleCrossRef" href="#bib0375">24</a> It also has deleterious effects on the coagulation cascade; hypothermia decreases all enzymatic reactions involved in the intrinsic and the extrinsic pathway. It has been shown that both the partial thromboplastin time (PTT) and prothrombin time (PT), are increased significally by hypothermia in surgery in regards to normothermic patients.<a class="elsevierStyleCrossRefs" href="#bib0380">25,26</a> Furthermore hypothermia causes transient thrombocytopenia and reduces platelet function by a transient decrease of thromboxane synthesis B2.<a class="elsevierStyleCrossRefs" href="#bib0390">27,28</a> A prospective controlled study by Cavallini<a class="elsevierStyleCrossRef" href="#bib0400">29</a> found that the group with intraoperative hypothermia presented partial times higher than thromboplastin preheated group, of which it was concluded that maintaining normothermia is one of the main strategies to reduce both intraoperative bleeding as the need for transfusions.Effects on the immune systemHypothermia has an immunosuppressive effect that lowers resistance to infection. It has been shown in vitro that low temperatures decrease leukocyte migration; reduces neutrophil phagocytic capacity;<a class="elsevierStyleCrossRef" href="#bib0405">30</a> decreases production of interleukins 1, 2 and 6 and the tumor necrosis factor;<a class="elsevierStyleCrossRef" href="#bib0410">31</a> antibody production decreases in T cells, while both complement activation and levels of C-reactive protein are deteriorated. Melling et al.<a class="elsevierStyleCrossRef" href="#bib0415">32</a> conducted a study in patients with clean surgical procedures (such as breast surgeries) and found that the group without warming had infection rates much higher than groups that underwent prewarming (15% vs 6% and 4%).Hypothermia classificationThe tympanic membrane, nasopharynx, esophagus and the distal pulmonary artery are the most accurate sites to monitor core temperature.Hypothermia is defined as a body core temperature below 36°C and classified as mild (36–32°C), moderate (28–31.9°C) and severe (less than 28°C).<a class="elsevierStyleCrossRef" href="#bib0420">33</a> However, Kirkpatrick,<a class="elsevierStyleCrossRef" href="#bib0425">34</a> has classified hypothermia in four phases, making a division of the mild phase; one of 36–34°C and other of 34–32°C.Risk factors for perioperative hypothermia in plastic surgeryThe most important risk factors include the air conditioning in the operating room, combine general and regional anesthesia, prior patient temperature <35.5°C, blood loss >30cc/kg<a class="elsevierStyleCrossRef" href="#bib0430">35</a> and the removal of fat in liposuction which also contributes to the hypothermia in this type of surgery.<a class="elsevierStyleCrossRef" href="#bib0435">36</a>Heating methods to prevent intraoperative hypothermiaPreventing hypothermia can ensure safer and pleasurable surgery. The aim is to avoid the temperature drops below 36°C, so it is essential monitoring body temperature by a probe.<a class="elsevierStyleCrossRefs" href="#bib0440">37,38</a> Studies conducted in Colombia show that temperature is monitored only in 10% of patients undergoing surgery and this leads us to ignore the magnitude of the problem.<a class="elsevierStyleCrossRef" href="#bib0450">39</a> One of the most important and effective measures, but also less implemented due to the discomfort for the entire surgical team is to maintain operating room temperatures above 22°C,<a class="elsevierStyleCrossRef" href="#bib0455">40</a> but this has been little used in practice.Effects of prewarmingPrewarming is perhaps the most important measure to prevent hypothermia in surgical. The patient can be prewarmed before surgery with a forced warm-air blanket system 30min to 1h. Raising the external temperature has little or nothing effect on the core temperature, however, this reduces the difference or temperature gradient between the core and the periphery and thus heat loss reduces by decreasing the delta temperature during the first hour of anesthesia and surgery, time in which fastest loss temperature occurs.<a class="elsevierStyleCrossRefs" href="#bib0460">41–43</a> During this first hour loss temperature decreases up to 2°C in patients without prewarming vs 0.9°C in patients prewarmed.<a class="elsevierStyleCrossRefs" href="#bib0475">44,45</a> Sessler<a class="elsevierStyleCrossRef" href="#bib0485">46</a> determined 1h as the ideal time to the patient should be prewarmed to significantly reduce heat loss during the first hour of surgery.Hot water mattressAlthough hot water mattresses have been widely used for decades and are considered as the classic heating system in surgery, actually their effectiveness is limited: the back is just a portion of the total body surface area and 90% of core heat is lost from the previous area of the body. In addition hot water mattresses have been associated with burned areas in pressure zones.<a class="elsevierStyleCrossRefs" href="#bib0325">14,47,48</a>Warming intravenous fluidsIt is known that 1l of saline solution intravenously infused at room temperature decreases the temperature in adults 0.25°C.<a class="elsevierStyleCrossRef" href="#bib0500">49</a> However, this is not the main cause of heat loss in plastic surgery patients in which the liquid handling is conservative, although some studies have shown that patients, who were infused with heating systems IV such as Hotline, could have some thermal benefit compared to those without any measure of thermal protection liquid.<a class="elsevierStyleCrossRef" href="#bib0505">50</a> Heaters should be an alternative only if IV fluids exceed 2l per hour as in the case of resuscitation or emergency surgery.Warming of liquids infiltration in plastic surgeryOne of the main reasons why hypothermia is common and severe in plastic surgery (liposuction in particular), is the large amount of liquids that are placed in subcutaneous infiltration. The most common in liposuction is to perform infiltration/aspiration ratios ranging from 1:1 with the superwet technique. This means that in a 4-l liposuction, 4l of normal saline solution should be infiltrated subcutaneously, which is usually done with liquid at room temperature. A study conducted by Robles-Cervantes et al.<a class="elsevierStyleCrossRef" href="#bib0510">51</a> compared the heat loss by using infiltration at room temperature (24°C) versus liquids prewarmed to 37°C. In the latter case temperatures raised 35.7°C against 34.9°C in the group without prewarmed. For this reason is considered an effective measure.ConclusionsPreventing hypothermia allows a safer surgery and a more pleasant postoperative recovery. Prevention measures result in great benefits such as reducing the rate of infections, improvement in cicatrization, less blood loss, less need of transfusion and a fast and pleasant wake up after anesthesia. Our goal is to avoid the patient temperature drops below 36°C. For this, the first step is a continuous monitoring of the core temperature during surgery. To achieve this aim the three most important measures are in order (1) prewarmed the patient with forced air blankets for 1h before surgery, (2) prewarmed of infiltration liquid at 37°C in the case of plastic surgery and (3) maintenance air conditioning in operating rooms above 22°C. All these measures are preventive, easy to implement and economic. Finally, it is important to highlight the need of specific studies about the temperature in the different specialties.FundingThe authors did not receive sponsorship to carry out this article.Conflicts of interestDr. Jorge Enrique Bayter-Marín is the coordinator of the Anesthesia Committee for Plastic Surgery at S.C.A.R.E.Dr. Jorge Rubio is the coordinator of the Committee of Ambulatory Anesthesia at S.C.A.R.E." "textoCompletoSecciones" => array:1 [ "secciones" => array:25 [ 0 => array:3 [ "identificador" => "xres785815" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec784527" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres785814" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec784526" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methodology" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Review" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Thermoregulation in humans" ] ] ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Body temperature regulation mechanisms" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Anesthetics effects on the heat conservation mechanisms" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Hypothermia phases during general anesthesia" ] 10 => array:2 [ "identificador" => "sec0040" "titulo" => "Regional anesthesia and hypothermia" ] 11 => array:2 [ "identificador" => "sec0045" "titulo" => "Hemodynamic and autonomic effects in response to cold" ] 12 => array:2 [ "identificador" => "sec0050" "titulo" => "Hematologic effects" ] 13 => array:2 [ "identificador" => "sec0055" "titulo" => "Effects on the immune system" ] 14 => array:2 [ "identificador" => "sec0060" "titulo" => "Hypothermia classification" ] 15 => array:2 [ "identificador" => "sec0065" "titulo" => "Risk factors for perioperative hypothermia in plastic surgery" ] 16 => array:2 [ "identificador" => "sec0070" "titulo" => "Heating methods to prevent intraoperative hypothermia" ] 17 => array:2 [ "identificador" => "sec0075" "titulo" => "Effects of prewarming" ] 18 => array:2 [ "identificador" => "sec0080" "titulo" => "Hot water mattress" ] 19 => array:2 [ "identificador" => "sec0085" "titulo" => "Warming intravenous fluids" ] 20 => array:2 [ "identificador" => "sec0090" "titulo" => "Warming of liquids infiltration in plastic surgery" ] 21 => array:2 [ "identificador" => "sec0095" "titulo" => "Conclusions" ] 22 => array:2 [ "identificador" => "sec0100" "titulo" => "Funding" ] 23 => array:2 [ "identificador" => "sec0105" "titulo" => "Conflicts of interest" ] 24 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-09-11" "fechaAceptado" => "2016-08-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec784527" "palabras" => array:5 [ 0 => "Hypothermia" 1 => "Anesthesia, general" 2 => "Anesthesia, conduction" 3 => "Body temperature" 4 => "Ambulatory surgical procedures" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec784526" "palabras" => array:5 [ 0 => "Hipotermia" 1 => "Anestesia, general" 2 => "Anestesia de conducción" 3 => "Temperatura corporal" 4 => "Procedimientos quirúrgicos ambulatorios" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionHypothermia is perhaps the most frequent undesirable event in elective surgery. It is estimated that 1h after surgery has initiated 70–90% of patients will experience hypothermia. In elective surgery, there are several factors leading to temperatures under 34°C. Hypothermia may increases infections, bleeding and need for transfusion as well as the occurrence of an undesirable effect of discomfort and feared such as cold and postoperative shivering that can lead to cardiac complications due to increased of sympathetic influence. ObjectivesReview the causes of these low temperatures within intraoperative elective surgery and check if the current alternatives to prevent hypothermia are effective. MethodsReview of non-systematic literature in PubMed and Medline was performed. ResultsHypothermia is the most common and least diagnosed undesirable event of patients undergoing surgery although it is easy to detect and preventive measures do not present major difficulties in their implementation. ConclusionsThere are effective measures easy to set up, economical and effective to prevent hypothermia; the most important is the patient warm with hot air under pressure for 1h and maintenance of air conditioning in the room above 22°C. We just need to understand these measures and start to implement them." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa hipotermia es tal vez el evento indeseable mas frecuente en los pacientes que van a cirugía programada. Se considera que 1 hora después de iniciada la cirugía el 70 al 90% de los pacientes se encuentran hipotérmicos. En cirugía Electiva en pacientes sanos hay varios factores que llevan a que nuestros pacientes mantengan cifras de temperaturas de 34°C e inclusive menores. El problema está en que la hipotermia aumenta las infecciones, el sangrado y la necesidad de trasfusión, la aparición de un efecto indeseable y temido por el paciente como es el frío y temblor postoperatorio que puede llevar a complicaciones cardiacas debido al aumento del influjo simpático. ObjetivosRevisar las causas que llevan a estas bajas temperaturas intraoperatorias en cirugía programada y revisar si las opciones que tenemos hoy en día para prevenir la hipotermia pueden ser efectivas. MétodosSe realizó una revisión de la literatura no sistemática en las bases de datos PubMed y Medline. ResultadosLa hipotermia es el evento indeseable más frecuente y menos diagnosticado en el paciente que va a cirugía a pesar que es fácil de detectar y las medidas preventivas son relativamente fáciles de instaurar. ConclusionesHay medidas efectivas, fáciles de instaurar, económicas y efectivas para evitar la hipotermia y entre ellas la más importante es el precalentamiento del paciente con aire caliente a presión por 1 hora, el mantenimiento del aire acondicionado de la sala por encima de 22 grados centígrados. Solo necesitamos entender cuales son estas medidas e iniciar a ponerlas en practica." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Bayter-Marín JE, Rubio J, Valedón A, Macías ÁA. Hipotermia en cirugía electiva. El enemigo oculto. Rev Colomb Anestesiol. 2017;45:48–53." ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "Member of International Committee of SAMBA." "identificador" => "fn1" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:51 [ 0 => array:3 [ "identificador" => "bib0260" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Temperature monitoring and perioperative thermoregulation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.I. Sessler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e31817f6d76" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2008" "volumen" => "109" "paginaInicial" => "318" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18648241" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0265" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isoflurane anesthesia and circadian temperature cycles" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.I. Sessler" 1 => "K.A. Lee" 2 => "J. McGuire" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Anestesiology" "fecha" => "1991" "volumen" => "75" "paginaInicial" => "985" "paginaFinal" => "989" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0270" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perianesthetic thermoregulation and heat balance in humans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.I. Sessler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "FASEB J" "fecha" => "1993" "volumen" => "7" "paginaInicial" => "638" "paginaFinal" => "644" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8500688" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0275" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The human sleep-wake cycle reconsidered from a thermoregulatory point of view" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Kräuchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.physbeh.2006.09.005" "Revista" => array:6 [ "tituloSerie" => "Physiol Behav" "fecha" => "2007" "volumen" => "90" "paginaInicial" => "236" "paginaFinal" => "245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17049364" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0280" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "System properties, feedback control and effector coordination of human temperature regulation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Werner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00421-009-1216-1" "Revista" => array:6 [ "tituloSerie" => "Eur J Appl Physiol" "fecha" => "2009" "volumen" => "109" "paginaInicial" => "13" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19787369" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0285" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A thermosensory pathway that controls body temperature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Nakamura" 1 => "S.F. Morrison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nn2027" "Revista" => array:6 [ "tituloSerie" => "Nat Neurosci" "fecha" => "2008" "volumen" => "11" "paginaInicial" => "62" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18084288" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0290" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Central control of thermogenesis in mammals" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.F. Morrison" 1 => "K. Nakamura" 2 => "C.J. Madden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ex Physiol" "fecha" => "2008" "volumen" => "93" "paginaInicial" => "773" "paginaFinal" => "797" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0295" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thermoregulatory defense mechanisms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.I. Sessler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Crit Care Med" "fecha" => "2009" "volumen" => "37" "paginaInicial" => "203" "paginaFinal" => "210" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0300" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mild perioperative hypothermia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.I. Sessler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199706123362407" "Revista" => array:6 [ "tituloSerie" => "New Engl J Med" "fecha" => "1997" "volumen" => "336" "paginaInicial" => "1730" "paginaFinal" => "1737" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9180091" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0305" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perioperative heat balance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.I. Sessler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2000" "volumen" => "92" "paginaInicial" => "578" "paginaFinal" => "596" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10691247" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0310" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Desflurane reduces the gain of thermoregulatory arteriovenous shunt vasoconstriction in humans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Kurz" 1 => "J. Xiong" 2 => "D.I. Sessler" 3 => "M. Dechert" 4 => "K. Noyes" 5 => "K. Belani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1995" "volumen" => "83" "paginaInicial" => "1212" "paginaFinal" => "1219" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8533914" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0315" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mild hypothermia during halothane induced anaesthesia decreases resistance to Staphylococcus aureus dermal infection in guinea pigs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.W. Sheffield" 1 => "D.I. Sessler" 2 => "T.K. Hunt" 3 => "H. Scheunenstuhl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1524-475X.1994.20108.x" "Revista" => array:7 [ "tituloSerie" => "Wound Repair Regen" "fecha" => "1994" "volumen" => "2" "paginaInicial" => "48" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17168911" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0165032715311939" "estado" => "S300" "issn" => "01650327" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0320" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The