Ultrasound monitoring to detect embolic phenomena in the inferior vena cava during hip arthroplasty | Revista Española de Anestesiología y Reanimación (English Edition)

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            "entidad" => "Departamento de Anestesiolog&#237;a&#44; Banco de pr&#243;tesis&#44; Montevideo&#44; Uruguay"
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            "entidad" => "Department of Anesthesia and Pain Management&#44; Toronto Western Hospital&#44; University Health Network&#46; Department of Anesthesiology and Pain Medicine&#44; University of Toronto&#44; Toronto&#44; ON&#44; Canada"
            "etiqueta" => "c"
            "identificador" => "aff0015"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Severity of embolic phenomena identified at different intraoperative time points&#46; The y-axis shows the incidence of the different degrees of severity&#44; expressed as a percentage of patients&#46; The x axis shows the different intraoperative time points&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Embolic phenomena are common during all hip joint replacements&#44; but particularly during cemented procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They are usually overlooked by the anaesthesiologist&#44; since they cannot be identified using standard monitoring and are usually well tolerated in patients with no underlying cardiovascular pathologies&#46; However&#44; severe embolic events can lead to severe haemodynamic compromise and death&#44; particularly in frail patients with multiple comorbidities&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Transoesophageal echocardiography &#40;TOE&#41; is a useful and safe technique for diagnosing these embolic events during joint replacement surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> However&#44; it is often unavailable in non-cardiac operating rooms&#44; and is usually used in intubated patients under general anaesthesia&#46; In orthopaedics&#44; joint replacement surgery is often performed under spinal anaesthesia with mild sedation&#44; so TOE is not feasible in these cases&#46; Moreover&#44; the vast majority of non-cardiovascular anaesthesiologists have no formal training in transoesophageal ultrasound&#44; further limiting its use in this context&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">As venous return from the lower extremities drains into the right atrium through the inferior vena cava &#40;IVC&#41;&#44; we propose an alternative ultrasound monitoring technique using a subcostal view of the IVC&#46; The main objectives of this prospective exploratory study are to determine the feasibility of monitoring the IVC during hip replacement surgery and to study the intra- and interobserver reliability of the findings&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0020" class="elsevierStylePara elsevierViewall">This prospective exploratory study was approved by the Ethics Committee of the Prosthesis Bank in Montevideo &#8211; Uruguay &#40;approval date 15 February 2022&#41;&#44; and has been reported according to the Guidelines for reporting reliability and agreement studies&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Patients scheduled for hip joint replacement surgery between 1 and 31 May 2022 were invited to participate in the study&#46; The inclusion criteria were&#58; age over 18 years&#44; body mass index &#60;&#8239;40&#8239;mg&#47;m<span class="elsevierStyleSup">2</span>&#44; ASA I-III&#44; supine position during surgery&#44; unilateral cemented hip arthroplasty under spinal anaesthesia with mild sedation&#44; ability to understand the objective of the study and its implications and to provide informed consent&#46; The exclusion criteria were&#58; urgent surgery&#44; bilateral hip arthroplasty&#44; lateral decubitus position&#44; general anaesthesia&#44; presence of and inferior vena cava filter&#44; previous lower abdominal surgery&#44; and significant hepatobiliary pathology that would distort the subcostal window&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">All patients recruited for this study gave their written informed consent prior to inclusion&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The primary objective was to determine the feasibility of the technique&#44; defined as the ability to monitor the intrahepatic IVC and its junction with the right atrium&#46; The secondary objectives were&#58; 1&#41; to determine inter- and intra-observer reliability using the qualitative transoesophageal ultrasound embolism severity index previously described by Pitto et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> adapted to the subcostal window by the authors&#59; 2&#41; to describe the ultrasound findings and the correlation between the severity of the embolism and each intraoperative time point&#59; and 3&#41; to evaluate the correlation between the degree of embolism and the patient&#8217;s vital and haemodynamic signs&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All patients in this study underwent total hip arthroplasty with replacement of the acetabulum and femur with cemented prosthetic components&#46; The bone cement used was CM&#174;&#44; or GMW&#174;&#44; &#40;DePuy Synthes&#44; United Kingdom&#41;&#46; Our hospital&#8217;s standard surgical approach was used&#44; which consists of a modified Hardinge technique with the patient supine&#44; slight lateralization of the operated hip&#44; layered dissection from the skin to the subcutaneous tissue&#44; fascia&#44; and muscle planes to free and dislocate the joint&#46; Following this&#44; the femoral neck is removed&#44; the acetabulum is perforated and reamed&#44; and the cup is cemented&#46; Then the femur is prepared by removing bone stock using progressively fine rasps&#46; When this is complete&#44; the alignment