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Laguna, F. Suárez-Sipmann, G. Tusman, J. Ripollés, O. Díaz-Cambronero, R. Pujol, E. Rivas, I. Garutti, R. Mellado, J. Vallverdú, A. Jacas, A. Fervienza, R. Marrero, J. Librero, J. Villar, C. Ferrando" "autores" => array:16 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Laguna" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Suárez-Sipmann" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Tusman" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Ripollés" ] 4 => array:2 [ "nombre" => "O." "apellidos" => "Díaz-Cambronero" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Pujol" ] 6 => array:2 [ "nombre" => "E." "apellidos" => "Rivas" ] 7 => array:2 [ "nombre" => "I." "apellidos" => "Garutti" ] 8 => array:2 [ "nombre" => "R." "apellidos" => "Mellado" ] 9 => array:2 [ "nombre" => "J." "apellidos" => "Vallverdú" ] 10 => array:2 [ "nombre" => "A." "apellidos" => "Jacas" ] 11 => array:2 [ "nombre" => "A." "apellidos" => "Fervienza" ] 12 => array:2 [ "nombre" => "R." 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No data were provided for Bosnia Herzegovina and the United Kingdom.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Abramovich, I. Crisan, D. Sobreira Fernandes, S. De Hert, A. Lukic, G. Norte, B. Matias, M. Majić, J. Berger-Estilita" "autores" => array:9 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Abramovich" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Crisan" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Sobreira Fernandes" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "De Hert" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Lukic" ] 5 => array:2 [ "nombre" => "G." "apellidos" => "Norte" ] 6 => array:2 [ "nombre" => "B." "apellidos" => "Matias" ] 7 => array:2 [ "nombre" => "M." "apellidos" => "Majić" ] 8 => array:2 [ "nombre" => "J." "apellidos" => "Berger-Estilita" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935624000069" "doi" => "10.1016/j.redar.2023.08.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935624000069?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119292400074X?idApp=UINPBA00004N" "url" => "/23411929/0000007100000006/v2_202407071251/S234119292400074X/v2_202407071251/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Effect of coadministration of 10 mg/kg calcium chloride and neostigmine on extubation time: A randomized controlled trial" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "438" "paginaFinal" => "444" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Elkenany, M.M. Alseoudy, M.E. Elshehawi, S. Bakrey, M. Aboelela" "autores" => array:5 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Elkenany" ] 1 => array:4 [ "nombre" => "M.M." "apellidos" => "Alseoudy" "email" => array:1 [ 0 => "drs3ody.mansora@mans.edu.eg" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "M.E." "apellidos" => "Elshehawi" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Bakrey" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Aboelela" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto de la coadministración de 10 mg/kg de cloruro cálcico y neostigmina en el tiempo de extubación: ensayo controlado aleatorizado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2549 "Ancho" => 2925 "Tamanyo" => 322441 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart showing patient recruitment, randomization, and follow-up.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Muscle relaxants are used to facilitate endotracheal intubation and provide the paralysis required for different surgeries performed under general anaesthesia.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Postoperative residual neuromuscular block (RNMB), defined as a train of four (TOF) ratio <0.9, occurs in 63.5% of patients at tracheal extubation and in 56.5% on arrival at the post anaesthesia care unit (PACU).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">RNMB is a major problem that adversely impacts clinical outcomes and causes multiple complications, such as hypoxia, pulmonary aspiration of gastric contents, weakness, atelectasis, and pneumonia<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>; therefore, adequate neuromuscular recovery is mandatory for patient safety.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Recovery from neuromuscular blockade can either be enhanced or delayed by several factors, including serum electrolytes.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Ionised calcium is known to play a role in facilitating neuromuscular transmission by increasing acetylcholine release from motor nerve endings.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Some studies investigating the effect of ionised calcium on neostigmine-induced recovery from neuromuscular blockade have found that this combination enhanced recovery but had no significant effect on clinical outcomes, such as the incidence of postoperative residual curarization (PORC) and time to extubation.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We hypothesised that a higher dose of calcium chloride (10 mg/kg) combined with neostigmine would further enhance neuromuscular recovery, and this in turn could shorten the time to extubation and reduce PORC.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this study was to evaluate the effect of co-administration of calcium chloride 10 mg/kg with neostigmine on time to extubation and PORC in patients undergoing general anaesthesia with atracurium for neuromuscular blockade.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Ethics board approval and registration</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study was approved by the Institutional Review Board of the Mansoura faculty of medicine (R/18.05.191) and was registered on <a href="http://www.pactr.org">www.pactr.org</a> (PACTR201811703495809), (Registered on 3/11/2018). Patients were included between November 2018 and February 2023.