threshold for thermoregulatory vasoconstriction during nitrous oxide/sevoflurane anesthesia is reduced in elderly patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Ozaki" 1 => "D.I. Sessler" 2 => "H. Ozaqui" 3 => "K. Atarashi" 4 => "C. Negishi" 5 => "H. Suzuki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "1997" "volumen" => "84" "paginaInicial" => "1029" "paginaFinal" => "1033" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9141926" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0325" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "“Burns” occurring during lengthy surgical procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Gendron" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Eng" "fecha" => "1980" "volumen" => "5" "paginaInicial" => "20" "paginaFinal" => "26" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0330" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The accuracy and precisión of body temperature monitoring methods during regional and general anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.G. Cattaneo" 1 => "S.M. Frank" 2 => "T.W. Hesel" 3 => "H.K. El-Rahmany" 4 => "L.J. Kim" 5 => "K.M. Tran" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2000" "volumen" => "90" "paginaInicial" => "938" "paginaFinal" => "945" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10735803" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0335" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of hypothermia during spinal anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.M. Frank" 1 => "H.K. El-Rahmany" 2 => "C.G. Cattaneo" 3 => "R.A. Barnes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2000" "volumen" => "92" "paginaInicial" => "1330" "paginaFinal" => "1334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10781278" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0340" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Temperature monitoring and management during neuraxial anesthesia: an observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.M. Arkiliç" 1 => "O. Akça" 2 => "A. Taguchi" 3 => "D.I. Sessler" 4 => "A. Kurz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2000" "volumen" => "91" "paginaInicial" => "662" "paginaFinal" => "666" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10960396" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0345" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin and central temperatures during continuous epidural analgesia and general anaesthesia in patients subjected to open prostatectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Hendolin" 1 => "E. Lansimies" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Clin Res" "fecha" => "1982" "volumen" => "14" "paginaInicial" => "181" "paginaFinal" => "186" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7168548" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0350" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spinal anesthesia only minimally increases the efficacy of postoperative forced-air rewarming" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Szmuk" 1 => "T. Ezri" 2 => "D.I. Sessler" 3 => "A. Stein" 4 => "D. Geva" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1997" "volumen" => "87" "paginaInicial" => "1050" "paginaFinal" => "1054" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9366455" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0355" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adrenergic, respiratory, and cardiovascular effects of core cooling in humans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.M. Frank" 1 => "M.S. Higgins" 2 => "L.A. Fleisher" 3 => "J.V. Sitzmann" 4 => "H. Raff" 5 => "M.J. Breslow" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Physiol" "fecha" => "1997" "volumen" => "272" "paginaInicial" => "R557" "paginaFinal" => "R562" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9124478" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0360" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Frank" 1 => "L.A. Fleisher" 2 => "M.J. Breslow" 3 => "M.S. Higgins" 4 => "K.F. Olson" 5 => "S. Kelly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Med Assoc" "fecha" => "1997" "volumen" => "277" "paginaInicial" => "1127" "paginaFinal" => "1134" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0365" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood pressure response to thermoregulatory vasoconstriction during isoflurane and desflurane anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Greif" 1 => "S. Laciny" 2 => "A. Rajek" 3 => "A.G. Doufas" 4 => "D.I. Sessler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "2003" "volumen" => "47" "paginaInicial" => "847" "paginaFinal" => "852" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12859306" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0370" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unintentional hypothermia is associated with postoperative myocardial ischemia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Frank" 1 => "C. Beattie" 2 => "R. Christopherson" 3 => "E.J. Norris" 4 => "B.A. Perler" 5 => "G.M. Williams" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1993" "volumen" => "78" "paginaInicial" => "468" "paginaFinal" => "476" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8457047" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0375" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Viscosity of normal human blood under normothermic and hypothermic conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.W. Rand" 1 => "E. Lacombe" 2 => "H.E. Hunt" 3 => "W.H. Austin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Appl Physiol" "fecha" => "1964" "volumen" => "19" "paginaInicial" => "117" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14104265" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0380" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of hypothermia on the coagulation cascade" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.J. Rohrer" 1 => "A.M. Natale" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "1992" "volumen" => "20" "paginaInicial" => "1402" "paginaFinal" => "1405" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1395660" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0385" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet kinetics during deep hypothermia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Hessel" 1 => "G. Schmer" 2 => "D. Dillard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Surg Res" "fecha" => "1980" "volumen" => "28" "paginaInicial" => "23" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7359906" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0390" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypothermia-induced reversible platelet dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.R. Valeri" 1 => "G. Cassidy" 2 => "S. Khuri" 3 => "H. Feingold" 4 => "G. Ragno" 5 => "M.D. Altschule" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "1987" "volumen" => "205" "paginaInicial" => "175" "paginaFinal" => "181" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3813688" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0395" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mild intraoperative hypothermia increases blood loss and allogenic transfusion requirements during total hip arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Schmied" 1 => "A. Kurz" 2 => "D.I. Sessler" 3 => "S. Kozek" 4 => "A. Reiter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Lancet" "fecha" => "1996" "volumen" => "347" "paginaInicial" => "289" "paginaFinal" => "292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8569362" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S016383431200206X" "estado" => "S300" "issn" => "01638343" ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0400" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of mild hypothermia on blood coagulation in patients undergoing elective plastic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Cavallini" 1 => "F.W.B. Preis" 2 => "A. Casati" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "2005" "volumen" => "116" "paginaInicial" => "316" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15988284" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0405" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of temperature on the chemotaxis, phagocytic engulfment, digestion and oxygen consumption of human polymorphonuclear leukocytes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.J. Van Oss" 1 => "D.R. Absolam" 2 => "L.L. Moore" 3 => "B.H. Park" 4 => "J.R. Humbert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Reticuloendothelial Soc" "fecha" => "1980" "volumen" => "27" "paginaInicial" => "561" "paginaFinal" => "565" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0410" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of hypothermia and hyperthermia on cytokine production by cultured human mononuclear phagocytes from adults and newborns" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.D. Fairchild" 1 => "R.M. Viscardi" 2 => "L. Hester" 3 => "I.S. Singh" 4 => "J.D. Hasday" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/107999000750053708" "Revista" => array:6 [ "tituloSerie" => "J Interferon Cytokine Res" "fecha" => "2000" "volumen" => "20" "paginaInicial" => "1049" "paginaFinal" => "1055" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11152570" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0415" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.C. Melling" 1 => "B. Ali" 2 => "E.M. Scott" 3 => "D.J. Leaper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(01)06071-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2001" "volumen" => "358" "paginaInicial" => "876" "paginaFinal" => "880" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11567703" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0420" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of perioperative hypothermia and warming in surgical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Kumar" 1 => "P.F. Wong" 2 => "A.C. Melling" 3 => "D.J. Leaper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1742-4801.2005.00102.x" "Revista" => array:6 [ "tituloSerie" => "Int Wound J" "fecha" => "2005" "volumen" => "2" "paginaInicial" => "193" "paginaFinal" => "204" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16618324" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0425" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypothermia and the trauma patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.W. Kirkpatrick" 1 => "R. Chun" 2 => "R. Brown" 3 => "R.K. Simons" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Surg" "fecha" => "1999" "volumen" => "42" "paginaInicial" => "333" "paginaFinal" => "343" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10526517" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0430" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What are the most important risk factors for a patient's developing intraoperative hypothermia?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Macario" 1 => "F. Dexter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2002" "volumen" => "94" "paginaInicial" => "215" "paginaFinal" => "220" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11772832" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0435" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morphometric influences on intraoperative core temperature changes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Kurz" 1 => "D.I. Sessler" 2 => "E. Narzt" 3 => "R. Lenhardt" 4 => "F. Lackner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "1995" "volumen" => "80" "paginaInicial" => "562" "paginaFinal" => "657" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7864426" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0440" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Forced air warming versus routine thermal care and core temperature measurement sites" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.A. Krenzischek" 1 => "S.M. Frank" 2 => "S. Kelly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Postgrad Anesth Nurs" "fecha" => "1995" "volumen" => "10" "paginaInicial" => "69" "paginaFinal" => "78" ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0445" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Control of postanaesthetic shivering with radiant heat" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Giesecke" 1 => "A. Sharkey" 2 => "M. Murphy" 3 => "L. Rice" 4 => "J. Lipton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Anesthesiol Scand" "fecha" => "1987" "volumen" => "31" "paginaInicial" => "28" "paginaFinal" => "32" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0450" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manejo de la temperatura en el perioperatorio y frecuencia de hipotermia inadvertida en un hospital general" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.G. Castillo Monzón" 1 => "C.A. Candia Arana" 2 => "H.A. Valz" 3 => "F.A. Fernando Aguilar Rodríguez" 4 => "J.J. Benavides Mejía" 5 => "J.A. Alvarez Gómez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Colomb Anestesiol" "fecha" => "2013" "volumen" => "41" "paginaInicial" => "97" "paginaFinal" => "103" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0455" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adverse effects of hypothermia in postoperative patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.J. Slottman" 1 => "E.H. Jed" 2 => "K.W. Burchard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Surg" "fecha" => "1985" "volumen" => "149" "paginaInicial" => "495" "paginaFinal" => "501" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3985289" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0460" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of forced air warming system for intra-operative warming" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.L. Gauthier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Anaesthesiology" "fecha" => "1990" "volumen" => "73" "paginaInicial" => "462" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0465" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention of intraoperative hypothermia by preoperative skin-surface warming" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Just" 1 => "V. Trévien" 2 => "E. Delva" 3 => "A. Lienhart" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1993" "volumen" => "79" "paginaInicial" => "214" "paginaFinal" => "218" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8251019" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0470" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preanesthetic skin-surface warming reduces redistribution hypothermia caused by epidural block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Glosten" 1 => "J. Hynson" 2 => "D.I. Sessler" 3 => "J. McGuire" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "1993" "volumen" => "77" "paginaInicial" => "488" "paginaFinal" => "493" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8368549" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0475" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of pre-induction warming on temperature and blood pressure during propofol/nitrous oxide anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.M. Hynson" 1 => "D.I. Sessler" 2 => "A. Moayeri" 3 => "J. McGuire" 4 => "M. Schroeder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1993" "volumen" => "79" "paginaInicial" => "219" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8342834" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0480" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalisation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Kurz" 1 => "D.I. Sessler" 2 => "R. Lenhardt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199605093341901" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1996" "volumen" => "334" "paginaInicial" => "1209" "paginaFinal" => "1215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8606715" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0485" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optimal duration and temperature of prewarming" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.I. Sessler" 1 => "M. Schroeder" 2 => "B. Merrifield" 3 => "T. Matsukawa" 4 => "C. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1995" "volumen" => "82" "paginaInicial" => "674" "paginaFinal" => "681" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7879936" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0490" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin-surface warming: heat flux and central temperature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.I. Sessler" 1 => "A. Moayeri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1990" "volumen" => "73" "paginaInicial" => "218" "paginaFinal" => "224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2382847" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0495" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraoperative warming therapies: a comparison of three devices" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Hynson" 1 => "D.I. Sessler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Anesth" "fecha" => "1992" "volumen" => "4" "paginaInicial" => "194" "paginaFinal" => "199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1610573" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0500" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consequences and treatment of perioperative hypothermia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.I. Sessler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Anesth Clin N Am" "fecha" => "1994" "volumen" => "12" "paginaInicial" => "425" "paginaFinal" => "456" ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0505" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio comparativo de tres dispositivos para prevenir la hipotermia en pacientes sometidos a cirugía Plástica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Añorve" 1 => "F. De los Santos" 2 => "M. García" 3 => "J. Mikolajkczuc" 4 => "P. Segui¿" 5 => "F. Revilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Med Grupo los Angeles" "fecha" => "2012" "volumen" => "10" "paginaInicial" => "14" "paginaFinal" => "19" ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0510" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heating infiltration solutions used in tumescent liposuction: minimizing surgical risk" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Robles-Cervantes" 1 => "R. Martinez-Molina" 2 => "L. Cárdenas-Camarena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "2005" "volumen" => "116" "paginaInicial" => "1077" "paginaFinal" => "1081" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16163098" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22562087/0000004500000001/v1_201701060057/S2256208716300736/v1_201701060057/en/main.assets" "Apartado" => array:4 [ "identificador" => "62380" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Reviews" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22562087/0000004500000001/v1_201701060057/S2256208716300736/v1_201701060057/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208716300736?idApp=UINPBA00004N"]