and stability are evaluated using a tester&#46; If the test is successful&#44; cement is inserted into the femoral canal and the femoral shaft is inserted with manual pressure&#46; Once the cement has set&#44; the arthroplasty is aligned&#44; and mobility and stability are tested&#46; Then the blood vessels are sealed and the wound is closed&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All patients underwent standard non-invasive monitoring including non-invasive blood pressure measurements every 5&#8239;minutes&#44; 5-lead electrocardiogram&#44; oxygen saturation &#40;SaO<span class="elsevierStyleInf">2</span>&#41;&#44; and capnography connected to the oxygen mask&#46; Our multimodal analgesia protocol includes ultrasound-guided femoral and obturator block followed by spinal anaesthesia with 8&#8211;10&#8239;mg of isobaric bupivacaine&#46; Before the procedure&#44; patients were sedated with fentanyl 1&#8239;mcg&#47;kg and midazolam 1&#8211;2&#8239;mg with metoclopramide 10&#8239;mg&#44; and during the procedure midazolam and fentanyl were titrated to achieve a Ramsay score of 2&#8211;3&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Each patient was managed independently by the treating anaesthesiologist while an observer anaesthesiologist who was involved in the study monitored the IVC through the subcostal window&#46; The ultrasound device used to scan the subcostal window and identify the intrahepatic IVC was a portable Sonosite X Porte &#40;FUJIFILM Sonosite Inc&#46; Bothell&#44; Washington&#44; USA&#41; and a convex transducer&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We used the qualitative scale originally described by Pitto et al&#46; for transoesophageal ultrasound and adapted it to our study&#46; This scale scores the severity of the embolism from 0 to 3&#58; Grade 0&#8239;&#61;&#8239;no emboli&#59; Grade 1&#8239;&#61;&#8239;a few fine emboli&#59; Grade 2&#8239;&#61;&#8239;cascade of small emboli or embolic masses with a diameter &#60;&#8239;5&#8239;mm&#59; Grade 3&#8239;&#61;&#8239;a cascade of small emboli mixed with embolic masses with a diameter &#8805;&#8239;5&#8239;mm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The presence of emboli in the IVC was assessed qualitatively at 10 intraoperative time points&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0060" class="elsevierStylePara elsevierViewall">Baseline&#58; prior to manipulation in the operating room</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0065" class="elsevierStylePara elsevierViewall">Start&#58; Complete spinal anaesthesia&#59; start of surgery</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0070" class="elsevierStylePara elsevierViewall">Dislocation&#58; hip dislocation</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0075" class="elsevierStylePara elsevierViewall">End of cup preparation&#58; end of cup reaming and drilling</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0080" class="elsevierStylePara elsevierViewall">Cup cementation</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6</span><p id="par0085" class="elsevierStylePara elsevierViewall">Femur rasping</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7</span><p id="par0090" class="elsevierStylePara elsevierViewall">Femur cementing</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8</span><p id="par0095" class="elsevierStylePara elsevierViewall">Femoral stem insertion</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9</span><p id="par0100" class="elsevierStylePara elsevierViewall">Alignment of the hip&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10</span><p id="par0105" class="elsevierStylePara elsevierViewall">Transfer to post anaesthesia care</p></li></ul></p><p id="par0110" class="elsevierStylePara elsevierViewall">Video clips lasting 2&#8211;3&#8239;minutes were obtained at each intraoperative time point and recorded on a USB memory stick for subsequent evaluation&#46; Ultrasound assessments were performed by anaesthesiologists with prior experience in perioperative ultrasound&#46; The images obtained from each patient were evaluated by 2 independent observers&#46; Observer 1 performed the intraoperative ultrasound assessment&#46; Observer 2 performed an independent assessment of the images a few days after surgery&#46; To determine intra-observer reliability&#44; both observers independently reviewed the images twice&#44; with an interval of at least 7 days between evaluations&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Data confidentiality</span><p id="par0115" class="elsevierStylePara elsevierViewall">The data from each patient are held confidential&#46; Patient parameters are entered into forms specially designed for the purpose of the study that do not contain any information that could identify the patient&#46; Each patient is identified by a study number&#46; The data were entered into an electronic database for the purposes of statistical analysis and do not contain any information that could identify the patients&#44; other than their study number and the date of the study&#46; The informed consent form containing the patient&#8217;s name will be kept by the principal investigator in a locked cabinet&#46; The study information will be stored for 10 years&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0120" class="elsevierStylePara elsevierViewall">The sample size was estimated on the hypothesis that the reproducibility of the ultrasound findings &#40;intra-observer and inter-observer&#41; will be greater than a kappa coefficient of 0&#46;80 &#40;strong agreement&#41;&#46; For a type 1 error of 0&#46;05 and a power of 80&#37;&#44; we estimated that 20 patients and 10 observations per patient would be required&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Qualitative variables are described as absolute and