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study design</span><p id="par0040" class="elsevierStylePara elsevierViewall">Prospective, randomized, double-blinded, placebo-controlled study in consenting adult patients scheduled for surgery under general anaesthesia at a university hospital.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Inclusion criteria</span><p id="par0045" class="elsevierStylePara elsevierViewall">Adult ASA I–II patients of either sex, aged between 18 and 65, undergoing scheduled abdominal surgery under general anaesthesia lasting at least 1 h were enrolled in this study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Exclusion criteria</span><p id="par0050" class="elsevierStylePara elsevierViewall">Refusal to participate, anticipated difficult airway, chronic obstructive pulmonary disease, bronchial asthma, BMI ≥ 40, neuromuscular disease, suspected malignant hyperthermia, glaucoma, kidney or liver dysfunction, need for drugs that could affect NMB agents, pregnancy, breast feeding, hypo- or hypercalcaemia or hypo-albuminemia, hypo-magnesemia, peripheral neuropathy, burns, upper limb fracture, hyper- or hypothyroidism, and need for intraoperative blood transfusion.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Randomization, allocation, concealment and blinding</span><p id="par0055" class="elsevierStylePara elsevierViewall">Consenting patients that met the inclusion criteria and were scheduled for surgery under general anaesthesia were included in this study.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Patients were randomised to 2 groups using the sealed envelope system. The groups were based on the neostigmine combination administered at the end of surgery: <span class="elsevierStyleBold">calcium group</span> (n = 44), which received 10 mg/kg<span class="elsevierStyleSup">−</span> of calcium chloride; and <span class="elsevierStyleBold">placebo group</span> (n = 44), which received the same volume of normal saline.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Study medications were prepared by a single anaesthesiologist and pre-loaded in syringes according to randomization. This same anaesthesiologist also injected the drug combination when requested to do so by another blinded anaesthesiologist who was responsible for the patient’s care. Another investigator who was not involved in patient care collected the perioperative data.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conduct of the study</span><p id="par0070" class="elsevierStylePara elsevierViewall">All patients underwent a routine preoperative assessment as per our local protocol. On arrival at the operating room, 22 gauge venous catheters were inserted in the forearm on the opposite side of the acceleromyograph. Monitoring consisted of electrocardiogram, non-invasive blood pressure (NIBP), oxygen saturation, bispectral index, and a nasopharyngeal probe for core temperature measurement.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Anaesthesia was induced with intravenous propofol 1.5–2.5 mg/kg (Diprivan, Fresenius KABI) and fentanyl 2 μg/kg (Hameln pharmaceuticals, Germany), after induction, patients were ventilated by face mask and neuromuscular (NM) monitoring was started before administering the muscle relaxant.</p><p id="par0080" class="elsevierStylePara elsevierViewall">NM monitoring followed international consensus guidelines<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> (monitoring the adductor pollicis muscle in response to ulnar nerve stimulation) using the TOF-Watch-SX® (Organon [Ireland] Ltd., Drynam Road, Swords, Co. Dublin, Ireland). The acceleration transducer was placed on the palmar aspect of the distal thumb using an adapter. The fingers and the forearm were immobilized, and two stimulating skin electrodes were placed no more than 6 cm apart on the ulnar nerve proximal to the wrist. Hand temperature was maintained above 32 °C. The device was calibrated automatically, and TOF stimulation (supramaximal square wave stimuli of 0.2 ms duration at 2 Hz frequency) continued until the signal was stable. After stabilization, patients received atracurium 0.5 mg/kg, and TOF stimulation was monitored at 15 s intervals. The patients were intubated when the TOF count (TOF<span class="elsevierStyleInf">C</span>) was 0, and were mechanically ventilated to maintain ETCO<span class="elsevierStyleInf">2</span> at 35–40 mmHg. Anaesthesia was maintained with inhaled minimum alveolar concentrations (MAC) of sevoflurane 0.7–1.5 vaporized in oxygen-air (40% inspired fraction) based on entropy readings to achieve BIS values of between 40–60, and were given intravenous fentanyl as required. TOF was assessed at 10 min intervals until the end of surgery. During surgery, atracurium 0.1 mg/kg was injected when the TOF<span class="elsevierStyleInf">C</span> exceeded 1.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Acetate Ringer’s solution was used for fluid management, and blood loss was replaced by colloid solution. Patients with an ongoing need for blood transfusion (according to ASA guidelines) were withdrawn from the study. Body core temperature was maintained around 36.0 °C using a forced air warmer. An 18-gauge venous catheter was inserted in the right or left external jugular vein to administer fluids or study medication.</p><p id="par0090" class="elsevierStylePara elsevierViewall">At the end of the surgery, patients remained sedated with sevoflurane adjusted for a BIS of 60–80 until the TOF ratio reached 0.9, at which point sedation was discontinued.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Patients were allowed to recover spontaneously from NMB. With the return of the fourth twitch (TOFC-4) at 3 consecutive TOF measurements,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> patients in both groups received the reversal agent (neostigmine 50 µg/kg combined with atropine 20 µg/kg). Patients in the calcium group received 10 mg/kg calcium chloride with the reversal agent, and in the placebo group the reversal agent was combined with 10 mg/kg normal saline. If any calcium-related complications were observed, e.g., cardiac dysrhythmia, hypotension, venous irritation, or skin redness, the infusion was stopped, the complication was treated, and the case was excluded from the analysis.