Statistics

Review

Hypothermia in elective surgery: The hidden enemy

Hipotermia en cirugía electiva. El enemigo oculto

Jorge Enrique Bayter-Marína,b,◊,

Corresponding author

jokibay@yahoo.com

Corresponding author at: Clínica El Pinar, Centro Empresarial Natura, Km 2 Anillo vial Autopista Floridablanca – Girón, Torre 2, Floridablanca, Santander, Colombia.

, Jorge Rubioc,d,◊, Arnaldo Valedóne,◊, Álvaro Andrés Macíasf,◊

a Medical director, Clínica El Pinar, Bucaramanga, Colombia

b Anesthesia Committee Coordinator for Plastic Surgery, Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), Bogotá, D.C., Colombia

c Anesthesiologist, Centro Quirúrgico Ambulatorio, Salud SURA, Medellin, Colombia

d Committee Coordinator of Ambulatory Anesthesia, Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), Bogotá, D.C., Colombia

e Chief Ambulatory Division and Managing Partner, First Colonies Anesthesia Associates, Baltimore, USA

f Staff Anesthesiologist, Brigham and Womens Hospital, Department of Anesthesiology, Massachusetts Eye and Ear, Boston, USA

Read

7509

Times
was read the article

981

Total PDF

6528

Total HTML

Share statistics

 array:25 [
  "pii" => "S2256208716300736"
  "issn" => "22562087"
  "doi" => "10.1016/j.rcae.2016.11.003"
  "estado" => "S300"
  "fechaPublicacion" => "2017-01-01"
  "aid" => "320"
  "copyright" => "Sociedad Colombiana de Anestesiolog&#237;a y Reanimaci&#243;n"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-sa/4.0/"
  "subdocumento" => "ssu"
  "cita" => "Rev Colomb Anestesiol. 2017;45:48-53"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1099
    "formatos" => array:3 [
      "EPUB" => 113
      "HTML" => 730
      "PDF" => 256
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S0120334716301174"
      "issn" => "01203347"
      "doi" => "10.1016/j.rca.2016.08.003"
      "estado" => "S300"
      "fechaPublicacion" => "2017-01-01"
      "aid" => "320"
      "copyright" => "Sociedad Colombiana de Anestesiolog&#237;a y Reanimaci&#243;n"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "ssu"
      "cita" => "Rev Colomb Anestesiol. 2017;45:48-53"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 5873
        "formatos" => array:3 [
          "EPUB" => 141
          "HTML" => 5082
          "PDF" => 650
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Revisi&#243;n</span>"
        "titulo" => "Hipotermia en cirug&#237;a electiva&#46; El enemigo oculto"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "48"
            "paginaFinal" => "53"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Hypothermia in elective surgery&#46; The hidden enemy"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Jorge Enrique Bayter-Mar&#237;n, Jorge Rubio, Arnaldo Valed&#243;n, &#193;lvaro Andr&#233;s Mac&#237;as"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Jorge Enrique"
                "apellidos" => "Bayter-Mar&#237;n"
              ]
              1 => array:2 [
                "nombre" => "Jorge"
                "apellidos" => "Rubio"
              ]
              2 => array:2 [
                "nombre" => "Arnaldo"
                "apellidos" => "Valed&#243;n"
              ]
              3 => array:2 [
                "nombre" => "&#193;lvaro Andr&#233;s"
                "apellidos" => "Mac&#237;as"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2256208716300736"
          "doi" => "10.1016/j.rcae.2016.11.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208716300736?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334716301174?idApp=UINPBA00004N"
      "url" => "/01203347/0000004500000001/v2_201701100131/S0120334716301174/v2_201701100131/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2256208716300803"
    "issn" => "22562087"
    "doi" => "10.1016/j.rcae.2016.11.010"
    "estado" => "S300"
    "fechaPublicacion" => "2017-01-01"
    "aid" => "323"
    "copyright" => "Sociedad Colombiana de Anestesiolog&#237;a y Reanimaci&#243;n"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "ssu"
    "cita" => "Rev Colomb Anestesiol. 2017;45:54-61"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1226
      "formatos" => array:3 [
        "EPUB" => 102
        "HTML" => 871
        "PDF" => 253
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "The basic principles of anesthesia for the neonate"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "54"
          "paginaFinal" => "61"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Principios b&#225;sicos de la anestesia neonatal"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0015"
          "etiqueta" => "Fig&#46; 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Reproduced with permission from LeDez and Lerman&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">41</span></a>"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1333
              "Ancho" => 1464
              "Tamanyo" => 72438
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The minimum alveolar concentration &#40;MAC&#41; of isoflurane and post-conceptual age&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lynn D&#46; Martin"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Lynn D&#46;"
              "apellidos" => "Martin"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0120334716301204"
        "doi" => "10.1016/j.rca.2016.07.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334716301204?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208716300803?idApp=UINPBA00004N"
    "url" => "/22562087/0000004500000001/v1_201701060057/S2256208716300803/v1_201701060057/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2256208716300785"
    "issn" => "22562087"
    "doi" => "10.1016/j.rcae.2016.11.008"
    "estado" => "S300"
    "fechaPublicacion" => "2017-01-01"
    "aid" => "327"
    "copyright" => "Sociedad Colombiana de Anestesiolog&#237;a y Reanimaci&#243;n"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "dis"
    "cita" => "Rev Colomb Anestesiol. 2017;45:46-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1106
      "formatos" => array:3 [
        "EPUB" => 110
        "HTML" => 760
        "PDF" => 236
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Brief Academy</span>"
      "titulo" => "Commentary on &#8220;Reflections about euthanasia in Colombia&#8221;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "46"
          "paginaFinal" => "47"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Comentario sobre &#8220;Reflexiones acerca de la eutanasia en Colombia&#8221;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "&#193;lvaro Sanz-Rubiales, Mar&#237;a Luisa del Valle"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "&#193;lvaro"
              "apellidos" => "Sanz-Rubiales"
            ]
            1 => array:2 [
              "nombre" => "Mar&#237;a Luisa"
              "apellidos" => "del Valle"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0120334716301289"
        "doi" => "10.1016/j.rca.2016.11.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334716301289?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208716300785?idApp=UINPBA00004N"
    "url" => "/22562087/0000004500000001/v1_201701060057/S2256208716300785/v1_201701060057/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
    "titulo" => "Hypothermia in elective surgery&#58; The hidden enemy"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "48"
        "paginaFinal" => "53"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Jorge Enrique Bayter-Mar&#237;n, Jorge Rubio, Arnaldo Valed&#243;n, &#193;lvaro Andr&#233;s Mac&#237;as"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Jorge Enrique"
            "apellidos" => "Bayter-Mar&#237;n"
            "email" => array:1 [
              0 => "jokibay&#64;yahoo&#46;com"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#9674;</span>"
                "identificador" => "fn1"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Jorge"
            "apellidos" => "Rubio"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#9674;</span>"
                "identificador" => "fn1"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Arnaldo"
            "apellidos" => "Valed&#243;n"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#9674;</span>"
                "identificador" => "fn1"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "&#193;lvaro Andr&#233;s"
            "apellidos" => "Mac&#237;as"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#9674;</span>"
                "identificador" => "fn1"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:6 [
          0 => array:3 [
            "entidad" => "Medical director&#44; Cl&#237;nica El Pinar&#44; Bucaramanga&#44; Colombia"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Anesthesia Committee Coordinator for Plastic Surgery&#44; Sociedad Colombiana de Anestesiolog&#237;a y Reanimaci&#243;n &#40;S&#46;C&#46;A&#46;R&#46;E&#46;&#41;&#44; Bogot&#225;&#44; D&#46;C&#46;&#44; Colombia"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Anesthesiologist&#44; Centro Quir&#250;rgico Ambulatorio&#44; Salud SURA&#44; Medellin&#44; Colombia"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Committee Coordinator of Ambulatory Anesthesia&#44; Sociedad Colombiana de Anestesiolog&#237;a y Reanimaci&#243;n &#40;S&#46;C&#46;A&#46;R&#46;E&#46;&#41;&#44; Bogot&#225;&#44; D&#46;C&#46;&#44; Colombia"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Chief Ambulatory Division and Managing Partner&#44; First Colonies Anesthesia Associates&#44; Baltimore&#44; USA"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Staff Anesthesiologist&#44; Brigham and Womens Hospital&#44; Department of Anesthesiology&#44; Massachusetts Eye and Ear&#44; Boston&#44; USA"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>&#58; Cl&#237;nica El Pinar&#44; Centro Empresarial Natura&#44; Km 2 Anillo vial Autopista Floridablanca &#8211; Gir&#243;n&#44; Torre 2&#44; Floridablanca&#44; Santander&#44; Colombia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Hipotermia en cirug&#237;a electiva&#46; El enemigo oculto"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hypothermia is the hidden enemy in most elective surgery procedures&#46; Very few anesthesiologists and surgeons take into account this problem intraoperatively despite all the adverse effects caused in the postoperative period&#46; It is considered that 70&#8211;90&#37; of patients undergoing surgery develop hypothermia even if surgery only takes 1<span class="elsevierStyleHsp" style=""></span>h&#46; The restoration of normothermia can take up to 4<span class="elsevierStyleHsp" style=""></span>h if measures for preventing hypothermia are not taken&#46; Both general and regional anesthesia&#44; contribute to deteriorate protective mechanisms of hypothermia&#46; In addition to the known effects of hypothermia such as increased infection rate&#44; impairment of clotting mechanisms and major bleeding&#44; there are adverse events due to the inevitable tremors that cause great discomfort and unpleasant feeling&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methodology</span><p id="par0010" class="elsevierStylePara elsevierViewall">A non-systematic literature review was performed in databases such as PubMed and Medline&#44; entering keywords in English&#58; hypothermia in plastic surgery&#44; complications of hypothermia&#44; prevention of hypothermia&#44; maintaining normothermia&#46; The articles were read&#44; those referring to the subject were consulted and according to this methodology 52 references were selected&#46; The results of this review are presented below&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Review</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Thermoregulation in humans</span><p id="par0015" class="elsevierStylePara elsevierViewall">Human being is homeothermic and endothermic&#46; This means that&#44; in addition to maintaining its temperature in narrow ranges&#44; can produce heat by itself&#46; In simple terms&#44; the human body is divided into two compartments&#44; one central that produces heat and one peripheral that regulates heat loss&#46; Our tight regulatory mechanisms are made to protect our central compartment at the expense of the peripheral&#46; Thus&#44; the core temperature&#44; and especially the temperature in the brain&#44; is regulated close to 37<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; with an almost perfect thermoregulation&#44; but at the expense of the skin&#44; which is actually poikilothermic and its temperature resembles the ambient temperature about 33<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Under normal conditions&#44; the production of body heat is the result of the basal metabolic rate of internal organs such as the brain and those of the thoracic and abdominal cavity as heart&#44; lung&#44; liver&#44; intestine and kidney&#46; Blood passes through these organs is heated and then is distributed by the cardiovascular system by convection from the central region to skin region&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The core that integrates and regulates body temperature and actually acts as a thermostat is in the posterior hypothalamus&#46; Thus the blood temperature that reaches the hypothalamus is the major determinant of the body&#39;s response to climate change and is responsible for maintaining a balance between heat production and heat transfer processes &#40;gain and loss&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">These transfer processes between our body and the external medium is produced in two ways&#58; by evaporation and no evaporative mechanisms &#40;radiation&#44; conduction and convection&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">According to the second law of thermodynamics heat can only flow by temperature gradient from the body that is warmer toward the periphery or the environment that is colder&#44; therefore&#44; the body never can be heated from the periphery to the core which is usually warmer than the outside&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Body temperature regulation mechanisms</span><p id="par0035" class="elsevierStylePara elsevierViewall">Body temperature is regulated exclusively by nervous mechanisms of negative feedback operating in the thermoregulatory centers in the hypothalamus&#46; In few cases&#44; body temperature can only be altered by internal heat generation&#44; regularly is by cooling or heating of the environment&#46; For its part&#44; transient receptor potential &#40;TRP&#41; channels in the skin are widely present in