relative frequencies and continuous variables as summary measures&#46; Continuous variables were tested for normality using the Kolmogorov-Smirnov test&#46; Intra- and inter-observer agreement was determined using the Kappa Index&#46; Temporal changes in normal continuous variables were analysed using ANOVA&#44; and the Friedman test was used in the case of non-normal continuous variables&#46; Significance was set at 0&#46;05&#46; The statistical analysis was performed with Minitab v&#46;21&#46;1&#46;1&#46;0&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">A total of 20 patients &#40;12 women and 8 men&#41; were included in the study&#46; Patient demographics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">A good subcostal window was obtained and assessed in 90&#37; of cases&#46; Visualisation of the ultrasound window was rated as Excellent&#44; Good&#44; Fair&#44; and Impossible&#46; Eleven patients presented an Excellent ultrasound window with excellent images at all intraoperative time points&#59; 3 patients presented a Good window&#44; defined as overall excellent visualisation with occasional poorer quality that nevertheless permitted adequate qualitative assessment at all time points&#59; 4 patients presented a Fair window with occasional poor visualization that nevertheless permitted adequate qualitative assessment and did not warrant exclusion from the study&#46; A subcostal window could not be obtained in 2 patients&#44; and they were classified as Impossible&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Intra-observer variability for observer 1&#44; observer 2&#44; total intra-observer &#40;observer 1 and observer 2&#41; and inter-observer variability had a high kappa index of &#62;&#8239;0&#46;80&#44; p&#8239;&#60;&#8239;0&#46;001&#46; In the literature&#44; this is considered almost perfect agreement &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Embolization was observed in 17 of 18 patients &#40;95&#37;&#41;&#46; The severity varied considerably&#58; 9 patients &#40;50&#37;&#41; presented ultrasound images suggestive of severe embolism &#40;Grade 3&#41;&#59; 5 patients &#40;28&#37;&#41; presented moderate embolism &#40;Grade 2&#41;&#59; 3 patients &#40;17&#37;&#41; presented mild embolism &#40;Grade 1&#41;&#44; and 1 patient &#40;5&#37;&#41; presented no evidence of embolism at any intraoperative time point &#40;Grade 0&#41;&#46; The highest degree of embolism severity &#40;Grade 2 and 3&#41; was observed during insertion of the femoral stem&#44; followed by cementation of the femur and hip alignment &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Mean systolic and diastolic blood pressure decreased between baseline and the remaining intraoperative time points&#44; as is to be expected during spinal anaesthesia with sedation &#40;p&#8239;&#60;&#8239;0&#46;001&#41;&#46; Heart rate&#44; respiratory rate&#44; and oxygen saturation remained stable in 17 of 18 patients &#40;p&#8239;&#62;&#8239;0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; One patient presented significant haemodynamic instability that led to cardiac arrest after grade 3 embolism was observed during stem insertion&#46; This patient required brief cardiopulmonary resuscitation with external cardiac massage and 1&#8239;mg intravenous epinephrine&#44; after which he quickly regained spontaneous circulation and the surgery could be completed&#46; The rapid response to resuscitation precluded the need for more advanced strategies&#44; such as intubation&#44; arterial line&#44; or central venous line&#46; The patient spent the immediate postoperative period in the intensive care area and was discharged with no neurological sequelae&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">This results of this prospective exploratory study suggest that ultrasound can be used to monitor embolic phenomena through a subcostal window of the IVC&#46; We were able to obtain the window in 90&#37; of patients undergoing hip replacement surgery in the supine position&#44; and the severity of embolization assessed on a 0&#8211;3 scale showed high intra- and inter-observer reliability &#40;or reproducibility&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In joint replacement surgery&#44; emboli consist of bone and soft tissue mixed with fresh thrombi&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However&#44; pulmonary cement embolisms were found in 46&#46;3&#37; of cases in a post mortem study of patients undergoing cemented hip and knee arthroplasty&#46; Although this was not considered a cause of death or even a contributing factor&#44; it shows that cement is a potential component of embolic material&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> There is also an isolated report of a cement embolus perforating the wall of the right atrium after hip replacement&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Cementation is associated with a significant exothermic reaction with increased pressure in the medullary cavity of the femur and penetration of bone tissue causing mild to severe cardiovascular reactions&#44; increased pulmonary vascular resistance&#44; increased right ventricular afterload&#44; and possible hypotension&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">In certain patients with severe cardiac pathology &#40;for example severe aortic stenosis&#41;&#44; it may be safer to perform surgery under general anaesthesia and invasive monitoring&#44; and in these cases TOE can be performed&#46; TOE is routinely used during non-cardiac surgery in many operating rooms&#44; and is now considered a useful and safe tool&#46; For other patients&#44; however&#44; spinal anaesthesia with mild sedation is a highly popular option in orthopaedic surgery&#44; and TOE can be difficult in these cases&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Assessment of the IVC through a subcostal window has been used as an indirect indicator of intravascular volume status and haemodynamic response to intravenous fluids&#44; but this is the first time this technique has been used to monitor perioperative embolic phenomena&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12&#44;13</span></a> The subcostal window is less invasive&#44; easy to obtain in both sedated and awake patients&#44; and is probably a more useful diagnostic tool than transoesophageal ultrasound for non-cardiovascular anaesthesiologists&#46; To obtain the subcostal view of the heart&#44; the transducer must be tilted towards the heart&#44; and this can cause discomfort&#46; The IVC view&#44; in contrast&#44; requires little pressure and only a slight tilt&#44; and is therefore more comfortable for the patient&#46; Ultrasound assessment of the IVC during joint arthroplasties could facilitate early diagnosis of severe embolic phenomena that could cause haemodynamic instability and even circulatory collapse&#44; particularly in the case of frail patients&#46; Walker et al&#46; described the use of transthoracic echocardiography to evaluate in-transit thrombi in the right atrium during knee arthroplasty&#44; and found that 85&#37; of patients presented significant particulate matter in the right atrium after release of the tourniquet&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> These authors performed echocardiography in 5 views prior to surgery&#44; and then chose the best view for evaluating the right atrium in each patient &#40;apical or subcostal&#41;&#46; The severity of the embolism was assessed using a computer-based luminosity index that analysed the maximum absolute increase in luminosity after release of the tourniquet and the area under the curve&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> As these measurements were performed after surgery&#44; they cannot guide intraoperative management and are not easily applicable in routine practice&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> We suggest using a single window &#40;subcostal IVC&#41; obtained in real time using a convex transducer&#44; and rating the severity of echogenic embolization using a previously described qualitative scale that we adapted for this purpose&#46; This allowed us to assess our findings at the point of care&#44; which is the primary objective of perioperative ultrasound&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The high intra- and inter-observer reliability values obtained in our study suggest that ultrasound monitoring of the IVC using the qualitative Pitto severity scale is a highly reliable and reproducible technique for identifying intraoperative embolisms&#46; The incidence of embolic events &#40;95&#37;&#41; and severe embolism &#40;50&#37;&#41; in our study is similar to results from previously studies using TOE&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Regarding physiological parameters&#44; only 1 patient developed significant haemodynamic instability that led to cardiac arrest and required brief cardiopulmonary resuscitation&#46; In this case&#44; persistent Grade 3 embolism observed during insertion of the femoral stem placed the surgical team on high alert&#44; and they were therefore able to take immediate effective action seconds before the extent of the instability became evident on standard monitoring&#46; The remaining patients remained stable during surgery - an observation consistent with previous literature&#46; The statistically significant differences in blood pressure values between baseline and intraoperative time points are to be expected given the sympathetic blockade caused by spinal anaesthesia&#59; however&#44; there were no significant overall differences in physiological parameters at intraoperative time points associated with a higher risk of embolisms&#44; such as&#44; insertion of the stem&#44; cementing of the femur&#44; and alignment of the hip&#46; These 3 intraoperative time points with the highest embolic risk have previously been described by Hagio et al&#46; with the use of transoesophageal ultrasound&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is interesting to note that these authors reported a decrease in oxygen saturation&#44; blood pressure&#44; and heart rate in 2 patients presenting Grade 3 embolism that did not result in major complications&#46; Other authors have reported using transthoracic ultrasound to diagnose fat embolism as the cause of haemodynamic collapse in the postoperative period of hip arthroplasty&#46; This is further evidence of the usefulness of this tool in identifying the cause of cardiac arrest and guiding cardiopulmonary resuscitation&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Although the use of ultrasound to diagnose embolisms during arthroplasties is not common practice&#44; selective monitoring could be useful in frail patients in whom the haemodynamic impact is likely to be greater&#44; particularly during intraoperative time points associated with a higher degree of embolism&#46; This could also alert the surgical team of the need to change the technique in order to reduce the degree of embolization&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">This study has several limitations&#46; First&#44; patients with a body mass index above 40&#8239;kg&#47;m<span class="elsevierStyleSup">2</span> were not included&#59; the subcostal window could be more difficult to obtain in obese patients&#46; Second&#44; only patients undergoing hip joint replacement in the supine position were included&#59; therefore&#44; the applicability of our findings in surgeries in the lateral decubitus position remains unclear&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study suggests that ultrasound monitoring of the IVC can be used to evaluate embolic events during cemented hip joint replacement&#44; and the qualitative embolism severity assessment scale is highly reproducible and has high intra- and inter-observer reliability&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Key points</span><p id="par0195" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0200" class="elsevierStylePara elsevierViewall">We show that monitoring the inferior vena cava through a single subcostal window can detect the presence of embolic material from the lower limbs&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Prospective exploratory study&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0210" class="elsevierStylePara elsevierViewall">We studied 20 patients undergoing hip arthroplasty in the supine position&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0215" class="elsevierStylePara elsevierViewall">We were able to obtain the window in 90&#37; of patients &#40;n&#8239;&#61;&#8239;18&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0220" class="elsevierStylePara elsevierViewall">We adapted a previously described qualitative 0 to 3 grade scale to evaluate the severity of the embolism&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0225" class="elsevierStylePara elsevierViewall">This scale proved to be highly reliable &#40;kappa score &#62;&#8239;0&#46;80&#41;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8226;</span><p id="par0230" class="elsevierStylePara elsevierViewall">This real-time ultrasound monitoring technique can contribute to the early detection of embolic phenomena&#46; This could be clinically useful&#44; particularly in elderly patients or patients with underlying pathologies&#46;</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleGrantSponsor" id="gs1">Internal departmental</span> funding</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interests</span><p id="par0240" class="elsevierStylePara elsevierViewall">Alejandro Corujo&#44; Gonzalo Irizaga&#44; Laura Gir&#243;n-Arango&#44; Natalia Pandolfo and Manuel Mart&#237;nez have no conflicts of interest to declare&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Anah&#237; Perlas receives academic support from a Merit Award from the Department of Anaesthesiology and Pain Medicine at the University of Toronto&#46; She also does consulting work for FUJIFILM Sonosite</p></span></span>"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-03-10"
    "fechaAceptado" => "2023-06-30"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
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          "identificador" => "xpalclavsec1858177"
          "palabras" => array:4 [
            0 => "Ultrasound"
            1 => "Embolism"
            2 => "Arthroplasty"
            3 => "Inferior vena cava"
          ]
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          "palabras" => array:4 [
            0 => "Ultrasonido"
            1 => "Embolismo"
            2 => "Artroplastia"
            3 => "Vena cava inferior"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Embolic phenomena frequently occur during hip joint replacement surgery&#44; and may lead to haemodynamic instability in frail patients&#46; Transoesophageal ultrasound monitoring is rarely available in non-cardiac operating theatres&#44; and cannot be performed in awake patients under spinal anaesthesia&#46; The main objectives of this prospective exploratory study were to determine the feasibility of using an alternative ultrasound approach to monitor the inferior vena cava during hip replacement surgery&#44; and to determine the intra and interobserver reliability of the ultrasound findings&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We conducted a prospective exploratory study in 20 patients undergoing cemented hip arthroplasty in the supine position under spinal anaesthesia and sedation&#46; The inferior vena cava was assessed through a subcostal window at 10 intraoperative time points&#44; and the findings were rated on a qualitative embolism severity scale&#46; The ultrasound images were evaluated by 2 independent observers&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">An adequate subcostal window was obtained in 90&#37; of cases&#46; Intra- and inter-observer reliability was high &#40;kappa index &#62;0&#46;80&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#46; Nearly all &#40;95&#37;&#41; patients presented some degree of embolism&#44; which was severe in 50&#37; of cases&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Our study suggests that ultrasound assessment of embolic phenomena in the inferior vena cava through a subcostal window is feasible in 90&#37; of cases&#46; The qualitative embolic severity rating scale is highly reproducible and has high intra- and inter-observer reliability&#46;</p></span>"
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            "titulo" => "Introduction and objectives"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Los fen&#243;menos emb&#243;licos son frecuentes en los reemplazos articulares de cadera&#44; pudiendo llevar a compromiso hemodin&#225;mico en pacientes fr&#225;giles&#46; La monitorizaci&#243;n sonogr&#225;fica con ecograf&#237;a transesof&#225;gica no est&#225; normalmente disponible en las salas operatorias no-cardiacas y no es aplicable al paciente despierto bajo anestesia raqu&#237;dea&#46; Los objetivos principales de este estudio prospectivo exploratorio son determinar la factibilidad del monitoreo sonogr&#225;fico alternativo de la Vena Cava Inferior durante la cirug&#237;a de reemplazo de cadera y estudiar la fiabilidad intra e interobservador del examen&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio prospectivo exploratorio donde se incluyeron 20 pacientes sometidos a artroplastia de cadera cementada en dec&#250;bito supino bajo anestesia raqu&#237;dea y sedaci&#243;n a los cuales se les realiz&#243; una valoraci&#243;n intraoperatoria de la vena cava inferior a trav&#233;s de una ventana subcostal durante 10 diferentes momentos quir&#250;rgicos aplicando una escala cualitativa de severidad de embolia&#46; Las im&#225;genes de cada caso fueron evaluadas por dos observadores independientes&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Una ventana subcostal adecuada se pudo obtener y monitorizar en el 90&#37; de los casos&#46; La variabilidad intra e inter observador present&#243; un alto &#237;ndice de fiabilidad &#40;&#237;ndice kappa &#62;0&#46;80&#44; p&#8239;&#60;&#8239;0&#44;001&#41;&#46; El 95&#37; de los pacientes present&#243; alg&#250;n grado de embolia&#44; siendo severa en el 50&#37; de estos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio sugiere que el monitoreo sonogr&#225;fico de la Vena Cava Inferior a trav&#233;s de una ventana subcostal es factible para la evaluaci&#243;n de fen&#243;menos emb&#243;licos durante reemplazos articulares de cadera en el 90&#37; de los casos&#46; La escala de valoraci&#243;n cualitativa de severidad de embolia es altamente reproducible con una alta fiabilidad intra e inter observador&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&#8239;&#61;&#8239;18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74&#46;1&#8239;&#177;&#8239;10&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Comorbidities&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intra-Observer 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">92&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intra-Observer total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#8239;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">90&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Inter-Observer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;848&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#8239;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">76&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intraoperative period&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">O<span class="elsevierStyleInf">2</span> &#40;l&#47;m&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Baseline&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">147&#46;8&#8239;&#177;&#8239;5&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">79&#46;1&#8239;&#177;&#8239;3&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">79 &#40;60&#8211;91&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;14&#8211;17&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">98&#46;1&#8239;&#177;&#8239;0&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5&#46;1&#8239;&#177;&#8239;0&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Start&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">120&#46;3&#8239;&#177;&#8239;3&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">63&#46;9&#8239;&#177;&#8239;2&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">77 &#40;70&#8211;86&#41;&nbsp;\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">15 &#40;14&#8211;16&#41;&nbsp;\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
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                  \t\t\t\t">99&#46;3&#8239;&#177;&#8239;0&#46;2&nbsp;\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
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                  \t\t\t\t">4&#46;5&#8239;&#177;&#8239;0&#46;3&nbsp;\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">Dislocation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">119&#46;8&#8239;&#177;&#8239;3&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#46;8&#8239;&#177;&#8239;2&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">77 &#40;69&#8211;87&#41;&nbsp;\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
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                  \t\t\t\t">14 &#40;14&#8211;17&#41;&nbsp;\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
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                  \t\t\t\t">99&#46;5&#8239;&#177;&#8239;0&#46;2&nbsp;\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
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                  \t\t\t\t">4&#46;6&#8239;&#177;&#8239;0&#46;3&nbsp;\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 cup preparation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">111&#46;2&#8239;&#177;&#8239;3&#46;3&nbsp;\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
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                  \t\t\t\t">56&#46;7&#8239;&#177;&#8239;1&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77 &#40;69&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;14&#8211;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&#46;6&#8239;&#177;&#8239;0&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \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">Cup cement&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">119&#46;3&#8239;&#177;&#8239;4&#46;6&nbsp;\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">59&#46;4&#8239;&#177;&#8239;2&#46;0&nbsp;\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">73 &#40;66&#8211;82&#41;&nbsp;\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 &#40;13&#8211;14&#41;&nbsp;\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">99&#46;2&#8239;&#177;&#8239;0&#46;4&nbsp;\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&#46;6&#8239;&#177;&#8239;0&#46;3&nbsp;\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
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                  \t\t\t\t">Femur rasping&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">118&#46;3&#8239;&#177;&#8239;4&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \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">62&#46;0&#8239;&#177;&#8239;2&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \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">76 &#40;64&#8211;84&#41;&nbsp;\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 &#40;17&#8211;17&#41;&nbsp;\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">99&#46;3&#8239;&#177;&#8239;0&#46;2&nbsp;\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&#46;7&#8239;&#177;&#8239;0&#46;3&nbsp;\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">Femur cementing&nbsp;\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
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                  \t\t\t\t">109&#46;5&#8239;&#177;&#8239;8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">59&#46;2&#8239;&#177;&#8239;4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">76 &#40;68&#8211;83&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;14&#8211;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#46;3&#8239;&#177;&#8239;5&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;9&#8239;&#177;&#8239;0&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Stem insertion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">125&#46;9&#8239;&#177;&#8239;4&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#46;9&#8239;&#177;&#8239;2&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">76 &#40;66&#8211;83&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">99&#46;2&#8239;&#177;&#8239;0&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;9&#8239;&#177;&#8239;0&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alignment&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">122&#46;4&#8239;&#177;&#8239;4&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">99&#46;1&#8239;&#177;&#8239;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#46;9&#8239;&#177;&#8239;0&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Exit operating room&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">123&#46;3&#8239;&#177;&#8239;3&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64&#46;8&#8239;&#177;&#8239;2&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;3&#8239;&#177;&#8239;0&#46;4&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Vital signs at different intraoperative time points&#46;</p>"
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        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical features and echocardiography of embolism during cemented hip arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46;D&#46; Lafont"
                            1 => "M&#46;K&#46; Kalonji"
                            2 => "J&#46; Barre"
                            3 => "C&#46; Guillaume"
                            4 => "J&#46;G&#46; Boogaerts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF03012997"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Anaesth"
                        "fecha" => "1997"
                        "volumen" => "44"
                        "paginaInicial" => "112"
                        "paginaFinal" => "117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9043721"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Embolic events during total hip arthroplasty&#58; an echocardiographic study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Hagio"
                            1 => "N&#46; Sugano"
                            2 => "M&#46; Takashina"
                            3 => "T&#46; Nishii"
                            4 => "H&#46; Yoshikawa"
                            5 => "T&#46; Ochi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1054/arth.2003.50027"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2003"
                        "volumen" => "18"
                        "paginaInicial" => "186"
                        "paginaFinal" => "192"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12629609"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraoperative embolism and hip arthroplasty&#58; intraoperative transesophageal echocardiographic study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Bisignani"
                            1 => "M&#46; Bisignani"
                            2 => "G&#46;S&#46; Pasquale"
                            3 => "F&#46; Greco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2459/JCM.0b013e32807fb03a"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cardiovasc Med"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "277"
                        "paginaFinal" => "281"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for Reporting Reliability and Agreement Studies &#40;GRRAS&#41; were proposed"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Kottner"
                            1 => "L&#46; Audig&#233;"
                            2 => "S&#46; Brorson"
                            3 => "A&#46; Donner"
                            4 => "B&#46;J&#46; Gajewski"
                            5 => "A&#46; Hrobjartsson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/J.JCLINEPI.2010.03.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Epidemiol"
                        "fecha" => "2011"
                        "volumen" => "64"
                        "paginaInicial" => "96"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21130355"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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                  ]
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              ]
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              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during total hip arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            2 => "J&#46;W&#46; Kuehle"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.2106/00004623-199906000-00010"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Jt Surg"
                        "fecha" => "1999"
                        "volumen" => "81"
                        "paginaInicial" => "831"
                        "paginaFinal" => "843"
                      ]
                    ]
                  ]
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              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The measurement of observer agreement for categorical data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;R&#46; Landis"
                            1 => "G&#46;G&#46; Koch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2307/2529310"
                      "Revista" => array:5 [
                        "tituloSerie" => "Biometrics"
                        "fecha" => "1977"
                        "volumen" => "33"
                        "paginaInicial" => "159"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/843571"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
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                ]
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                      "titulo" => "Relationship between intraoperative transoesophageal echocardiography findings and perfusion lung scintigraphy results on first postoperative day"
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                            3 => "T&#46; Kano"
                            4 => "T&#46; Okawa"
                            5 => "M&#46; Ishibashi"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aei112"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2005"
                        "volumen" => "94"
                        "paginaInicial" => "607"
                        "paginaFinal" => "612"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15749733"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pulmonary cement embolism is frequently observed but not a contributing factor for death in patients with cemented total hip and knee arthroplasty&#58; a postmortem study"
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                        0 => array:2 [
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                            4 => "T&#46; Rolvien"
                            5 => "K&#46; P&#252;schel"
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                        "fecha" => "2022"
                        "volumen" => "46"
                        "paginaInicial" => "1225"
                        "paginaFinal" => "1232"
                        "link" => array:1 [
                          0 => array:2 [
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                        "paginaFinal" => "1048"
                        "link" => array:1 [
                          0 => array:2 [
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                            1 => "A&#46;R&#46; Panchal"
                            2 => "C&#46; Boulger"
                            3 => "A&#46; Vira"
                            4 => "J&#46;J&#46; Bischof"
                            5 => "C&#46; Amick"
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                        0 => array:2 [
                          "etal" => true
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                            3 => "K&#46; Pnagouli"
                            4 => "E&#46; Pistiolo"
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                    0 => array:2 [
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                        "tituloSerie" => "J Clin Ultrasound"
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                        "volumen" => "50"
                        "paginaInicial" => "733"
                        "paginaFinal" => "744"
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                    ]
                  ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Fluid responsiveness assessment using inferior vena cava collapsibility among spontaneously breathing patients&#58; systematic review and meta-analysis"
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                            2 => "B&#46;A&#46;M&#46;P&#46; Besen"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/J.MEDINE.2021.12.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2023"
                        "volumen" => "47"
                        "paginaInicial" => "90"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36272909"
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                ]
              ]
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                      "titulo" => "Evaluation of echogenic emboli during total knee arthroplasty using transthoracic echocardiography"
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                            3 => "W&#46; Bruce"
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                        "tituloSerie" => "Knee Surg Sport Traumatol Arthrosc"
                        "fecha" => "2012"
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                        "paginaInicial" => "2480"
                        "paginaFinal" => "2486"
                      ]
                    ]
                  ]
                ]
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                    0 => array:2 [
                      "titulo" => "Focused assessed transthoracic echocardiography for the diagnosis of fat embolism in an orthopedic patient with hip hemiarthroplasty"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1053/j.jvca.2014.03.001"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cardiothorac Vasc Anesth"
                        "fecha" => "2014"
                        "volumen" => "28"
                        "paginaInicial" => "e40"
                        "paginaFinal" => "e41"
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