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Patients were extubated when they met the criteria for extubation and were transferred to the PACU, where they were asked about general weakness, difficulty swallowing, visual symptoms, or any sign of residual muscle blockade.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In the PACU, recovery was evaluated every 5 min using the modified Aldret’s score until discharge criteria had been met.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Outcomes</span><p id="par0105" class="elsevierStylePara elsevierViewall">The primary outcome was time from neostigmine administration to extubation (extubation time). Secondary outcomes were: recovery time (time from administration of neostigmine to TOFr ≥ 0.9), TOFr at 5, 10, 15, and 20 min after neostigmine administration, and the incidence of residual neuromuscular blockade (RNMB) (TOFr < 0.9 on quantitative monitoring) measured at the same intervals as TOFr.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Sample size and statistical analysis</span><p id="par0110" class="elsevierStylePara elsevierViewall">The sample size was calculated using G*Power software (version 3.0.10.), and was based on a pilot study with 10 patients in each group in which the time from neostigmine administration to extubation was the primary outcome. The results of the pilot study showed that mean time to extubation ± SD was 8.56 ± 1.90 min in the control group and 7.30 ± 1.77 min in the calcium group. We calculated that 40 participants in each group would achieve a power of 85% with a type I (α) error of 0.05, using a two- sided two-sample t test. The sample size was increased by 10% to compensate for dropouts, giving a final sample size of 88 patients.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Data were statistically analysed using SPSS version 20, and were tested for normality using the Kolmogorov–Smirnov test. The Chi square test was used for categorical data. Means were compared with repeated measures ANOVA. The independent samples t-test and Mann Whitney U test were used to compare continuous and non-continuous variables. The data were expressed as mean ± SD, number (percentage), or median (interquartile range). A <span class="elsevierStyleItalic">P</span> value <.05 was considered to represent statistical significance.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Participants and drop outs</span><p id="par0120" class="elsevierStylePara elsevierViewall">One hundred and one patients were screened for eligibility; 7 did not meet the inclusion criteria and were excluded, and 4 refused to participate. Ninety patients meeting the inclusion criteria were randomised to one of the study groups. However, 1 participant in the placebo group and 1 in the calcium group were excluded (the former needed blood transfusion and the latter developed cardiac dysrhythmia following calcium infusion). The remaining 88 patients completed the study (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Patient demographics and intraoperative data</span><p id="par0125" class="elsevierStylePara elsevierViewall">The groups were evenly matched in terms of demographic and intraoperative data (<span class="elsevierStyleItalic">P</span> > .05) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). There were no statistically significant differences between the two groups in terms of arterial pH, body temperature, end tidal sevoflurane concentration, serum magnesium, and ionized calcium levels at the time of neostigmine administration (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Primary and secondary outcomes</span><p id="par0130" class="elsevierStylePara elsevierViewall">In comparison to the control group, patients in the calcium group presented significantly shorter time to extubation (6.5 [5.52–7.43] vs 9.78 [8.35–11] min, <span class="elsevierStyleItalic">P</span> < .001) and recovery from NMB (5 [4.35−5.9] vs 7.1 [6.3−8.4] min, <span class="elsevierStyleItalic">P</span> < .001), higher TOFr and lower incidence of RNMB at 5 and 10 min after neostigmine administration (90.5 [89−92] and 98.5 [96−100]% vs 74.5 [66.25−84.70] and 93 [91.25−95.70]%), respectively, and (14 [31.81] and 0 [0]% vs 39 [88.63] and 7 [45.910]%, respectively, <span class="elsevierStyleItalic">P</span> < .001 and .006) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">TOFr and the incidence of RNMB were similar in both groups at 15 and 20 min following neostigmine administration (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Serum ionized calcium 20 min after study drug infusion was significantly higher in the calcium group; however, none of the patients developed hypercalcaemia (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Clinical signs of PORC in the PACU were not observed in any of the patients in either group.</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Studies analysing the effect of different doses of calcium on recovery from neostigmine-induced neuromuscular blockade have reported enhanced recovery from NMB and a lower incidence of RNMB,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> but none have reported the impact of enhanced recovery on time to extubation.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In this randomized controlled study, we show that the addition of 10 mg/kg calcium to neostigmine enhanced neuromuscular recovery, significantly reduced (by around 32%) time to extubation, increased TOFr, reduced the incidence of RNMB 5 and 10 min after neostigmine administration, and did not cause significant adverse effects.