sensory neurons&#46; TRPM8 subtype exhibits activation at a room temperature &#60;27<span class="elsevierStyleHsp" style=""></span>&#176;C that is when there is a slight cold&#46; The central thermoreceptors are located in the brain&#44; spinal cord and abdomen&#46; Lateral parabrachial nucleus neurons are activated by cooling signal&#44; which promotes an excitatory influx aimed at GABAergic interneurons&#46; This GABA influx inhibits inhibitory neurons in the preoptic area in the hypothalamus&#44; which is the area in charge of temperature control&#44; among other functions&#46; The result is the disinhibition of thermogenesis-promoting neurons in the hypothalamus&#46; The spinal sympathetic influx and somatic motor circuits are activated by these fibers to trigger thermogenesis&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">5&#8211;7</span></a> Thus&#44; the coordination of a thermoregulatory response with a perfect hierarchical organization takes place from the preoptic area of the anterior hypothalamus&#44; coordination that goes far beyond a simple spinal cord response as vasoconstriction&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A symphatic spinal flow is triggered with a large release of adrenaline and noradrenaline due to hypothermia&#44; which produces an extensive peripheral vasoconstriction with arteriovenous shunts that reduce the blood flow to these cold peripheral areas and&#44; in turn&#44; keeps the warm blood in the central compartment&#46; Thus we have a gradient between the central and peripheral temperature&#44; which can be 2&#8211;4&#176; with peripheral temperatures of 32<span class="elsevierStyleHsp" style=""></span>&#176;C and centrals of 36<span class="elsevierStyleHsp" style=""></span>&#176;C or lower&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Anesthetics effects on the heat conservation mechanisms</span><p id="par0045" class="elsevierStylePara elsevierViewall">All inhaled anesthetics impaired deeply the autonomic responses that defend us from hypothermia&#46; These responses are given in therapeutic ranges&#44; thus interthreshold range may increase 10&#8211;20 times &#40;4<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; meaning that the response of peripheral vasoconstriction&#44; usually given at 37<span class="elsevierStyleHsp" style=""></span>&#176;C with inhaled anesthesia&#44; can be given at 34<span class="elsevierStyleHsp" style=""></span>&#176;C or 35<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; It means being totally exposed to hypothermia during surgery&#59; regional anesthesia may increase the range only 3 or 4 times&#44; but also has a direct vasodilator effect that deteriorates the response to cold&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Hypothermia phases during general anesthesia</span><p id="par0050" class="elsevierStylePara elsevierViewall">Temperature changes occur in three phases during anesthesia&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">10</span></a> The greatest decline takes place during the first phase&#59; temperature drops from 1<span class="elsevierStyleHsp" style=""></span>&#176;C to 1&#46;5<span class="elsevierStyleHsp" style=""></span>&#176;C in the first hour due to a redistribution of heat from the center to the periphery&#46; Heat loss in this phase is the result of the normal gradient&#44; from 2<span class="elsevierStyleHsp" style=""></span>&#176;C to 4<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; between the core to the periphery and the vasodilatation that exists at the peripheral level due to the loss of the mechanisms of vasoconstriction by anesthesia&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">11&#8211;13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">During the second phase &#40;second and third hour&#41; occurs a slow linear reduction of temperature due to central heat loss by decreased of basal metabolism&#46; Hypothermia is also exacerbated by the low temperatures in the operating room&#44; the body sites exposed &#40;for example in liposuction&#41; and the amount of cold liquids infiltrated subcutaneously&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In the third phase &#40;third and fourth hour&#41; or plateau&#44; temperature maintains a relatively stable state&#46; In this phase&#44; normally between 34<span class="elsevierStyleHsp" style=""></span>&#176;C and 35<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; the mechanisms of protection against lost hypothermia such as vasoconstriction and the closure of shunts in hands and feet&#44; are activated again&#46; At this stage the heat loss is minimized&#44; but it never gets to reheat the body&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Regional anesthesia and hypothermia</span><p id="par0065" class="elsevierStylePara elsevierViewall">Hypothermia is frequent in both general and regional anesthesia&#46; Some studies may show that the loss of temperature may be slightly lower in the first hour with regional anesthesia &#40;0&#46;8<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; versus general anesthesia &#40;1&#46;2<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">14&#8211;16</span></a> while others have shown no difference&#46; Phases 1 and 2 are almost equal to the general anesthesia ones&#44; but the phase 3 has complications&#46; Vasoconstriction is not activated at 34<span class="elsevierStyleHsp" style=""></span>&#176;C with regional anesthesia&#44; therefore&#44; in this third phase &#40;phase Plateau in general anesthesia&#41; heat loss may continue in the patient&#44; after 3 or 4<span class="elsevierStyleHsp" style=""></span>h&#46; Thus&#44; hypothermia can become even more serious with regional anesthesia&#44; especially during lengthy surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">17&#44;18</span></a> Hypothermia is more severe&#44; depending on the dermatomes blocked and hence of the sympathetic blockade&#46; Some studies have shown a decrease in 0&#46;15<span class="elsevierStyleHsp" style=""></span>&#176;C per dermatome blocked&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">19</span></a> In plastic surgery this is a matter of great concern since very extensive blockages are performed that might include the thoracolumbar system in cases of tummy tucks and breast procedures with double puncture&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Hemodynamic and autonomic effects in response to cold</span><p id="par0070" class="elsevierStylePara elsevierViewall">Even mild hypothermia &#40;1&#8211;2<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; Norepinephrine values increase up to 7 times that generate a considerable hyperdynamic response&#46; It has been proved that this can cause morbid cardiac events in susceptible individuals&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">20&#8211;22</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">According to a study published by Frank &#40;1993&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">23</span></a> which compares normothermic patients versus hypothermic patients intraoperatively&#44; it was found the latter was three times more risk of myocardial infarction and 12 times more risk of angina&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Hematologic effects</span><p id="par0080" class="elsevierStylePara elsevierViewall">Hypothermia increases blood viscosity which can lead to a deterioration of perfusion&#46; Hematocrit levels rises by 2&#37; per 1<span class="elsevierStyleHsp" style=""></span>&#176;C decline in temperature&#46; This false hematocrit increase can be misleading in a hypothermic patient with blood loss&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">24</span></a> It also has deleterious effects on the coagulation cascade&#59; hypothermia decreases all enzymatic reactions involved in the intrinsic and the extrinsic pathway&#46; It has been shown that both the partial thromboplastin time &#40;PTT&#41; and prothrombin time &#40;PT&#41;&#44; are increased significally by hypothermia in surgery in regards to normothermic patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">25&#44;26</span></a> Furthermore hypothermia causes transient thrombocytopenia and reduces platelet function by a transient decrease of thromboxane synthesis B2&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">27&#44;28</span></a> A prospective controlled study by Cavallini<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">29</span></a> found that the group with intraoperative hypothermia presented partial times higher than thromboplastin preheated group&#44; of which it was concluded that maintaining normothermia is one of the main strategies to reduce both intraoperative bleeding as the need for transfusions&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Effects on the immune system</span><p id="par0085" class="elsevierStylePara elsevierViewall">Hypothermia has an immunosuppressive effect that lowers resistance to infection&#46; It has been shown in vitro that low temperatures decrease leukocyte migration&#59; reduces neutrophil phagocytic capacity&#59;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">30</span></a> decreases production of interleukins 1&#44; 2 and 6 and the tumor necrosis factor&#59;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">31</span></a> antibody production decreases in T cells&#44; while both complement activation and levels of C-reactive protein are deteriorated&#46; Melling et al&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">32</span></a> conducted a study in patients with clean surgical procedures &#40;such as breast surgeries&#41; and found that the group without warming had infection rates much higher than groups that underwent prewarming &#40;15&#37; vs 6&#37; and 4&#37;&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Hypothermia classification</span><p id="par0090" class="elsevierStylePara elsevierViewall">The tympanic membrane&#44; nasopharynx&#44; esophagus and the distal pulmonary artery are the most accurate sites to monitor core temperature&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Hypothermia is defined as a body core temperature below 36<span class="elsevierStyleHsp" style=""></span>&#176;C and classified as mild &#40;36&#8211;32<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; moderate &#40;28&#8211;31&#46;9<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; and severe &#40;less than 28<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">33</span></a> However&#44; Kirkpatrick&#44;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">34</span></a> has classified hypothermia in four phases&#44; making a division of the mild phase&#59; one of 36&#8211;34<span class="elsevierStyleHsp" style=""></span>&#176;C and other of 34&#8211;32<span class="elsevierStyleHsp" style=""></span>&#176;C&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Risk factors for perioperative hypothermia in plastic surgery</span><p id="par0100" class="elsevierStylePara elsevierViewall">The most important risk factors include the air conditioning in the operating room&#44; combine general and regional anesthesia&#44; prior patient temperature &#60;<span class="elsevierStyleHsp" style=""></span>35&#46;5<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; blood loss &#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cc&#47;kg<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">35</span></a> and the removal of fat in liposuction which also contributes to the hypothermia in this type of surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">36</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Heating methods to prevent intraoperative hypothermia</span><p id="par0105" class="elsevierStylePara elsevierViewall">Preventing hypothermia can ensure safer and pleasurable surgery&#46; The aim is to avoid the temperature drops below 36<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; so it is essential monitoring body temperature by a probe&#46;<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">37&#44;38</span></a> Studies conducted in Colombia show that temperature is monitored only in 10&#37; of patients undergoing surgery and this leads us to ignore the magnitude of the problem&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">39</span></a> One of the most important and effective measures&#44; but also less implemented due to the discomfort for the entire surgical team is to maintain operating room temperatures above 22<span class="elsevierStyleHsp" style=""></span>&#176;C&#44;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">40</span></a> but this has been little used in practice&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Effects of prewarming</span><p id="par0110" class="elsevierStylePara elsevierViewall">Prewarming is perhaps the most important measure to prevent hypothermia in surgical&#46; The patient can be prewarmed before surgery with a forced warm-air blanket system 30<span class="elsevierStyleHsp" style=""></span>min to 1<span class="elsevierStyleHsp" style=""></span>h&#46; Raising the external temperature has little or nothing effect on the core temperature&#44; however&#44; this reduces the difference or temperature gradient between the core and the periphery and thus heat loss reduces by decreasing the delta temperature during the first hour of anesthesia and surgery&#44; time in which fastest loss temperature occurs&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">41&#8211;43</span></a> During this first hour loss temperature decreases up to 2<span class="elsevierStyleHsp" style=""></span>&#176;C in patients without prewarming vs 0&#46;9<span class="elsevierStyleHsp" style=""></span>&#176;C in patients prewarmed&#46;<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">44&#44;45</span></a> Sessler<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">46</span></a> determined 1<span class="elsevierStyleHsp" style=""></span>h as the ideal time to the patient should be prewarmed to significantly reduce heat loss during the first hour of surgery&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Hot water mattress</span><p id="par0115" class="elsevierStylePara elsevierViewall">Although hot water mattresses have been widely used for decades and are considered as the classic heating system in surgery&#44; actually their effectiveness is limited&#58; the back is just a portion of the total body surface area and 90&#37; of core heat is lost from the previous area of the body&#46; In addition hot water mattresses have been associated with burned areas in pressure zones&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">14&#44;47&#44;48</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Warming intravenous fluids</span><p id="par0120" class="elsevierStylePara elsevierViewall">It is known that 1<span class="elsevierStyleHsp" style=""></span>l of saline solution intravenously infused at room temperature decreases the temperature in adults 0&#46;25<span class="elsevierStyleHsp" style=""></span>&#176;C&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">49</span></a> However&#44; this is not the main cause of heat loss in plastic surgery patients in which the liquid handling is conservative&#44; although some studies have shown that patients&#44; who were infused with heating systems IV such as Hotline&#44; could have some thermal benefit compared to those without any measure of thermal protection liquid&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">50</span></a> Heaters should be an alternative only if IV fluids exceed 2<span class="elsevierStyleHsp" style=""></span>l per hour as in the case of resuscitation or emergency surgery&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Warming of liquids infiltration in plastic surgery</span><p id="par0125" class="elsevierStylePara elsevierViewall">One of the main reasons why hypothermia is common and severe in plastic surgery &#40;liposuction in particular&#41;&#44; is the large amount of liquids that are placed in subcutaneous infiltration&#46; The most common in liposuction is to perform infiltration&#47;aspiration ratios ranging from 1&#58;1 with the superwet technique&#46; This means that in a 4-l liposuction&#44; 4<span class="elsevierStyleHsp" style=""></span>l of normal saline solution should be infiltrated subcutaneously&#44; which is usually done with liquid at room temperature&#46; A study conducted by Robles-Cervantes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">51</span></a> compared the heat loss by using infiltration at room temperature &#40;24<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; versus liquids prewarmed to 37<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; In the latter case temperatures raised 35&#46;7<span class="elsevierStyleHsp" style=""></span>&#176;C against 34&#46;9<span class="elsevierStyleHsp" style=""></span>&#176;C in the group without prewarmed&#46; For this reason is considered an effective measure&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">Preventing hypothermia allows a safer surgery and a more pleasant postoperative recovery&#46; Prevention measures result in great benefits such as reducing the rate of infections&#44; improvement in cicatrization&#44; less blood loss&#44; less need of transfusion and a fast and pleasant wake up after anesthesia&#46; Our goal is to avoid the patient temperature drops below 36<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; For this&#44; the first step is a continuous monitoring of the core temperature during surgery&#46; To achieve this aim the three most important measures are in order &#40;1&#41; prewarmed the patient with forced air blankets for 1<span class="elsevierStyleHsp" style=""></span>h before surgery&#44; &#40;2&#41; prewarmed of infiltration liquid at 37<span class="elsevierStyleHsp" style=""></span>&#176;C in the case of plastic surgery and &#40;3&#41; maintenance air conditioning in operating rooms above 22<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; All these measures are preventive&#44; easy to implement and economic&#46; Finally&#44; it is important to highlight the need of specific studies about the temperature in the different specialties&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Funding</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors did not receive sponsorship to carry out this article&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">Dr&#46; Jorge Enrique Bayter-Mar&#237;n is the coordinator of the Anesthesia Committee for Plastic Surgery at S&#46;C&#46;A&#46;R&#46;E&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Dr&#46; Jorge Rubio is the coordinator of the Committee of Ambulatory Anesthesia at S&#46;C&#46;A&#46;R&#46;E&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:25 [
        0 => array:3 [
          "identificador" => "xres785815"
          "titulo" => "Abstract"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Objectives"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Methods"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Results"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec784527"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres785814"
          "titulo" => "Resumen"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Objetivos"
            ]
            2 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "M&#233;todos"
            ]
            3 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Resultados"
            ]
            4 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec784526"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methodology"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Review"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Thermoregulation in humans"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Body temperature regulation mechanisms"
        ]
        8 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Anesthetics effects on the heat conservation mechanisms"
        ]
        9 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Hypothermia phases during general anesthesia"
        ]
        10 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Regional anesthesia and hypothermia"
        ]
        11 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Hemodynamic and autonomic effects in response to cold"
        ]
        12 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Hematologic effects"
        ]
        13 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Effects on the immune system"
        ]
        14 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Hypothermia classification"
        ]
        15 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Risk factors for perioperative hypothermia in plastic surgery"
        ]
        16 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Heating methods to prevent intraoperative hypothermia"
        ]
        17 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Effects of prewarming"
        ]
        18 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Hot water mattress"
        ]
        19 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Warming intravenous fluids"
        ]
        20 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Warming of liquids infiltration in plastic surgery"
        ]
        21 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Conclusions"
        ]
        22 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Funding"
        ]
        23 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Conflicts of interest"
        ]
        24 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-09-11"
    "fechaAceptado" => "2016-08-01"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec784527"
          "palabras" => array:5 [
            0 => "Hypothermia"
            1 => "Anesthesia&#44; general"
            2 => "Anesthesia&#44; conduction"
            3 => "Body temperature"
            4 => "Ambulatory surgical procedures"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec784526"
          "palabras" => array:5 [
            0 => "Hipotermia"
            1 => "Anestesia&#44; general"
            2 => "Anestesia de conducci&#243;n"
            3 => "Temperatura corporal"
            4 => "Procedimientos quir&#250;rgicos ambulatorios"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "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">Hypothermia is perhaps the most frequent undesirable event in elective surgery&#46; It is estimated that 1<span class="elsevierStyleHsp" style=""></span>h after surgery has initiated 70&#8211;90&#37; of patients will experience hypothermia&#46; In elective surgery&#44; there are several factors leading to temperatures under 34<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Hypothermia may increases infections&#44; bleeding and need for transfusion as well as the occurrence of an undesirable effect of discomfort and feared such as cold and postoperative shivering that can lead to cardiac complications due to increased of sympathetic influence&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Review the causes of these low temperatures within intraoperative elective surgery and check if the current alternatives to prevent hypothermia are effective&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Review of non-systematic literature in PubMed and Medline was performed&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hypothermia is the most common and least diagnosed undesirable event of patients undergoing surgery although it is easy to detect and preventive measures do not present major difficulties in their implementation&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">There are effective measures easy to set up&#44; economical and effective to prevent hypothermia&#59; the most important is the patient warm with hot air under pressure for 1<span class="elsevierStyleHsp" style=""></span>h and maintenance of air conditioning in the room above 22<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; We just need to understand these measures and start to implement them&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objectives"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La hipotermia es tal vez el evento indeseable mas frecuente en los pacientes que van a cirug&#237;a programada&#46; Se considera que 1 hora despu&#233;s de iniciada la cirug&#237;a el 70 al 90&#37; de los pacientes se encuentran hipot&#233;rmicos&#46; En cirug&#237;a Electiva en pacientes sanos hay varios factores que llevan a que nuestros pacientes mantengan cifras de temperaturas de 34<span class="elsevierStyleHsp" style=""></span>&#176;C e inclusive menores&#46; El problema est&#225; en que la hipotermia aumenta las infecciones&#44; el sangrado y la necesidad de trasfusi&#243;n&#44; la aparici&#243;n de un efecto indeseable y temido por el paciente como es el fr&#237;o y temblor postoperatorio que puede llevar a complicaciones cardiacas debido al aumento del influjo simp&#225;tico&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Revisar las causas que llevan a estas bajas temperaturas intraoperatorias en cirug&#237;a programada y revisar si las opciones que tenemos hoy en d&#237;a para prevenir la hipotermia pueden ser efectivas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una revisi&#243;n de la literatura no sistem&#225;tica en las bases de datos PubMed y Medline&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La hipotermia es el evento indeseable m&#225;s frecuente y menos diagnosticado en el paciente que va a cirug&#237;a a pesar que es f&#225;cil de detectar y las medidas preventivas son relativamente f&#225;ciles de instaurar&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Hay medidas efectivas&#44; f&#225;ciles de instaurar&#44; econ&#243;micas y efectivas para evitar la hipotermia y entre ellas la m&#225;s importante es el precalentamiento del paciente con aire caliente a presi&#243;n por 1 hora&#44; el mantenimiento del aire acondicionado de la sala por encima de 22 grados cent&#237;grados&#46; Solo necesitamos entender cuales son estas medidas e iniciar a ponerlas en practica&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivos"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "M&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Bayter-Mar&#237;n JE&#44; Rubio J&#44; Valed&#243;n A&#44; Mac&#237;as &#193;A&#46; Hipotermia en cirug&#237;a electiva&#46; El enemigo oculto&#46; Rev Colomb Anestesiol&#46; 2017&#59;45&#58;48&#8211;53&#46;</p>"
      ]
      1 => array:3 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Member of International Committee of SAMBA&#46;</p>"
        "identificador" => "fn1"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:51 [
            0 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temperature monitoring and perioperative thermoregulation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;I&#46; Sessler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e31817f6d76"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2008"
                        "volumen" => "109"
                        "paginaInicial" => "318"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18648241"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Isoflurane anesthesia and circadian temperature cycles"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;I&#46; Sessler"
                            1 => "K&#46;A&#46; Lee"
                            2 => "J&#46; McGuire"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Anestesiology"
                        "fecha" => "1991"
                        "volumen" => "75"
                        "paginaInicial" => "985"
                        "paginaFinal" => "989"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perianesthetic thermoregulation and heat balance in humans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;I&#46; Sessler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "FASEB J"
                        "fecha" => "1993"
                        "volumen" => "7"
                        "paginaInicial" => "638"
                        "paginaFinal" => "644"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8500688"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The human sleep-wake cycle reconsidered from a thermoregulatory point of view"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Kr&#228;uchi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.physbeh.2006.09.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Physiol Behav"
                        "fecha" => "2007"
                        "volumen" => "90"
                        "paginaInicial" => "236"
                        "paginaFinal" => "245"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17049364"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "System properties&#44; feedback control and effector coordination of human temperature regulation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Werner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00421-009-1216-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Appl Physiol"
                        "fecha" => "2009"
                        "volumen" => "109"
                        "paginaInicial" => "13"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19787369"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A thermosensory pathway that controls body temperature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Nakamura"
                            1 => "S&#46;F&#46; Morrison"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nn2027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Neurosci"
                        "fecha" => "2008"
                        "volumen" => "11"
                        "paginaInicial" => "62"
                        "paginaFinal" => "71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18084288"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central control of thermogenesis in mammals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;F&#46; Morrison"
                            1 => "K&#46; Nakamura"
                            2 => "C&#46;J&#46; Madden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ex Physiol"
                        "fecha" => "2008"
                        "volumen" => "93"
                        "paginaInicial" => "773"
                        "paginaFinal" => "797"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thermoregulatory defense mechanisms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;I&#46; Sessler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "37"
                        "paginaInicial" => "203"
                        "paginaFinal" => "210"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mild perioperative hypothermia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;I&#46; Sessler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199706123362407"
                      "Revista" => array:6 [
                        "tituloSerie" => "New Engl J Med"
                        "fecha" => "1997"
                        "volumen" => "336"
                        "paginaInicial" => "1730"
                        "paginaFinal" => "1737"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9180091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative heat balance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;I&#46; Sessler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2000"
                        "volumen" => "92"
                        "paginaInicial" => "578"
                        "paginaFinal" => "596"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10691247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Desflurane reduces the gain of thermoregulatory arteriovenous shunt vasoconstriction in humans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Kurz"
                            1 => "J&#46; Xiong"
                            2 => "D&#46;I&#46; Sessler"
                            3 => "M&#46; Dechert"
                            4 => "K&#46; Noyes"
                            5 => "K&#46; Belani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "1995"
                        "volumen" => "83"
                        "paginaInicial" => "1212"
                        "paginaFinal" => "1219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8533914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mild hypothermia during halothane induced anaesthesia decreases resistance to <span class="elsevierStyleItalic">Staphylococcus aureus</span> dermal infection in guinea pigs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;W&#46; Sheffield"
                            1 => "D&#46;I&#46; Sessler"
                            2 => "T&#46;K&#46; Hunt"
                            3 => "H&#46; Scheunenstuhl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1524-475X.1994.20108.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Wound Repair Regen"
                        "fecha" => "1994"
                        "volumen" => "2"
                        "paginaInicial" => "48"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17168911"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0165032715311939"
                          "estado" => "S300"
                          "issn" => "01650327"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The threshold for thermoregulatory vasoconstriction during nitrous oxide&#47;sevoflurane anesthesia is reduced in elderly patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Ozaki"
                            1 => "D&#46;I&#46; Sessler"
                            2 => "H&#46; Ozaqui"
                            3 => "K&#46; Atarashi"
                            4 => "C&#46; Negishi"
                            5 => "H&#46; Suzuki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "1997"
                        "volumen" => "84"
                        "paginaInicial" => "1029"
                        "paginaFinal" => "1033"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9141926"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#8220;Burns&#8221; occurring during lengthy surgical procedures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46; Gendron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Eng"
                        "fecha" => "1980"
                        "volumen" => "5"
                        "paginaInicial" => "20"
                        "paginaFinal" => "26"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The accuracy and precisi&#243;n of body temperature monitoring methods during regional and general anesthesia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;G&#46; Cattaneo"
                            1 => "S&#46;M&#46; Frank"
                            2 => "T&#46;W&#46; Hesel"
                            3 => "H&#46;K&#46; El-Rahmany"
                            4 => "L&#46;J&#46; Kim"
                            5 => "K&#46;M&#46; Tran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2000"
                        "volumen" => "90"
                        "paginaInicial" => "938"
                        "paginaFinal" => "945"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10735803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of hypothermia during spinal anesthesia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;M&#46; Frank"
                            1 => "H&#46;K&#46; El-Rahmany"
                            2 => "C&#46;G&#46; Cattaneo"
                            3 => "R&#46;A&#46; Barnes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2000"
                        "volumen" => "92"
                        "paginaInicial" => "1330"
                        "paginaFinal" => "1334"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10781278"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temperature monitoring and management during neuraxial anesthesia&#58; an observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;M&#46; Arkili&#231;"
                            1 => "O&#46; Ak&#231;a"
                            2 => "A&#46; Taguchi"
                            3 => "D&#46;I&#46; Sessler"
                            4 => "A&#46; Kurz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2000"
                        "volumen" => "91"
                        "paginaInicial" => "662"
                        "paginaFinal" => "666"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10960396"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin and central temperatures during continuous epidural analgesia and general anaesthesia in patients subjected to open prostatectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Hendolin"
                            1 => "E&#46; Lansimies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Clin Res"
                        "fecha" => "1982"
                        "volumen" => "14"
                        "paginaInicial" => "181"
                        "paginaFinal" => "186"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7168548"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spinal anesthesia only minimally increases the efficacy of postoperative forced-air rewarming"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Szmuk"
                            1 => "T&#46; Ezri"
                            2 => "D&#46;I&#46; Sessler"
                            3 => "A&#46; Stein"
                            4 => "D&#46; Geva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "1997"
                        "volumen" => "87"
                        "paginaInicial" => "1050"
                        "paginaFinal" => "1054"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9366455"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adrenergic&#44; respiratory&#44; and cardiovascular effects of core cooling in humans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Frank"
                            1 => "M&#46;S&#46; Higgins"
                            2 => "L&#46;A&#46; Fleisher"
                            3 => "J&#46;V&#46; Sitzmann"
                            4 => "H&#46; Raff"
                            5 => "M&#46;J&#46; Breslow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Physiol"
                        "fecha" => "1997"
                        "volumen" => "272"
                        "paginaInicial" => "R557"
                        "paginaFinal" => "R562"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9124478"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events&#58; a randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Frank"
                            1 => "L&#46;A&#46; Fleisher"
                            2 => "M&#46;J&#46; Breslow"
                            3 => "M&#46;S&#46; Higgins"
                            4 => "K&#46;F&#46; Olson"
                            5 => "S&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Med Assoc"
                        "fecha" => "1997"
                        "volumen" => "277"
                        "paginaInicial" => "1127"
                        "paginaFinal" => "1134"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood pressure response to thermoregulatory vasoconstriction during isoflurane and desflurane anesthesia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Greif"
                            1 => "S&#46; Laciny"
                            2 => "A&#46; Rajek"
                            3 => "A&#46;G&#46; Doufas"
                            4 => "D&#46;I&#46; Sessler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Scand"
                        "fecha" => "2003"
                        "volumen" => "47"
                        "paginaInicial" => "847"
                        "paginaFinal" => "852"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12859306"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unintentional hypothermia is associated with postoperative myocardial ischemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Frank"
                            1 => "C&#46; Beattie"
                            2 => "R&#46; Christopherson"
                            3 => "E&#46;J&#46; Norris"
                            4 => "B&#46;A&#46; Perler"
                            5 => "G&#46;M&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "1993"
                        "volumen" => "78"
                        "paginaInicial" => "468"
                        "paginaFinal" => "476"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8457047"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Viscosity of normal human blood under normothermic and hypothermic conditions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;W&#46; Rand"
                            1 => "E&#46; Lacombe"
                            2 => "H&#46;E&#46; Hunt"
                            3 => "W&#46;H&#46; Austin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Appl Physiol"
                        "fecha" => "1964"
                        "volumen" => "19"
                        "paginaInicial" => "117"
                        "paginaFinal" => "122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14104265"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of hypothermia on the coagulation cascade"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;J&#46; Rohrer"
                            1 => "A&#46;M&#46; Natale"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1992"
                        "volumen" => "20"
                        "paginaInicial" => "1402"
                        "paginaFinal" => "1405"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1395660"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Platelet kinetics during deep hypothermia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Hessel"
                            1 => "G&#46; Schmer"
                            2 => "D&#46; Dillard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Surg Res"
                        "fecha" => "1980"
                        "volumen" => "28"
                        "paginaInicial" => "23"
                        "paginaFinal" => "34"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7359906"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypothermia-induced reversible platelet dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;R&#46; Valeri"
                            1 => "G&#46; Cassidy"
                            2 => "S&#46; Khuri"
                            3 => "H&#46; Feingold"
                            4 => "G&#46; Ragno"
                            5 => "M&#46;D&#46; Altschule"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1987"
                        "volumen" => "205"
                        "paginaInicial" => "175"
                        "paginaFinal" => "181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3813688"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mild intraoperative hypothermia increases blood loss and allogenic transfusion requirements during total hip arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Schmied"
                            1 => "A&#46; Kurz"
                            2 => "D&#46;I&#46; Sessler"
                            3 => "S&#46; Kozek"
                            4 => "A&#46; Reiter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1996"
                        "volumen" => "347"
                        "paginaInicial" => "289"
                        "paginaFinal" => "292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8569362"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S016383431200206X"
                          "estado" => "S300"
                          "issn" => "01638343"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of mild hypothermia on blood coagulation in patients undergoing elective plastic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Cavallini"
                            1 => "F&#46;W&#46;B&#46; Preis"
                            2 => "A&#46; Casati"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "2005"
                        "volumen" => "116"
                        "paginaInicial" => "316"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15988284"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of temperature on the chemotaxis&#44; phagocytic engulfment&#44; digestion and oxygen consumption of human polymorphonuclear leukocytes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;J&#46; Van Oss"
                            1 => "D&#46;R&#46; Absolam"
                            2 => "L&#46;L&#46; Moore"
                            3 => "B&#46;H&#46; Park"
                            4 => "J&#46;R&#46; Humbert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Reticuloendothelial Soc"
                        "fecha" => "1980"
                        "volumen" => "27"
                        "paginaInicial" => "561"
                        "paginaFinal" => "565"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of hypothermia and hyperthermia on cytokine production by cultured human mononuclear phagocytes from adults and newborns"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46;D&#46; Fairchild"
                            1 => "R&#46;M&#46; Viscardi"
                            2 => "L&#46; Hester"
                            3 => "I&#46;S&#46; Singh"
                            4 => "J&#46;D&#46; Hasday"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/107999000750053708"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Interferon Cytokine Res"
                        "fecha" => "2000"
                        "volumen" => "20"
                        "paginaInicial" => "1049"
                        "paginaFinal" => "1055"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11152570"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of preoperative warming on the incidence of wound infection after clean surgery&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;C&#46; Melling"
                            1 => "B&#46; Ali"
                            2 => "E&#46;M&#46; Scott"
                            3 => "D&#46;J&#46; Leaper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(01)06071-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2001"
                        "volumen" => "358"
                        "paginaInicial" => "876"
                        "paginaFinal" => "880"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11567703"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of perioperative hypothermia and warming in surgical practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Kumar"
                            1 => "P&#46;F&#46; Wong"
                            2 => "A&#46;C&#46; Melling"
                            3 => "D&#46;J&#46; Leaper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1742-4801.2005.00102.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Wound J"
                        "fecha" => "2005"
                        "volumen" => "2"
                        "paginaInicial" => "193"
                        "paginaFinal" => "204"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16618324"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypothermia and the trauma patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;W&#46; Kirkpatrick"
                            1 => "R&#46; Chun"
                            2 => "R&#46; Brown"
                            3 => "R&#46;K&#46; Simons"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Surg"
                        "fecha" => "1999"
                        "volumen" => "42"
                        "paginaInicial" => "333"
                        "paginaFinal" => "343"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10526517"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What are the most important risk factors for a patient&#39;s developing intraoperative hypothermia&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Macario"
                            1 => "F&#46; Dexter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2002"
                        "volumen" => "94"
                        "paginaInicial" => "215"
                        "paginaFinal" => "220"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11772832"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Morphometric influences on intraoperative core temperature changes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Kurz"
                            1 => "D&#46;I&#46; Sessler"
                            2 => "E&#46; Narzt"
                            3 => "R&#46; Lenhardt"
                            4 => "F&#46; Lackner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "1995"
                        "volumen" => "80"
                        "paginaInicial" => "562"
                        "paginaFinal" => "657"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7864426"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Forced air warming versus routine thermal care and core temperature measurement sites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;A&#46; Krenzischek"
                            1 => "S&#46;M&#46; Frank"
                            2 => "S&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Postgrad Anesth Nurs"
                        "fecha" => "1995"
                        "volumen" => "10"
                        "paginaInicial" => "69"
                        "paginaFinal" => "78"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Control of postanaesthetic shivering with radiant heat"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Giesecke"
                            1 => "A&#46; Sharkey"
                            2 => "M&#46; Murphy"
                            3 => "L&#46; Rice"
                            4 => "J&#46; Lipton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Anesthesiol Scand"
                        "fecha" => "1987"
                        "volumen" => "31"
                        "paginaInicial" => "28"
                        "paginaFinal" => "32"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Manejo de la temperatura en el perioperatorio y frecuencia de hipotermia inadvertida en un hospital general"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;G&#46; Castillo Monz&#243;n"
                            1 => "C&#46;A&#46; Candia Arana"
                            2 => "H&#46;A&#46; Valz"
                            3 => "F&#46;A&#46; Fernando Aguilar Rodr&#237;guez"
                            4 => "J&#46;J&#46; Benavides Mej&#237;a"
                            5 => "J&#46;A&#46; Alvarez G&#243;mez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Colomb Anestesiol"
                        "fecha" => "2013"
                        "volumen" => "41"
                        "paginaInicial" => "97"
                        "paginaFinal" => "103"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adverse effects of hypothermia in postoperative patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;J&#46; Slottman"
                            1 => "E&#46;H&#46; Jed"
                            2 => "K&#46;W&#46; Burchard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg"
                        "fecha" => "1985"
                        "volumen" => "149"
                        "paginaInicial" => "495"
                        "paginaFinal" => "501"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3985289"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of forced air warming system for intra-operative warming"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;L&#46; Gauthier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Anaesthesiology"
                        "fecha" => "1990"
                        "volumen" => "73"
                        "paginaInicial" => "462"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of intraoperative hypothermia by preoperative skin-surface warming"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46; Just"
                            1 => "V&#46; Tr&#233;vien"
                            2 => "E&#46; Delva"
                            3 => "A&#46; Lienhart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "1993"
                        "volumen" => "79"
                        "paginaInicial" => "214"
                        "paginaFinal" => "218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8251019"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preanesthetic skin-surface warming reduces redistribution hypothermia caused by epidural block"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46; Glosten"
                            1 => "J&#46; Hynson"
                            2 => "D&#46;I&#46; Sessler"
                            3 => "J&#46; McGuire"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "1993"
                        "volumen" => "77"
                        "paginaInicial" => "488"
                        "paginaFinal" => "493"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8368549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of pre-induction warming on temperature and blood pressure during propofol&#47;nitrous oxide anesthesia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;M&#46; Hynson"
                            1 => "D&#46;I&#46; Sessler"
                            2 => "A&#46; Moayeri"
                            3 => "J&#46; McGuire"
                            4 => "M&#46; Schroeder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "1993"
                        "volumen" => "79"
                        "paginaInicial" => "219"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8342834"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalisation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Kurz"
                            1 => "D&#46;I&#46; Sessler"
                            2 => "R&#46; Lenhardt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199605093341901"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1996"
                        "volumen" => "334"
                        "paginaInicial" => "1209"
                        "paginaFinal" => "1215"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8606715"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimal duration and temperature of prewarming"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;I&#46; Sessler"
                            1 => "M&#46; Schroeder"
                            2 => "B&#46; Merrifield"
                            3 => "T&#46; Matsukawa"
                            4 => "C&#46; Cheng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "1995"
                        "volumen" => "82"
                        "paginaInicial" => "674"
                        "paginaFinal" => "681"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7879936"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin-surface warming&#58; heat flux and central temperature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;I&#46; Sessler"
                            1 => "A&#46; Moayeri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "1990"
                        "volumen" => "73"
                        "paginaInicial" => "218"
                        "paginaFinal" => "224"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2382847"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraoperative warming therapies&#58; a comparison of three devices"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Hynson"
                            1 => "D&#46;I&#46; Sessler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Anesth"
                        "fecha" => "1992"
                        "volumen" => "4"
                        "paginaInicial" => "194"
                        "paginaFinal" => "199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1610573"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consequences and treatment of perioperative hypothermia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;I&#46; Sessler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Anesth Clin N Am"
                        "fecha" => "1994"
                        "volumen" => "12"
                        "paginaInicial" => "425"
                        "paginaFinal" => "456"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio comparativo de tres dispositivos para prevenir la hipotermia en pacientes sometidos a cirug&#237;a Pl&#225;stica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; A&#241;orve"
                            1 => "F&#46; De los Santos"
                            2 => "M&#46; Garc&#237;a"
                            3 => "J&#46; Mikolajkczuc"
                            4 => "P&#46; Segui¿"
                            5 => "F&#46; Revilla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Med Grupo los Angeles"
                        "fecha" => "2012"
                        "volumen" => "10"
                        "paginaInicial" => "14"
                        "paginaFinal" => "19"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heating infiltration solutions used in tumescent liposuction&#58; minimizing surgical risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Robles-Cervantes"
                            1 => "R&#46; Martinez-Molina"
                            2 => "L&#46; C&#225;rdenas-Camarena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "2005"
                        "volumen" => "116"
                        "paginaInicial" => "1077"
                        "paginaFinal" => "1081"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16163098"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22562087/0000004500000001/v1_201701060057/S2256208716300736/v1_201701060057/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "62380"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Reviews"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22562087/0000004500000001/v1_201701060057/S2256208716300736/v1_201701060057/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208716300736?idApp=UINPBA00004N"
]

Article information

ISSN: 22562087
Original language: English

DOI:10.1016/j.rcae.2016.11.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	36	6	42
2024 October	231	14	245
2024 September	346	30	376
2024 August	224	16	240
2024 July	222	26	248
2024 June	156	13	169
2024 May	227	18	245
2024 April	225	13	238
2024 March	260	29	289
2024 February	234	15	249
2024 January	258	24	282
2023 December	127	16	143
2023 November	212	31	243
2023 October	172	13	185
2023 September	114	13	127
2023 August	129	11	140
2023 July	113	13	126
2023 June	128	17	145
2023 May	107	14	121
2023 April	118	17	135
2023 March	85	5	90
2023 February	41	3	44
2023 January	47	18	65
2022 December	41	9	50
2022 November	54	18	72
2022 October	55	15	70
2022 September	47	13	60
2022 August	43	8	51
2022 July	46	11	57
2022 June	39	11	50
2022 May	59	15	74
2022 April	33	7	40
2022 March	49	10	59
2022 February	45	16	61
2022 January	55	14	69
2021 December	46	10	56
2021 November	49	6	55
2021 October	36	10	46
2021 September	621	10	631
2021 August	78	15	93
2021 July	40	10	50
2021 June	33	4	37
2021 May	35	9	44
2021 April	96	30	126
2021 March	46	11	57
2021 February	25	11	36
2021 January	41	5	46
2020 December	37	8	45
2020 November	51	7	58
2020 October	37	2	39
2020 September	14	7	21
2020 August	21	10	31
2020 July	23	18	41
2020 June	13	5	18
2020 May	25	5	30
2020 April	23	4	27
2020 March	24	3	27
2020 February	20	6	26
2020 January	26	10	36
2019 December	12	12	24
2019 November	14	5	19
2019 October	3	1	4
2019 September	7	2	9
2019 August	1	2	3
2019 July	0	9	9
2019 June	2	0	2
2019 May	2	6	8
2019 April	1	0	1
2019 January	1	0	1
2018 September	1	0	1
2018 June	6	2	8
2018 May	33	6	39
2018 April	44	10	54
2018 March	41	12	53
2018 February	28	12	40
2018 January	48	12	60
2017 December	28	17	45
2017 November	36	11	47
2017 October	28	7	35
2017 September	26	13	39
2017 August	24	9	33
2017 July	24	8	32
2017 June	41	9	50
2017 May	34	9	43
2017 April	59	13	72
2017 March	57	20	77
2017 February	25	14	39
2017 January	56	13	69
2016 December	8	9	17

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter