Original article
Brain damage after general anesthesia
Daño cerebral postanestesia general
Pablo Mesa Suáreza, José Diego Santotoribiob,c,
, Victoria Ramos Ramosd, María Ángela González Garcíae, Santiago Pérez Ramosb,c, David Portilla Huertasa, Antonio Muñoz Hoyosf
Corresponding author
a Unidad de Gestión Clínica de Anestesiología, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
b Unidad de Gestión Clínica de Laboratorio, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
c Departamento de Biomedicina, Biotecnología y Salud Pública, Universidad de Cádiz, Cádiz, Spain
d Unidad de Gestión Clínica de Pediatría, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain
e Unidad de Gestión Clínica de Análisis Clínicos, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain
f Departamento de Pediatría, Universidad de Granada, Granada, Spain
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=> "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Biomedicina, Biotecnología y Salud Pública, Universidad de Cádiz, Cádiz, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Pediatría, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Análisis Clínicos, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Departamento de Pediatría, Universidad de Granada, Granada, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Daño cerebral postanestesia general" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1044 "Ancho" => 1485 "Tamanyo" => 41091 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Graph with logarithmic transformation of serum S100B protein levels in the baseline sample (S100Bb) and in the postexposure sample to general anesthesia (S100Bp).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Exposure to anesthetic drugs can trigger apoptosis of the glial and neuronal cells of the central nervous system (CNS), that might cause brain damage.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> There are studies available linking exposure to general anesthesia at an early age with a deficient cognitive development, including language delay and delay in acquiring some mathematics skills.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Some of the anesthetic drugs frequently used include propofol, midazolam, fentanyl and sevoflurane. Propofol is the intravenous (iv) hypnotic agent universally used as an induction agent in general anesthesia. It involves the CNS lowering cerebral blood flow (CBF) and metabolism. It depresses respiratory function and decreases myocardial contractility and peripheral vascular resistance, at a cardiorespiratory level. Midazolam is one of the iv benzodiazepine most used in premedication due to its ability to cause anterograde amnesia, and it also decreases the CBF and depresses respiratory function. However, its cardiac depressant effects are minimal. Fentanyl is an opioid widely used in anesthesia to provide analgesia to the patient. These drugs do not depress myocardial contractility, but they do cause mild hypotension. Sevoflurane is a fluorinated halogenated liquid which subjected to high pressures becomes a gas and can be supplied for inhalation. It is often used as a hypnotic anesthetic agent for maintenance of anesthesia. It causes unconsciousness and amnesia, increasing the CBF due to its vasodilator effect, and decreasing the cerebral metabolic rate. Like propofol, it depresses respiratory function and decreases myocardial contractility and peripheral vascular resistance.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">S100B protein is a calcium binding protein located in the CNS cells, as part of the structure of astrocytes and Schwann cells.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6–9</span></a> It is also located in other tissues such as skin, adipose tissue and skeletal muscle as well as in melanoma tumor cells.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a> S100B protein is one of the most accurate serum markers of brain damage.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6,10</span></a> In a healthy patient, the serum S100B protein levels are low and it acts as a neurotrophic factor. However, in patients with brain damage it increases and acts as a neuro apoptotic factor.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6,11,12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to evaluate brain damage from general anesthesia by determining the concentration of serum S100B protein before and after exposure to anesthetic agents in children with tonsillar hypertrophy undergoing general anesthesia with propofol, midazolam, fentanyl and sevoflurane for tonsillectomy surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methodology</span><p id="par0025" class="elsevierStylePara elsevierViewall">Descriptive cross-sectional clinical trial of patients after exposure to anesthetic pharmacology. This clinical trial has been approved by the Research and Ethics Committee of the Puerto Real University Hospital and all participants have signed informed consent.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0030" class="elsevierStylePara elsevierViewall">Pediatric patients were included consecutively for 6 months, from 1 February to 31 July 2015. They received assistance at the pre-anesthesia consultation and were referred from the Department of Otolaryngology to undergo tonsillectomy due to tonsillar hypertrophy. The children included had no personal history of neurological disease and without clinical manifestations indicative of neurological dysfunction in their medical history. Patients with neurological disorders, history of prematurity, emergency surgery, blood dyscrasias or impaired liver or kidney functions, soft tissue and cartilage tumors or large injuries were excluded within 3 months before the intervention.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Method</span><p id="par0035" class="elsevierStylePara elsevierViewall">In the pre-anesthesia department a sample of peripheral venous blood was drawn from every patient included in this study into a serum gel tube (Vacuette<span class="elsevierStyleSup">®</span>) (baseline sample). Every patient underwent tonsillectomy under general anesthesia using the following anesthetic drugs: iv midazolam as an ananxiolytic agent, iv fentanyl as an analgesic agent, iv propofol is used to induce anesthesia and sevoflurane is used as an inhalational anesthetic for induction and maintenance of general anesthesia. Inhalational induction was conducted by administering 8% sevoflurane fraction through an external Mapleson type D circuit. The resulting mixture of fresh gas is air, oxygen and sevoflurane. After losing consciousness the inhaled infraction decreases up to 2% in order to maintain a minimum alveolar concentration (MAC) of about 1. At that moment, the venous route for administration of iv anesthetic drugs is canalized. The level of hypnosis is established using the patient's MAC and in no case MAC is over 1. Tonsillectomy was performed in all cases through a 3–5<span class="elsevierStyleHsp" style=""></span>mm resection of the anterior tonsillar pillars, with electrocautery at 15<span class="elsevierStyleHsp" style=""></span>W. After surgery, while awakening from anesthesia and the patient still in the operating room, one more peripheral venous blood sample (postexposure sample) was drawn. Baseline and post-exposure blood samples of each patient were centrifuged for 4<span class="elsevierStyleHsp" style=""></span>min at 4000<span class="elsevierStyleHsp" style=""></span>rpm to obtain serum. Serum S100B protein levels were determined in both samples through electrochemiluminescence immunoassay in the MODULAR E-170 autoanalyzer (Roche Diagnostics) with reference values for normality ranging from 5 to 105<span class="elsevierStyleHsp" style=""></span>ng/l.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The obtained data were processed using SPSS<span class="elsevierStyleSup">®</span> and MedCalc<span class="elsevierStyleSup">®</span> statistical programs, statistical significance being defined as <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05. To determine the type of variable distribution, the D’Agostino–Pearson test for normal distribution was used. Descriptive statistics is shown with the frequency of qualitative variables; with minimum, maximum value, the arithmetic mean and standard deviation of quantitative variables with normal distribution; and with the minimum, maximum, median and interquartile range of quantitative variables with non-Gaussian distribution. The correlation between variables with normal distribution was analyzed by the Pearson correlation coefficient. The correlation between variables with non-Gaussian distribution was analyzed using the Spearman's rank correlation coefficient (Rho). Groups were compared through analysis of variance test for variables with normal distribution. For variables with non-Gaussian distribution, nonparametric Mann–Whitney <span class="elsevierStyleItalic">U</span> test was used for independent data, and the Wilcoxon test for paired data.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 76 patients were included; 46 males and 30 females, aged from 3 to 14 years (median 5 years) and body weight ranging from 13 to 75<span class="elsevierStyleHsp" style=""></span>kg (median 21<span class="elsevierStyleHsp" style=""></span>kg).</p><p id="par0050" class="elsevierStylePara elsevierViewall">All variables studied followed a non-Gaussian distribution. By means of the nonparametric Mann–Whitney <span class="elsevierStyleItalic">U</span> test, no statistically significant differences between males and females were reported for the serum S100B protein levels of the baseline sample (S100BB), or for the values of postexposure sample (S100Bp). By analyzing the Spearman's rank correlation coefficient no significant correlation was reported between patient age and S100Bb or S100Bp values (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The time elapsed from the baseline sample extraction at the pre-anesthesia visit and post-exposure sample after surgery was 13–64 days (median 29 days).</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the descriptive statistics of the values obtained for S100Bb, S100Bp and the varying serum S100B protein after general anesthesia (S100Bp-b: difference between S100Bp and S100Bb). In all patients, serum S100B protein levels increased after general anesthesia (median 58<span class="elsevierStyleHsp" style=""></span>ng/l). The S100Bp values obtained (median 164.0<span class="elsevierStyleHsp" style=""></span>ng/l) were much higher than those obtained from S100Bb (median 94.5<span class="elsevierStyleHsp" style=""></span>ng/l), as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. By means of Wilcoxon test for paired data we found statistically significant differences between S100Bb and S100Bp (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Descriptive statistics of the total dose of iv anesthetic drugs administered to patients, time of exposure to anesthetic agents and surgery duration are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">It resulted in a positive correlation (directly proportional) between S100Bp-b and fentanyl total dose administered, Spearman's rho<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.317 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006). No correlation was obtained between S100Bp-b and total doses administered of midazolam or propofol (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0075" class="elsevierStylePara elsevierViewall">There was a negative correlation between S100Bp-b and time of exposure to anesthetic drugs, Spearman's rho<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.237 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0405).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In all patients included in this study S100Bp was higher than S100Bb, resulting in a significant increase in serum S100B protein after general anesthesia (median 58.0<span class="elsevierStyleHsp" style=""></span>ng/l).</p><p id="par0085" class="elsevierStylePara elsevierViewall">A large number of publications propose the S100B protein as one of the most accurate serum markers of brain damage and relate serum S100B protein levels directly with the severity of brain damage.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6,10</span></a> There have been increased serum S100B protein levels in patients with brain damage from head trauma<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13–15</span></a> or stroke,<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">16,17</span></a> in encephalopathy-associated sepsis<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> as well as in premature infants with ischemic brain damage<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a> and in hypoxic–ischemic encephalopathy of the newborn.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a> In this study, the increased concentration of serum S100B protein after exposure to anesthetic drugs may indicate brain damage.</p><p id="par0090" class="elsevierStylePara elsevierViewall">For general anesthesia in patients in this study, a combination of anesthetic drugs has been used (propofol, midazolam, fentanyl and sevoflurane). Therefore, we cannot link brain damage to a certain drug, but to general anesthesia as a whole.</p><p id="par0095" class="elsevierStylePara elsevierViewall">As for the total dosage of anesthetic drugs used, only the total dose of fentanyl was significantly correlated with S100Bp-by, indicating that the severity of brain damage can be dependent on the total dose of fentanyl used in general anesthesia.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Although correlation between S100Bp-b and time of exposure to anesthetic drugs or duration of surgery was negative, this was a very-low-intensity negative correlation (Spearman's rho<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.237), and we consider that the duration of the anesthesia did not show a significant protective effect.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The time of exposure to anesthetic drugs did not increase the severity of brain damage. This may be indicative of brain damage arising in the induction phase of general anesthesia. Induction was performed in the most universally extended way in pediatric anesthesia: sevoflurane inhaled at an 8% fraction and fentanyl bolus after intravenous cannulation. Both drugs are highly soluble and reach the brain quickly.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Sevoflurane administration may alter the electroencephalographic activity of the patient. At low doses it depresses electroencephalographic activity. However, at high doses it can produce electroencephalographic tracings indicating subclinical seizures that may cause increased levels of serum S100B protein, since high levels of serum S100B protein have been reported in epileptic children.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> In this study, low doses of sevoflurane were administered, maintaining the MAC within normal limits and not exceeding MAC over 1.</p><p id="par0115" class="elsevierStylePara elsevierViewall">In patients included in this study, extracerebral causes of elevated serum S100B protein, were ruled out, such as acute muscle injury<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> and malign melanoma.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> One of the limitations of this study is that patients were exposed to anesthetic drugs and tonsillectomy. Therefore, the surgery itself might have an influence on increasing S100B protein, but it cannot be withdrawn from the study because it would be unethical to subject patients to general anesthesia without good cause.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The brain damage caused by general anesthesia may be due to the pathophysiological changes caused by the anesthetic drugs on the CNS, such as decreased CBF and cerebral metabolism, and due to cardiorespiratory changes, such as depression of the respiratory function and decreased myocardial contractility and peripheral vascular resistance. These pathophysiological changes can cause hypoxia and apoptosis of neuronal cells, resulting in brain damage.</p><p id="par0125" class="elsevierStylePara elsevierViewall">None of the patients included in this study presented clinical manifestations of brain damage after general anesthesia and tonsillectomy. Further studies will be necessary to follow the course of these patients and assess whether or not the brain damage detected at molecular level by increased serum S100B protein causes clinical disorders.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The values obtained from serum S100B protein in the baseline sample of patients included in this study are remarkable. In normal population, reference values of serum S100B protein with the method used in this study are 5–105<span class="elsevierStyleHsp" style=""></span>ng/l. The median obtained from the S100Bb was 94.5<span class="elsevierStyleHsp" style=""></span>ng/l, very close to the upper limit of reference for the normal population. In addition, 26 of the 76 patients studied (34.2%) had S100Bb pathological values (>105<span class="elsevierStyleHsp" style=""></span>ng/l). In a recent study<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a> it turned out that the concentration of serum S100B protein was significantly higher in patients with chronic tonsillar hypertrophy compared to a control group. Therefore, it was concluded that the presence of chronic tonsillar hypertrophy can cause neuronal damage by chronic obstruction of the airways. This might explain the pathological values obtained from serum S100B protein in the baseline sample of the patients included in this study.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Patients with chronic tonsillar hypertrophy might present higher serum S100B protein levels than the healthy population. Therefore, the increased serum S100B protein might be due to the chronic tonsillar hypertrophy developed since baseline sample extraction until postexposure sample extraction. No studies are available to determine the variation of serum S100B protein levels over time in patients with chronic tonsillar hypertrophy. We believe that the time elapsed between extraction of the baseline sample and post-exposure sample (median 29 days) is not sufficient for a significant increase in serum S100B protein due to the course of chronic tonsillar hypertrophy itself. The time elapsed between extraction of baseline sample and post-exposure sample should have been reduced performing the basal extraction in the operating room prior to general anesthesia. In this study, baseline extraction was not possible in the same operating room as it is performed after anesthesia induction with sevoflurane inhaled, being the child unconscious. Therefore, the sample would have been affected by exposure to one of the drugs. Modifying the routine procedure of therapy for children undergoing surgery by changing the order of venipuncture and performing it before hypnosis would have been unethical. The blood sample required for the pre-anesthetic study was used to obtain the baseline sample, not subjecting children to additional venipuncture for conducting this study.</p><p id="par0140" class="elsevierStylePara elsevierViewall">On the other hand, the possibility that exposure to anesthetic drugs might cause brain damage raises the need for preventive treatment with neuroprotectors to all patients undergoing general anesthesia.</p><p id="par0145" class="elsevierStylePara elsevierViewall">We consider our results as preliminary. Further studies are required to confirm brain damage detected by increased serum S100B protein after general anesthesia.</p><p id="par0150" class="elsevierStylePara elsevierViewall">In conclusion, S100B can be used as a serum marker of postanesthesia brain damage. Serum S100B protein levels increased significantly after exposure to anesthetic drugs. Thus, general anesthesia can cause brain damage.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors report no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres728350" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec732549" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres728349" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec732550" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methodology" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-10-25" "fechaAceptado" => "2016-01-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec732549" "palabras" => array:7 [ 0 => "S100B protein" 1 => "General anesthesia" 2 => "Brain damage" 3 => "Midazolam" 4 => "Fentanyl" 5 => "Propofol" 6 => "Sevoflurane" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec732550" "palabras" => array:7 [ 0 => "Proteína S100B" 1 => "Anestesia general" 2 => "Daño cerebral" 3 => "Midazolam" 4 => "Fentanilo" 5 => "Propofol" 6 => "Sevoflurano" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">S100B protein is a serum marker of cerebral damage. The objective was to evaluate the brain damage caused by general anesthesia, by determining the concentration of serum S100B protein before and after of general anesthesia.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients with chronic adenotonsillar hypertrophy and indications for tonsillectomy were included. A venous blood sample was taken from the patients before general anesthesia (basal sample). The patients were anaesthetized using the following intravenous anesthetic drugs: midazolam, fentanyl and propofol; and inhaled sevoflurane. A second venous blood sample (postoperative sample) was taken from patients after the surgery, in the operating room. The concentration of serum S100B protein was determined in the basal sample (S100Bb) and postoperative sample (S100Bp) by immunoassay electro-chemiluminescence in MODULAR E-170 (Roche Diagnostics).</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Seventy-six patients were included, 46 males and 30 females, aged between 3 and 14 (median 5 years). In all the patients, serum S100B protein levels increased after general anesthesia. The values of S100Bp (median 164.0<span class="elsevierStyleHsp" style=""></span>ng/l) were significantly higher than the values of S100Bb (median 94.5<span class="elsevierStyleHsp" style=""></span>ng/l). The median of the difference between S100Bp and S100Bb was 58.0<span class="elsevierStyleHsp" style=""></span>ng/l. There were statistically significant differences between S100Bb and S100Bp using the Wilcoxon test (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The concentration of serum S100B protein increased significantly after general anesthesia. This indicates that general anesthesia may cause brain damage.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La proteína S100B es un marcador sérico de daño cerebral. El objetivo fue evaluar el daño cerebral producido por la anestesia general mediante la determinación de la concentración de proteína S100B sérica antes y después de la anestesia general.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron pacientes con intervención quirúrgica programada de amigdalectomía por hipertrofia amigdalar. En la consulta de preanestesia se extrajo una muestra de sangre venosa (muestra basal). Los pacientes fueron sometidos a anestesia general utilizando los siguientes fármacos anestésicos intravenosos: midazolam, fentanilo y propofol; y sevoflurano inhalado. Al finalizar la intervención quirúrgica y con el paciente aún en quirófano, se extrajo una segunda muestra de sangre venosa (muestra postexposición). Se determinó en suero la concentración de la proteína S100B en la muestra basal (S100Bb) y en la muestra postexposición (S100Bp), mediante inmunoanálisis de electroquimioluminiscencia en el MODULAR E-170 (Roche Diagnostics).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 76 pacientes, 46 varones y 30 hembras, con edades entre 3 y 14 años (mediana 5 años). En todos los pacientes, los niveles de proteína S100B sérica aumentaron tras la anestesia general. Los valores obtenidos de S100Bp (mediana 164,0<span class="elsevierStyleHsp" style=""></span>ng/l) fueron significativamente mayores que los obtenidos de S100Bb (mediana 94,5<span class="elsevierStyleHsp" style=""></span>ng/l). La mediana de la diferencia entre S100Bp y S100Bb fue de 58,0<span class="elsevierStyleHsp" style=""></span>ng/l. Mediante el test de Wilcoxon se encontraron diferencias estadísticamente significativas entre S100Bb y S100Bp (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La concentración de proteína S100B sérica aumentó significativamente tras la anestesia general. Esto indica que la anestesia general puede producir daño cerebral.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mesa Suárez P, Santotoribio JD, Ramos Ramos V, González García MÁ, Pérez Ramos S, Portilla Huertas D, et al. Daño cerebral postanestesia general. Med Clin (Barc). 2016;146:384–388.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1044 "Ancho" => 1485 "Tamanyo" => 41091 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Graph with logarithmic transformation of serum S100B protein levels in the baseline sample (S100Bb) and in the postexposure sample to general anesthesia (S100Bp).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; IR: interquartile range; S100Bb: serum S100B protein levels in the baseline sample; S100Bp: serum S100B protein levels in the postexposure sample; S100Bp-b: difference between S100Bp and S100Bb.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minimum \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Maximum \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median (CI 95%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IR \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S100Bp (ng/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">205.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.5 (89.0–103.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S100Bp (ng/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1052.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">164.0 (145.0–189.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">149 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S100Bp-b (ng/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">955.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.0 (42.0–75.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">136 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1200881.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Descriptive statistics of serum S100B protein levels in the baseline sample, in postexposure sample and varying concentration of serum S100B protein after general anesthesia.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; IR: interquartile range.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minimum \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Maximum \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median (CI 95%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IR \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Midazolam (mg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fentanyl (μg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">225 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (60–75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Propofol (mg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (30–70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (30–45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1200880.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Descriptive statistics of the total dose of intravenous anesthetic drugs administered to patients and time of exposure to anesthetic drugs or duration of surgery.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0125" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early exposure to general anesthesia disrupts spatial organization of presynaptic vesicles in nerve terminals of the developing rat" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Lunardi" 1 => "A. Oklopcic" 2 => "M. Prillaman" 3 => "A. Erisir" 4 => "V. Jevtovic-Todorovic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12035-015-9246-7" "Revista" => array:6 [ "tituloSerie" => "Mol Neurobiol" "fecha" => "2015" "volumen" => "52" "paginaInicial" => "942" "paginaFinal" => "951" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26048670" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0130" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early childhood general anaesthesia exposure and neurocognitive development" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aeq302" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2010" "volumen" => "105" "paginaInicial" => "i61" "paginaFinal" => "i68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21148656" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0135" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anesthesia and cognitive performance in children: no evidence for a causal relationship" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Bartels" 1 => "R.R. Althoff" 2 => "D.I. Boomsma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1375/twin.12.3.246" "Revista" => array:6 [ "tituloSerie" => "Twin Res Hum Genet" "fecha" => "2009" "volumen" => "12" "paginaInicial" => "246" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19456216" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0140" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cognitive and behavioral outcomes after early exposure to anesthesia and surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.P. Flick" 1 => "S.K. Katusic" 2 => "R.C. Colligan" 3 => "R.T. Wilder" 4 => "R.G. Voigt" 5 => "M.D. Olson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2011-0351" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2011" "volumen" => "128" "paginaInicial" => "e1053" "paginaFinal" => "e1061" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21969289" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0145" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anestesia intravenosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Fuertes Olivera" 1 => "N. Cuesta Marín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "titulo" => "Anestesiología y reanimación, una guía práctica" "fecha" => "2014" "paginaInicial" => "121" "paginaFinal" => "129" "editorial" => "Arán editores" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0150" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An experimental model of mass-type brain damage in the rat: expression of brain damage based on neurospecific enolase and protein S100B" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.J. Egea-Guerrero" 1 => "F. Murillo-Cabezas" 2 => "A. Rodríguez-Rodríguez" 3 => "E. Gordillo-Escobar" 4 => "J. Revuelto-Rey" 5 => "M.A. Muñoz-Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2013.03.015" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2014" "volumen" => "38" "paginaInicial" => "218" "paginaFinal" => "225" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23786666" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0155" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of S100B protein in urine and serum as an early predictor of mortality after severe traumatic brain injury in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Rodríguez-Rodríguez" 1 => "J.J. Egea-Guerrero" 2 => "A. León-Justel" 3 => "E. Gordillo-Escobar" 4 => "J. Revuelto-Rey" 5 => "A. Vilches-Arenas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cca.2012.09.025" "Revista" => array:6 [ "tituloSerie" => "Clin Chim Acta" "fecha" => "2012" "volumen" => "414" "paginaInicial" => "228" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23031665" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0160" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accuracy of the S100β protein as a marker of brain damage in traumatic brain injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.J. Egea-Guerrero" 1 => "J. Revuelto-Rey" 2 => "F. Murillo-Cabezas" 3 => "M.A. Muñoz-Sánchez" 4 => "A. Vilches-Arenas" 5 => "P. Sánchez-Linares" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/02699052.2011.635360" "Revista" => array:6 [ "tituloSerie" => "Brain Inj" "fecha" => "2012" "volumen" => "26" "paginaInicial" => "76" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22149446" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0165" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prognostic value of the temporal course of S100beta protein in post-acute severe brain injury: a prospective and observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Murillo-Cabezas" 1 => "M.A. Muñoz-Sánchez" 2 => "M.D. Rincón-Ferrari" 3 => "J.F. Martín-Rodríguez" 4 => "R. Amaya-Villar" 5 => "S. García-Gómez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/02699051003652823" "Revista" => array:6 [ "tituloSerie" => "Brain Inj" "fecha" => "2010" "volumen" => "24" "paginaInicial" => "609" "paginaFinal" => "619" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20235763" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0170" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood markers for the prognosis of ischemic stroke: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W. Whiteley" 1 => "W.L. Chong" 2 => "A. Sengupta" 3 => "P. Sandercock" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Stroke" "fecha" => "2009" "volumen" => "40" "paginaInicial" => "380" "paginaFinal" => "389" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0175" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "S100B protein in the nervous system and cardiovascular apparatus in normal and pathological conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Donato" 1 => "C.W. Heizmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2010/929712" "Revista" => array:5 [ "tituloSerie" => "Cardiovasc Psychiatry Neurol" "fecha" => "2010" "volumen" => "2010" "paginaInicial" => "929712" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21076683" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0180" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elective procedures and anesthesia in children: pediatric surgeons enter the dialogue on neurotoxicity questions, surgical options, and parental concerns" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.W. Byrne" 1 => "J.A. Ascherman" 2 => "P. Casale" 3 => "R.A. Cowles" 4 => "P.F. Gallin" 5 => "L.G. Maxwell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ANA.0b013e31826a032d" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg Anesthesiol" "fecha" => "2012" "volumen" => "24" "paginaInicial" => "396" "paginaFinal" => "400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23085786" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0185" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "S100B protein as a post-traumatic biomarker for prediction of brain death in association with patient outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Shakeri" 1 => "A. Mahdkhah" 2 => "F. Panahi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5812/atr.8549" "Revista" => array:6 [ "tituloSerie" => "Arch Trauma Res" "fecha" => "2013" "volumen" => "2" "paginaInicial" => "76" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24396798" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0190" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "S100B blood level measurement to exclude cerebral lesions after minor head injury: the multicenter STIC-S100 French study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Laribi" 1 => "J. Kansao" 2 => "D. Borderie" 3 => "C. Collet" 4 => "P. Deschamps" 5 => "R. Ababsa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1515/cclm-2013-0621" "Revista" => array:6 [ "tituloSerie" => "Clin Chem Lab Med" "fecha" => "2014" "volumen" => "52" "paginaInicial" => "527" "paginaFinal" => "536" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24225131" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0195" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A role of serum-based neuronal and glial markers as potential predictors for distinguishing severity and related outcomes in traumatic brain injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.Y. Lee" 1 => "C.Y. Lee" 2 => "H.R. Kim" 3 => "C.H. Lee" 4 => "H.W. Kim" 5 => "J.H. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3340/jkns.2015.58.2.93" "Revista" => array:6 [ "tituloSerie" => "J Korean Neurosurg Soc" "fecha" => "2015" "volumen" => "58" "paginaInicial" => "93" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26361523" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0200" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum S100B levels may be associated with cerebral infarction: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H. Ye" 1 => "L. Wang" 2 => "X.K. Yang" 3 => "L.P. Fan" 4 => "Y.G. Wang" 5 => "L. Guo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jns.2014.11.010" "Revista" => array:6 [ "tituloSerie" => "J Neurol Sci" "fecha" => "2015" "volumen" => "348" "paginaInicial" => "81" "paginaFinal" => "88" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25434713" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0205" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biomarkers of brain damage and postoperative cognitive disorders in orthopedic patients: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Tomaszewski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2015/402959" "Revista" => array:5 [ "tituloSerie" => "Biomed Res Int" "fecha" => "2015" "volumen" => "2015" "paginaInicial" => "402959" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26417595" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0210" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elevated S100B levels do not correlate with the severity of encephalopathy during sepsis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O. Piazza" 1 => "E. Russo" 2 => "S. Cotena" 3 => "G. Esposito" 4 => "R. Tufano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aem201" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2007" "volumen" => "99" "paginaInicial" => "518" "paginaFinal" => "521" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17650519" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0215" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elevation of serum S100 protein concentration as a marker of ischemic brain damage in extremely preterm infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.M. Chiang" 1 => "W.Y. Chen" 2 => "Y.C. Yang" 3 => "M.J. Jeng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcma.2015.06.009" "Revista" => array:6 [ "tituloSerie" => "J Chin Med Assoc" "fecha" => "2015" "volumen" => "78" "paginaInicial" => "610" "paginaFinal" => "616" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26285828" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0220" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "S100 proteins in mouse and man: from evolution to function and pathology (including an update of the nomenclature)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Marenholz" 1 => "C.W. Heizmann" 2 => "G. Fritz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbrc.2004.07.096" "Revista" => array:6 [ "tituloSerie" => "Biochem Biophys Res Commun" "fecha" => "2004" "volumen" => "322" "paginaInicial" => "1111" "paginaFinal" => "1122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15336958" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0225" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elevated serum S-100B levels in children with temporal lobe epilepsy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Calik" 1 => "M. Abuhandan" 2 => "A. Sonmezler" 3 => "H. Kandemır" 4 => "I. Oz" 5 => "A. Taskin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.seizure.2012.10.012" "Revista" => array:6 [ "tituloSerie" => "Seizure" "fecha" => "2013" "volumen" => "22" "paginaInicial" => "99" "paginaFinal" => "102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23146618" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0230" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Causes of elevated serum levels of S100B protein in athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Donato" 1 => "F. Riuzzi" 2 => "G. Sorci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00421-012-2566-7" "Revista" => array:6 [ "tituloSerie" => "Eur J Appl Physiol" "fecha" => "2013" "volumen" => "113" "paginaInicial" => "819" "paginaFinal" => "820" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23241954" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0235" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "S100 proteins in cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.R. Bresnick" 1 => "D.J. Weber" 2 => "D.B. Zimmer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrc3893" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Cancer" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "96" "paginaFinal" => "109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25614008" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0240" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of preoperative and postoperative S-100B levels in children with chronic adenotonsillar hypertrophy: preliminary results" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Bozkus" 1 => "S. Sarıkaya" 2 => "O. Kocaturk" 3 => "M. Calik" 4 => "M. Abuhandan" 5 => "A. Altintas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Rev Med Pharmacol Sci" "fecha" => "2014" "volumen" => "18" "paginaInicial" => "1549" "paginaFinal" => "1553" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24899616" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014600000009/v1_201609081639/S2387020616303709/v1_201609081639/en/main.assets" "Apartado" => array:4 [ "identificador" => "43310" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014600000009/v1_201609081639/S2387020616303709/v1_201609081639/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616303709?idApp=UINPBA00004N" ]
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