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The significantly reduced time to extubation after neostigmine administration observed in our study may be due to our use of calcium chloride at a dose of 10 mg/kg, in contrast to Raghavan et al., and Choi et al. <a class="elsevierStyleCrossRefs" href="#bib0035">[7,8]</a> who used calcium gluconate (calcium chloride delivers more elementary calcium than calcium gluconate). In addition to this, our larger sample size may have enabled us to detect this significant difference. Some authors have suggested that ionized calcium facilitates transmitter release and contributes in part to synaptic delay, thereby reducing sensitivity to nondepolarizing NMBAs and reducing the depth of nondepolarizing neuromuscular blockade.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Despite the documented rapid and complete reversal of nondepolarizing neuromuscular blockade with the use of sugammadex <a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>, neostigmine – an acetylcholinesterase inhibitor – is still in use in countries with limited economic resources. Sugammadex, moreover, cannot be used in patients with impaired kidney function,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> cannot reverse benzylisoquinolinium-induced NMB,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> has been associated with anaphylaxis,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and has no benefit vs neostigmine in the reversal of shallow blockade.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">All this shows that neostigmine cannot be replaced entirely by sugammadex in clinical practice, and it is therefore interesting to study any strategy that could improve its neuromuscular recovery profile. Ju et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> found that 5 mg/kg calcium chloride co-administered with neostigmine had no effect on time to extubation, so we hypothesised that increasing the dose to 10 mg/kg might enhance recovery and thereby reduce time to extubation.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Since a dose of 10 mg/kg of calcium chloride is expected to elevate serum ionized calcium by 1.4,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> we were able to use that dose safely by monitoring serum ionized calcium 20 min after infusion. None of our patients presented hypercalcemia.</p><p id="par0170" class="elsevierStylePara elsevierViewall">This study has some limitations: first, we studied the effect of calcium in patients with shallow block. Further studies are needed to study its effect on moderate and deep blockade. Second; patients with renal impairment and those with abnormal serum calcium levels (hypo- or hypercalcaemia) were excluded from our analysis. Further studies including these patients are needed. Third, a further study with a group receiving calcium chloride alone, without neostigmine, is needed to determine the effect of calcium on the neuromuscular junction. Fourth, we did not collect certain data, such as pulmonary complications and length of hospital stay, and did not perform postoperative follow up.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Calcium chloride at a dose of 10 mg/kg co-administered with neostigmine enhances early recovery from depolarizing neuromuscular blockade, and this shortens time to extubation, with a reported median difference about 3.28 min between groups.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Financial disclosures</span><p id="par0180" class="elsevierStylePara elsevierViewall">This study is not funded.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Data availability</span><p id="par0185" class="elsevierStylePara elsevierViewall">Upon request, the authors will provide the study data.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">IRB number</span><p id="par0190" class="elsevierStylePara elsevierViewall">R/18.05.191.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Clinical trial registration number</span><p id="par0195" class="elsevierStylePara elsevierViewall">PACTR201811703495809.</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Declaration of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres2199355" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1845980" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2199356" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1845981" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Ethics board approval and registration" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study design" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Inclusion criteria" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Exclusion criteria" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Randomization, allocation, concealment and blinding" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Conduct of the study" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Outcomes" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Sample size and statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0055" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Participants and drop outs" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Patient demographics and intraoperative data" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Primary and secondary outcomes" ] ] ] 7 => array:2 [ "identificador" => "sec0075" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0080" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0085" "titulo" => "Financial disclosures" ] 10 => array:2 [ "identificador" => "sec0090" "titulo" => "Data availability" ] 11 => array:2 [ "identificador" => "sec0095" "titulo" => "IRB number" ] 12 => array:2 [ "identificador" => "sec0100" "titulo" => "Clinical trial registration number" ] 13 => array:2 [ "identificador" => "sec0105" "titulo" => "Declaration of interest" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-08-09" "fechaAceptado" => "2023-10-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1845980" "palabras" => array:5 [ 0 => "Calcium chloride" 1 => "Residual neuromuscular block" 2 => "Extubation time" 3 => "Neostigmine" 4 => "Neuromuscular recovery" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1845981" "palabras" => array:5 [ 0 => "Cloruro cálcico" 1 => "Bloqueo neuromuscular residual" 2 => "Tiempo hasta la extubación" 3 => "Neostigmina" 4 => "Recuperación neuromuscular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Some studies investigating the effect of calcium on neostigmine-induced recovery of neuromuscular blockade have shown that this combination promotes neuromuscular recovery, but does not significantly affect the incidence of postoperative residual curarization and time to extubation. This study aimed to evaluate the effects of 10 mg/kg calcium chloride co-administered with neostigmine on early recovery and time to extubation.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">This prospective, randomized, double-blinded, placebo-controlled study included 88 ASA I–II patients aged between 18 and 65 years who were scheduled for elective surgery lasting at least 1 h under general anaesthesia in which 10 mg/kg of calcium chloride or the same volume of normal saline was co-administered with 5 μg/kg of neostigmine at the end of surgery. Time to extubation (time from neostigmine administration to extubation), time from neostigmine administration to TOF ratio (TOFr) 0.9 (neuromuscular recovery), and the incidence of residual neuromuscular blockade (RNMB) and other adverse effects were recorded.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Median (Q1, Q3) extubation time was significantly shorter in the calcium group vs. the placebo group (6.5 min [5.52–7.43] vs. 9.78 min [8.35–11]), <span class="elsevierStyleItalic">P</span> < .001. Median neuromuscular recovery time in the calcium group was 5 min vs. 7.1 min in the placebo group, <span class="elsevierStyleItalic">P</span> < .001. Patients in the calcium group had significantly higher TOFr and lower incidence of RNMB at 5 and 10 min vs. the placebo group, and no significant side effects.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Calcium chloride at a dose of 10 mg/kg co-administered with neostigmine promotes early neuromuscular recovery and reduces time to extubation by about 32%.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción y objetivos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Algunos estudios que han investigado el efecto del calcio en la recuperación inducida por neostigmina del bloqueo neuromuscular han reflejado que esta combinación promueve la recuperación neuromuscular, pero no afecta significativamente a la incidencia de curarización residual postoperatoria y al tiempo de extubación. El objetivo de este estudio fue evaluar los efectos de la coadministración de 10 mg/kg de cloruro cálcico y neostigmina en la recuperación temprana y el tiempo hasta la extubación.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Este estudio prospectivo, aleatorizado, doble ciego y controlado por placebo incluyó 88 pacientes ASA I–II de edades comprendidas entre 18 y 65 años que fueron programados para cirugía electiva y recibieron al menos una hora de anestesia general en la que se coadministraron 10 mg/kg de cloruro cálcico o el mismo volumen de solución salina normal, y 5 μg/kg de neostigmina al finalizar la cirugía. Se registraron el tiempo transcurrido hasta la extubación (tiempo desde la administración de neostigmina hasta la extubación), el tiempo desde la administración de neostigmina hasta lograr una ratio TOF (TOFr) de 0,9 (recuperación neuromuscular) y la incidencia de bloqueo neuromuscular residual, así como otros efectos adversos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">El tiempo medio hasta la extubación (Q1, Q3) fue significativamente menor en el grupo de calcio en comparación con el grupo placebo (6,5 min [5,52–7,43] frente a 9,78 min [8,35–11]), p < 0,001. El tiempo de recuperación neuromuscular medio en el grupo de calcio fue de 5 min frente a 7,1 min en el grupo placebo, p < 0,001. Los pacientes del grupo calcio tuvieron una ratio TOFr significativamente más alto y una menor incidencia de RNMB transcurridos 5 y 10 min, en comparación con el grupo placebo, sin efectos secundarios significativos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">La coadministración de cloruro cálcico a una dosis de 10 mg/kg y neostigmina promueve la recuperación neuromuscular temprana y reduce el tiempo hasta la extubación en casi un 32%.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2549 "Ancho" => 2925 "Tamanyo" => 322441 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart showing patient recruitment, randomization, and follow-up.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Data are mean (SD), number/or (%), median (interquartile range).</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> < .05 statistical significance.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">BMI: body mass index.</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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Calcium group (n = 44) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Placebo group (n = 44) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.02 ± 13.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.70 ± 11.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (61.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (54.54%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (38.63%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (45.45%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.57 (28.77–33.10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.20 (28.56–33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total atracurium dose (mg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.50 (60–75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 (55–75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgery duration (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.50 (75–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.00 ( 66.5–94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anaesthesia duration (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113.29 ± 18.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">114.84 ± 16.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3589895.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients demographics and operative data.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Data are median (interquartile range).</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> < .05 statistical significance.</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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Calcium group (n = 44) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Placebo group (n = 44) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.38 (7.36–7.40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.37 (7.35–7.39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Temperature (°C) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.6 (36.40–36.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (36.20–36.80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End tidal sevoflurane concentration (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 (0.6–0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6 (0.5–0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum magnesium level (mmoL/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.7 (1.5–1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 (1.5–1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum ionized calcium (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5 (4.2–4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.4 (4.1–4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum ionized calcium after 20 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5 (4.2–4.7)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3 (4.2–4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3589896.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Significant compared to the Placebo group.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Patient parameters at neostigmine administration and serum ionized calcium level 20 min thereafter.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Data are number (%), or median (interquartile range).</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span> < .05 statistical significance.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">TOFr; train of four ratio, RNMB; residual neuromuscular blockade.</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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Calcium group (n = 44) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Placebo group (n = 44) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TOFr at neostigmine administration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (37–50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.50 (38–52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TOFr after neostigmine administration</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.5 (89–92)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.5 (66.25–84.70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>10 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.5 (96−100)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 (91.25−95.70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>15 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 (100–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 (100–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>20 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 (100–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 (100–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RNMB after neostigmine administration</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (31.81%)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 (88.63%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>10 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (100%)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (15.90%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>15 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>20 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recovery time (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (4.35–5.9)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.1 (6.3−8.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Extubation time (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.5 (5.52–7.43)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.78 (8.35–11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3589894.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Significant compared to the Placebo group.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Neuromuscular blockade recovery profile.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.S. Murphy" 1 => "S.J. Brull" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "AnesthAnalg" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "120" "paginaFinal" => "128" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The RECITE study: a Canadian prospective, multicenter study of the incidence and severity of residual neuromuscular blockade" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.P. Fortier" 1 => "D. McKeen" 2 => "K. Turner" 3 => "E. de Médicis" 4 => "B. Warriner" 5 => "P. 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Original article
Effect of coadministration of 10 mg/kg calcium chloride and neostigmine on extubation time: A randomized controlled trial
Impacto de la coadministración de 10 mg/kg de cloruro cálcico y neostigmina en el tiempo de extubación: ensayo controlado aleatorizado
S. Elkenany, M.M. Alseoudy
, M.E. Elshehawi, S. Bakrey, M. Aboelela
Corresponding author
Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt