Monitoring intraoperative neuromuscular blockade and blood pressure with one device (TOF-Cuff): A comparative study with mechanomyography and invasive blood pressure | Revista Española de Anestesiología y Reanimación (English Edition)

array:24 ["pii" => "S234119291730152X" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.09.002" "estado" => "S300" "fechaPublicacion" => "2017-12-01" "aid" => "819" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2017;64:560-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935617301068" "issn" => "00349356" "doi" => "10.1016/j.redar.2017.03.013" "estado" => "S300" "fechaPublicacion" => "2017-12-01" "aid" => "819" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Anestesiol Reanim. 2017;64:560-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 175 "formatos" => array:2 [ "HTML" => 146 "PDF" => 29 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "560" "paginaFinal" => "567" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Monitoring intraoperative neuromuscular blockade and blood pressure with one device (TOF-Cuff): A comparative study with mechanomyography and invasive blood pressure" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 540 "Ancho" => 1600 "Tamanyo" => 139392 ] ] "descripcion" => array:1 [ "es" => "Manguito TOF-Cuff y monitor con 3 canales de entrada: PANI, monitorización neuromuscular mediante TOF-Cuff y MMG." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Veiga Ruiz, J. García Cayuela, J. Orozco Montes, M. Parreño Caparrós, B. García Rojo, J.L. Aguayo Albasini" "autores" => array:6 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Veiga Ruiz" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "García Cayuela" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Orozco Montes" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Parreño Caparrós" ] 4 => array:2 [ "nombre" => "B." "apellidos" => "García Rojo" ] 5 => array:2 [ "nombre" => "J.L." "apellidos" => "Aguayo Albasini" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S234119291730152X" "doi" => "10.1016/j.redare.2017.09.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119291730152X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617301068?idApp=UINPBA00004N" "url" => "/00349356/0000006400000010/v1_201711141119/S0034935617301068/v1_201711141119/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2341192917301555" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.09.005" "estado" => "S300" "fechaPublicacion" => "2017-12-01" "aid" => "824" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2017;64:568-76" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Ultrasound-guided genicular nerve block for pain control after total knee replacement: Preliminary case series and technical note" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "568" "paginaFinal" => "576" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bloqueo ecoguiado de los nervios geniculados en el manejo analgésico de la artroplastia de rodilla: descripción de la técnica y resultados clínicos preliminares" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1846 "Ancho" => 2486 "Tamanyo" => 125524 ] ] "descripcion" => array:1 [ "en" => "Postoperative pain scores according to the numerical scale in the postanaesthesia care unit (PACU) after complete reversal of the subarachnoid block (chart A) and at 12h (chart B). Data shown as percentage of patients with each pain score." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. González Sotelo, F. Maculé, J. Minguell, R. Bergé, C. Franco, X. Sala-Blanch" "autores" => array:6 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "González Sotelo" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Maculé" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Minguell" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Bergé" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Franco" ] 5 => array:2 [ "nombre" => "X." "apellidos" => "Sala-Blanch" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617301111" "doi" => "10.1016/j.redar.2017.04.001" "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/S0034935617301111?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917301555?idApp=UINPBA00004N" "url" => "/23411929/0000006400000010/v1_201711240853/S2341192917301555/v1_201711240853/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192917301622" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.09.012" "estado" => "S300" "fechaPublicacion" => "2017-12-01" "aid" => "817" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2017;64:550-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Clinical residual symptomatology and associated factors in multiple organ failure survivors: A long-term mortgage" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "550" "paginaFinal" => "559" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sintomatología clínica residual y factores asociados en supervivientes de un fracaso multiorgánico: una hipoteca a largo plazo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2989 "Ancho" => 2233 "Tamanyo" => 469008 ] ] "descripcion" => array:1 [ "en" => "Study flow chart." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Rodríguez-Villar, J.L. Rodríguez-García, J. Arévalo-Serrano, M. Sánchez-Casado, H. Fletcher" "autores" => array:5 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Rodríguez-Villar" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Rodríguez-García" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Arévalo-Serrano" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Sánchez-Casado" ] 4 => array:2 [ "nombre" => "H." "apellidos" => "Fletcher" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617301044" "doi" => "10.1016/j.redar.2017.03.011" "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/S0034935617301044?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917301622?idApp=UINPBA00004N" "url" => "/23411929/0000006400000010/v1_201711240853/S2341192917301622/v1_201711240853/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Monitoring intraoperative neuromuscular blockade and blood pressure with one device (TOF-Cuff): A comparative study with mechanomyography and invasive blood pressure" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "560" "paginaFinal" => "567" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. Veiga Ruiz, J. García Cayuela, J. Orozco Montes, M. Parreño Caparrós, B. García Rojo, J.L. Aguayo Albasini" "autores" => array:6 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Veiga Ruiz" "email" => array:1 [ 0 => "gloriaveiga@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "García Cayuela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Orozco Montes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Parreño Caparrós" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "B." "apellidos" => "García Rojo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "J.L." "apellidos" => "Aguayo Albasini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología, Reanimación y T. del dolor, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía General, Hospital General Morales Meseguer, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 950 "Tamanyo" => 120016 ] ] "descripcion" => array:1 [ "en" => "Placement of MMG for NMB monitoring." ] ] ] "textoCompleto" => "IntroductionNeuromuscular monitoring plays a key role in ensuring the safety of perioperative neuromuscular blocking agents (NMBA) and in reducing the associated respiratory complications. It can be used to determine the timing of tracheal intubation, to adjust the level of neuromuscular blockade (NMB) to the needs of the patient and the type of surgery, to guide the use of NMBA<a class="elsevierStyleCrossRef" href="#bib0005">1</a> reversal agents, and to prevent residual neuromuscular blockade (RNMB).The only reliable method of measuring neuromuscular function is to stimulate an accessible peripheral motor nerve and measure the evoked response of the skeletal muscle thus innervated. Response can be assessed either mechanically and electrically (quantitative monitoring) using, for example, mechanomiography (MMG) (evoked muscle contraction), electromyography (muscle action potential), and acceleromyography (AMG) (thumb acceleration), or by visual or tactile means (subjective or qualitative monitoring). Although MMG at the adductor pollicis is the gold standard, it is impractical in routine surgical practice.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Nevertheless, all quantitative NMB measurement methods are validated in relation to MMG.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a>TargetsThe following objectives were established for our study:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-To compare and validate the neuromuscular relaxation values obtained with TOF-Cuff (modified pressure cuff with stimulation electrodes) against those obtained with MMG (control method) during reversal of NMB (main variable).</li><li class="elsevierStyleListItem" id="lsti0010">-To compare and validate the non-invasive blood pressure measurements (NIBP) obtained with the TOF-Cuff device against invasive blood pressure measured in the radial artery.</li><li class="elsevierStyleListItem" id="lsti0015">-To verify that the TOF-Cuff does not cause injuries or side effects.</li></ul>Material and methodsA single-centre, open label, case-controlled clinical trial in 32 patients scheduled for elective surgery under general anaesthesia in the supine position lasting at least 30min and requiring administration of NMBAs.The TOF-Cuff device was also validated for NIBP monitoring compared to invasive blood pressure at the radial artery (control method) in an additional study in 17 patients. This study was conducted after the foregoing trial.The study was approved by the hospital's Clinical Research Ethics Committee (EC 2013-03 TOF-CUFF-01.doc) and was conducted between October 2013 and March 2014.Inclusion criteria: patients age 18–65 years, ASAI-III, who had previously given their consent by reading and signing the information sheet.Exclusion criteria: patients who refused to give informed consent; patients with concomitant disease that could prevent adherence to study protocol; patients with predicted difficult airway; pregnant women; lactating women; patients receiving drugs that affect neuromuscular transmission.The study consisted of 2 visits: a screening visit that coincided with the preoperative visit, and on the day of surgery, which included pre-anaesthesia workup, anaesthesia follow-up, and a post-anaesthetic visit in the PACU.On the day of surgery, NMB was monitored simultaneously with the TOF-Cuff method and MMG (control method), placing the TOF-Cuff with the electrodes on the brachial plexus at humeral level, and the MMG on the contralateral arm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>During anaesthesia induction, both methods were used simultaneously to evoke muscle response, according to the following pattern: single twitch (ST) delivered at a frequency of 1Hz for 1min, followed by automatic calibration to determine the intensity of the supramaximal stimulus, and then periodic TOF stimulation every 20s with an intensity 5mA higher than the supramaximal stimulus. At that time, the NMBA intubation dose was administered, and endotracheal intubation was performed at maximum blockade. TOF stimulation was continued throughout the intervention, and post-tetanic count was applied manually during the deep NMB phase (TOF=0), at the discretion of the anaesthesiologist. At the end of surgery, when NMB was moderate (TOF ≥ 2) o superficial (TOF>0.1), an NMB reversal agent (neostigmine or sugammadex) was administered. At TOF=0.9, the patients were extubated.The anaesthetic technique used was: premedication with IV midazolam 1–2mg and/or fentanyl 0.5–1μg/kg−1. SatO2, NIBP, ECG and entropy were monitored. Anaesthesia was induced with propofol 2mg/kg−1 and rocuronium 0.6mg/kg−1, and intubation was performed when optimal conditions were achieved (TOF<4). Anaesthesia was maintained with sevofluorane in 50% oxygen/air, with a 1–2% end-tidal concentration and a fresh gas flow of 1–2L, or with target controlled infusion of propofol balanced with remifentanil at 0.1–0.2μg/kg−1/min−1, as required by each patient, to maintain the entropy level between 40 and 60. Boluses of 0.1mg/kg−1 rocuronium were administered if neuromuscular monitoring with MMG showed the need for additional relaxation. Mechanical ventilation was adjusted to maintain normocarbia with an end tidal CO2 of 30–35mm Hg. After surgery, and when NMB was moderate or superficial, sugammadex or neostigmine was administered in alternate patients. Neostigmine was administered at a dose of 0.03–0.06mg/kg−1, while sugammadex was administered at a dose of 2mg/kg−1.After the intervention, patients were transferred to the PACU, where they immediately underwent a preliminary evaluation for the presence of clinical signs of residual blockade, erythema, petechiae, ecchymosis or erosions on the arm where the cuff had been placed, and pain at that level was assessed using a visual analogue scale. A second and final study evaluation was carried out at 4h, also in the PACU.TOF-Cuff specificationsThe study device consists of a modified blood pressure cuff attached to a portable monitor (RGB Medical Devices, Madrid, Spain) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The cuff contains electrodes that stimulate the brachial plexus at the level of the humerus. The electrodes are placed in contact with the skin on the inside of the arm, directly on the path of the nerve branches of the brachial plexus at the level of the musculocutaneous, median and radial nerves.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>The portable monitor has 3 input ports for connection to the TOF-Cuff, invasive blood pressure transducer and MMG, a high resolution TFT screen for graphic and alphanumeric display of measurements, an internal rechargeable battery, and an output port for exporting data to a computer. Stimulation and responses over time are recorded periodically in a log.Statistical analysisThe correlation between the measurements obtained with the study device and the control method was analysed using the Bland and Altman method, which consists of graphically representing the difference between the means of each pair of values, using the correlation coefficient to determine the level of agreement between the 2 methods.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a>ResultsA total of 37 patients selected. Three were excluded due to interference during monitoring (involuntary movement of the MMG monitored arm) and 2 due to incomplete data (loss of connection with the PC); 32 patients (11 men and 21 women) completed the study between October 2013 and March 2014. The mean age was 49.4 years and the mean BMI was 27.2kg/m−2. Four patients were ASA I, 19 were ASA II, and 9 were ASA III (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the results, considering that the current criterion for safe extubation is TOF>0.9 with the TOF-Cuff method, and TOF>0.7 with MMG (main variable).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The specificity and the positive predictive value, important indicators in the decision to extubate, were 91% and 84%, respectively. Thus, in 84% of patients, the TOF-Cuff extubation criteria (TOF>0.9) would be a true value, and in 91% of cases TOF<0.9 on the TOF-Cuff would correspond to TOF<0.7 on MMG, indicating a risk of RNMB and advising against extubation.In <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, the Bland–Altman plot shows the differences between TOF-Cuff and MMG measurements in respect of the means of both measurements. The horizontal lines represent the mean error and the limits of agreement for a 95% confidence level (mean error±1.96 standard deviation). With the TOF-Cuff method, an average error of 4.7 was obtained for TOF>0.7 (limits of −19 and 28 for a 95% confidence level).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>The TOF ratio measured with TOF-Cuff was slightly higher that the MMG measurement, both when sugammadex (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) and neostigmine (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>) were used to reverse NMB.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Nineteen patients were recruited to the complementary study of NIBP monitoring using the TOF-Cuff vs invasive blood pressure, of whom 2 were excluded due to inability to place a radial artery line (No.=17). In order to evaluate the accuracy of TOF-Cuff blood pressure values, measurements were taken simultaneously with the study device, using the invasive blood pressure device as the control method. Slightly over half (55%) of measurements were taken from men, and 45% from women. The mean age was 49.9 years and the mean BMI was 26.2kg/m−2 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Most patients were ASA II, with an arm circumference of between 25 and 35cm, although in 2 patients the circumference was less than 25cm and in other 2 it was greater than 35cm.Systolic and diastolic blood pressure values were compared. Accuracy was determined by calculating the mean error and standard deviation. <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the results obtained.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> shows the Bland–Altman plot for systolic blood pressure (mean error 1.6 and standard deviation 7mmHg) and diastolic blood pressure (mean error −3.4 and standard deviation 6.3mmHg).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>DiscussionObjective, routine monitoring of NMB is the best strategy for reducing incidence of RNMB and its associated respiratory complications, and is widely recommended<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> provided NMBAs<a class="elsevierStyleCrossRef" href="#bib0045">9</a> are used. However, the practice is not widespread in routine clinical practice, mainly due to technical difficulties and the need to optimise surgery times, which do not take into account anaesthesia requirements. The new TOF-Cuff is an easy-to-use, inexpensive NMB monitoring device based on a modified blood pressure cuff. As it does not require immobilisation of the arm, it does not interfere with the surgical process.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>The aim of this study has been to compare 2 neuromuscular monitoring methods, irrespective of other aspects such as pharmacodynamic response to the NMBA. We followed the same guidelines on monitoring depth of neuromuscular blockade used in most similar studies,<a class="elsevierStyleCrossRefs" href="#bib0005">1,11</a> and our methodology and statistical analysis is also comparable to these papers.<a class="elsevierStyleCrossRefs" href="#bib0030">6,12,13</a>Inter-individual response to NMBAs varies greatly, and therefore monitoring NMB during anaesthesia induction can determine the best moment to perform intubation. It also allows anaesthetists to adjust muscle relaxation to the requirements of each patient and each type of intervention. In order to avoid complications, patients should only be extubated once neuromuscular function has been recovered after surgery.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>This study complements the study carried out in 2005 by Rodiera et al. comparing a prototype TOF-Cuff device with a control method (MMG) for neuromuscular monitoring. The authors found a high correlation between both methods.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>A TOF>0.9 measurement on the TOF-Cuff method obtained a specificity of 91% and a positive predictive value of 84%. This is a good result, and is consistent with the values found in NMB monitoring methods currently used in clinical practice (AMG, electromyography). However, much lower values are obtained for NMB reversal (TOF=0.7) (specificity 66% and positive predictive value 71%).Studies performed so far have compared the MMG method with AMG-based devices,<a class="elsevierStyleCrossRefs" href="#bib0065">13,15,16</a> which are the most widely used in routine clinical practice. These studies show a relatively low error but considerable variability in the recovery phase. Other studies that have compared AMG and MMG<a class="elsevierStyleCrossRef" href="#bib0080">16</a> and AMG and electromyography<a class="elsevierStyleCrossRef" href="#bib0060">12</a> have concluded that the same TOF ratio measured with all these devices cannot be used to detect RNMB, since AMG overestimates reversal of NMB. The authors recommend that anaesthesiologists confirm complete reversal using clinical signs before extubating. Therefore, since our study shows that the TOF-Cuff also overestimates TOF in NMB reversal, as is the case when comparing AMG and MMG, the TOF-Cuff device could be as safe as AMG in clinical practice, although neither show the same measurements as MMG. To ensure safe extubation, both a TOF ratio of 0.9 by AMG or TOF-Cuff and an assessment of the clinical situation of the patient should be taken into account.When neostigmine (which is slower-acting than sugammadex) is used for NMB reversal, TOF-Cuff measurements are even higher than measurements in patients receiving sugammadex for reversal. This could be related with the different position of the stimulation electrodes in both methods (MMG is applied to the adductor pollicis, while TOF-Cuff stimulates several muscles innervated by the brachial plexus), since these muscle groups react differently to NMBAs.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Due to its ease of use, simplicity and accessibility, we expect this quantitative NMB monitoring method to become more widely used, enabling such monitoring to become a part of routine surgical practice.No adverse events related to the use of the TOF-Cuff, even on the skin in contact with the electrodes, were observed in our patients, and no patients reported pain after awakening.According to European standard 93/42/EEC, a pressure measuring device must be accurate to within ±5mmHg with a maximum standard deviation±8mmHg. In our study, the accuracy of the TOF-Cuff was within this range.ConclusionsA TOF>0.9 quantified using the TOF-Cuff device showed good correlation with a TOF>0.7 measured with MMG, suggesting that the TOF-Cuff can safely be used in clinical practice. The ease of use and accessibility of the TOF-Cuff device could help to extend the routine use of neuromuscular monitoring, and its use as part of standard operating room monitoring could improve patient safety by reducing the risk of residual blockage. The TOF-Cuff is also valid for measuring NIBP, and was not associated with any adverse events, skin lesions or residual pain.Ethical responsibilitiesProtection of human and animal rightsThe authors declare that the procedures followed adhere to the ethical guidelines of the responsible committee on human experimentation and comply with the Declaration of Helsinki of the World Medical Association.Data confidentialityThe authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications.Right to privacy and informed consentThe authors have obtained the informed consent of all patients and/or subjects included in this manuscript. The informed consent forms can be obtained from the author for correspondence.Conflict of interestsThe authors declare they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres945434" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec918121" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres945435" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec918120" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Targets" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Material and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "TOF-Cuff specifications" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions" ] 10 => array:3 [ "identificador" => "sec0045" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Protection of human and animal rights" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-09-28" "fechaAceptado" => "2017-03-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec918121" "palabras" => array:5 [ 0 => "TOF-Cuff" 1 => "Neuromuscular monitoring" 2 => "Neuromuscular blockade" 3 => "Mechanomyography" 4 => "Muscle relaxants" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec918120" "palabras" => array:5 [ 0 => "TOF-Cuff" 1 => "Monitorización neuromuscular" 2 => "Bloqueo neuromuscular" 3 => "Mecanomiografía" 4 => "Relajantes musculares" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveThe overall objective of the study is to determine the ability of TOF-Cuff device (blood-pressure modified cuff, including stimulation electrodes) to monitor with the same device the non-invasive blood pressure (NIBP) and the depth of a neuromuscular blockade (NMB) induced pharmacologically, by stimulation of the brachial plexus at the humeral level and recording evoked changes in arterial pressure. Material and methodClinical, single-centre, open-controlled study with 32 adult patients ASA I-III for scheduled elective surgery under general anaesthesia in supine position, for the validation of neuromuscular monitoring, comparing the values obtained from neuromuscular relaxation TOF-Cuff with those obtained by mechanomyography (MMG) (control method) during the recovery phase of NMB, when a TOF ratio >0.7 and >0.9 (primary endpoint) were reached respectively. And an additional consecutive study of 17 patients for validation of NIBP monitoring with TOF-Cuff device vs invasive blood pressure measured by an intra-arterial catheter. All data were analysed using the Bland–Altman method. ResultsRecovery from NMB measured with the TOF-Cuff was earlier compared to MMG. Comparing TOF-ratio >0.9 measured with TOF-Cuff vs TOF-ratio >0.7 with MMG, a specificity of 91% and a positive predictive value of 84% were obtained.In NIBP measurement, the mean error and standard deviation of both systolic blood pressure (1.6±7mmHg) and diastolic blood pressure (−3.4±6.3) were within the European accuracy requirements for medical devices. ConclusionsThe TOF-Cuff device has been shown to be valid and safe in the monitoring of NMB and in the measurement of NIBP, with no patient presenting any adverse events, skin-level lesions or residual pain. It is not interchangeable with MMG, having a TOF-ratio >0.9 quantified by the TOF-Cuff device, a good correlation with a TOF-ratio >0.7 on MMG." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoDeterminar la capacidad del dispositivo TOF-Cuff (manguito de presión modificado que incluye electrodos de estimulación) para monitorizar la presión arterial no invasiva (PANI) y el nivel de bloqueo neuromuscular (BNM) inducido farmacológicamente. Material y métodoEstudio observacional, prospectivo, de 32 pacientes adultos ASA I-III programados para cirugía bajo anestesia general, para la validación de la monitorización del BNM con el dispositivo TOF-Cuff vs. mecanomiografía (MMG, método control) durante la fase de recuperación del BNM, cuando se alcanzó un TOF-ratio de 0,9 con TOF-Cuff y de 0,7 con la MMG (variable principal). Para completar el estudio principal se realizó un estudio adicional consecutivo al anterior y que incluyó a 17 pacientes para validar el dispositivo TOF-Cuff en la monitorización de la PANI en comparación con la presión arterial invasiva a nivel de la arteria radial (método control). Los datos fueron analizados mediante el método de Bland-Altman. ResultadosSe produjo un adelanto de la recuperación medida con TOF-Cuff respecto a la mecanomiografía. Al comparar un TOF-ratio>0,9 cuantificado mediante TOF-Cuff con un TOF-ratio>0,7 en la MMG tuvo una especificidad del 91% y un valor predictivo positivo del 84%.En la medición de la PANI, el error medio y la desviación estándar tanto de la presión arterial sistólica (1,6±7mmHg) como diastólica (−3,4±6,3) estuvieron dentro de los requisitos europeos de precisión para aparatos sanitarios. ConclusionesEl dispositivo TOF-Cuff ha mostrado ser válido y seguro en la monitorización del BNM y en la medición de la PANI, no presentando ningún paciente acontecimientos adversos, lesiones a nivel de la piel o dolor residual. No es intercambiable con la MMG, teniendo un TOF-ratio>0,9 cuantificado mediante el dispositivo TOF-Cuff, una buena correlación con un TOF-ratio>0,7 en la MMG." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Veiga Ruiz G, García Cayuela J, Orozco Montes J, Parreño Caparrós M, García Rojo B, Aguayo Albasini JL. Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva. Rev Esp Anestesiol Reanim. 2017;64:560–567." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "This article is part of the Anaesthesiology and Resuscitation Continuing Medical Education Program. An evaluation of the questions on this article can be made through the Internet by accessing the Education Section of the following web page: www.elsevier.es/redar" ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 950 "Tamanyo" => 120016 ] ] "descripcion" => array:1 [ "en" => "Placement of MMG for NMB monitoring." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 540 "Ancho" => 1600 "Tamanyo" => 140143 ] ] "descripcion" => array:1 [ "en" => "TOF-Cuff and monitor with 3 input channels: NIBP, TOF-Cuff neuromuscular monitoring and MMG." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1174 "Ancho" => 2177 "Tamanyo" => 137750 ] ] "descripcion" => array:1 [ "en" => "Bland–Altman plot of TOF values with TOF-Cuff and MMG, when TOF=0.7 on MMG." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 821 "Ancho" => 3031 "Tamanyo" => 195797 ] ] "descripcion" => array:1 [ "en" => "Bland–Altman plot of systolic and diastolic blood pressure measured with TOF-Cuff and invasive blood pressure measurements." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BMI: body mass index; BP: blood pressure; MMG: mechanomiography." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MMG group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BP group \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sample size \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex (men/women) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10/7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m−2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ASA I/II/III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/19/7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/10/4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arm circumference <25cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arm circumference <35cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1600638.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient demographics." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "+LR: positive likelihood ratio; −LR: negative likelihood ratio: Ac: accuracy; MMG: mechanomiography; NPV: negative predictive value; PPV: positive predictive value; Sen; sensitivity; SP: specificity." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sen (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ac (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">+LR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">−LR \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sugammadex (n=16 patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 (92–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (33–57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (62–78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (88–98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 (53–71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.87 (3.21–51.61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57 (0.45–0.72) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neostigmine (n=16 patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 (85–93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (40–54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (63–73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 (76–86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 (57–67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.31 (2.80–6.64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.60 (0.52–0.69) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">All patients (n=32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (87–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (40–52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (64–72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (80–88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 (58–66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.06 (3.35–7.63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.59 (0.52–0.67) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1600636.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "95% confidence interval shown in parentheses." ] ] ] "descripcion" => array:1 [ "en" => "Comparison between TOF>0.9 on TOF-Cuff and TOF>0.7<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> on MMG (NMB reversal level)." ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CI: confidence interval; Dur25: time in minutes from administration of reversal agent to TOF=0.25 on the measuring device; Dur50: time in minutes from administration of reversal agent to TOF=0.5 on the measuring device; Dur70: time in minutes from administration of reversal agent to TOF=0.7 on the measuring device; Dur90: time in minutes from administration of reversal agent to TOF=0.9 on the measuring device; Dur25–70: time in minutes from TOF=0.25 to TOF=0.7 measured on the same device; MMG: mechanomiography; NMB: neuromuscular blockade." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MMG \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TOF-Cuff \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Error \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower CI \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur25 (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur50 (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur70 (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur90 (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur25–70 (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1600637.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Time to NMB reversal measured with TOF-Cuff and MMG using sugammadex as the reversal agent." ] ] 7 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CI: Confidence interval; Dur25: time in minutes from administration of reversal agent to TOF=0.25 on the measuring device; Dur50: time in minutes from administration of reversal agent to TOF=0.5 on the measuring device; Dur70: time in minutes from administration of reversal agent to TOF=0.7 on the measuring device; Dur90: time in minutes from administration of reversal agent to TOF=0.9 on the measuring device; Dur25–70: time in minutes from TOF=0.25 to TOF=0.7 measured on the same device; MMG: mechanomiography; NMB: neuromuscular blockade." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MMG \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TOF-Cuff \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Error \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower CI \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur25 (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.8 (3.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−8.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur50 (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.7 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−9.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur70 (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.0 (7.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.8 (6.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−11.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur90 (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.0 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.5 (9.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−7.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur25–70 (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.9 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.4 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−6.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1600634.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Time to NMB reversal measured with TOF-Cuff and MMG using neostigmine as the reversal agent." ] ] 8 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Value \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of observations \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean error (mmHg) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Standard deviation (mmHg) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Systolic pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">155 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diastolic pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">155 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1600635.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison between TOF-Cuff and invasive blood pressure measurement." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Empleo clínico de bloqueantes neuromusculares y su reversión. Recomendaciones del grupo de expertos de la Sociedad española de Anestesiología, Reanimación y Tratamiento del Dolor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.A. Álvarez-Gómez" 1 => "J.J. Ariño Irujo" 2 => "C.L. Errando Oyonarte" 3 => "F. Martínez Torrente" 4 => "J. Roige i Sole" 5 => "F. Gilsanz Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2009" "volumen" => "56" "paginaInicial" => "616" "paginaFinal" => "627" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20151524" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Residual neuromuscular block: lessons unlearned. Part II: Methods to reduce the risk of residual weakness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.J. Brull" 1 => "G.S. Murphy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e3181da8312" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2010" "volumen" => "111" "paginaInicial" => "129" "paginaFinal" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20442261" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative residual curarization and evidence-based anaesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Viby-Mogensen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2000" "volumen" => "84" "paginaInicial" => "301" "paginaFinal" => "303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10793585" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuromuscular monitoring" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Viby-Mongensen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Anesthesia" "paginaInicial" => "1351" "paginaFinal" => "1366" "edicion" => "5th ed." "serieFecha" => "2000" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Statistical methods for assessing agreement between two methods of clinical measurement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Bland" 1 => "D.G. Altman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2468-1253(16)30077-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1986" "volumen" => "1" "paginaInicial" => "307" "paginaFinal" => "310" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28404201" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measurement error and correlation coefficients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Bland" 1 => "D.G. Altman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br Med J" "fecha" => "1996" "volumen" => "313" "paginaInicial" => "41" "paginaFinal" => "42" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of neuromuscular blockade in ambulatory patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.U. Schreiber" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0000000000000134" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2014" "volumen" => "27" "paginaInicial" => "583" "paginaFinal" => "588" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25251920" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Residual neuromuscular block should, and can be a «never event»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. El-Orbany" 1 => "H.H. Ali" 2 => "A. Baraka" 3 => "M.R. Salem" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000000091" "Revista" => array:5 [ "tituloSerie" => "Anesth Analg" "fecha" => "2014" "volumen" => "118" "paginaInicial" => "691" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24557117" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monitorización del bloqueo neuromuscular. 1.a parte" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Ariño-Irujo" 1 => "A. Calbet-Mañueco" 2 => "P.A. de la Calle-Elguezabal" 3 => "J.M. Velasco-Barrio" 4 => "F.M. López-Timoneda" 5 => "J.R. Ortiz-Gómez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2010" "volumen" => "57" "paginaInicial" => "153" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20422848" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The cuff method: a pilot study of a new method of monitoring neuromuscular function" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Rodiera" 1 => "A. Serradell" 2 => "J.A. Álvarez-Gómez" 3 => "L. Aliaga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-6576.2005.00777.x" "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "2005" "volumen" => "49" "paginaInicial" => "1552" "paginaFinal" => "1558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16223405" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current recommendations for monitoring depth of neuromuscular blockade" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.A. Lien" 1 => "A.F. Kopman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0000000000000132" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2014" "volumen" => "27" "paginaInicial" => "616" "paginaFinal" => "622" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25251919" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New equipment for neuromuscular transmission monitoring: a comparison of the TOF-Guard with the Myograph 2000" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H. Kirkegaard-Nielsen" 1 => "H.S. Helbo-Hansen" 2 => "P. Lindholm" 3 => "H.S. Pedersen" 4 => "J.K. Severinsen" 5 => "M.B. Schmidt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Monit Comput" "fecha" => "1998" "volumen" => "14" "paginaInicial" => "19" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9641852" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuromuscular blockade for optimising surgical conditions during abdominal and gynaecological surgery: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.V. Madsen" 1 => "A.K. Staehr-Rye" 2 => "M.R. Gätke" 3 => "C. Claudius" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/aas.12556" "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "2015" "volumen" => "59" "paginaInicial" => "1" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26059918" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuromuscular blockade improves surgical conditions (NISCO)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Blobner" 1 => "C.G. Frick" 2 => "R.B. Stäuble" 3 => "H. Feussner" 4 => "S.J. Schaller" 5 => "C. Unterbuchner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00464-014-3711-7" "Revista" => array:6 [ "tituloSerie" => "Surg Endosc" "fecha" => "2015" "volumen" => "29" "paginaInicial" => "627" "paginaFinal" => "636" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25125097" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arm-to-arm variation when evaluating neuromuscular block: an analysis of the precision and the bias and agreement between arms when using mechanomyography or acceleromyography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Claudius" 1 => "L.T. Skovgaard" 2 => "J. Viby-Mogensen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aeq162" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2010" "volumen" => "105" "paginaInicial" => "310" "paginaFinal" => "317" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20595196" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An effectiveness study of a new piezoelectric sensor for train-of-four measurement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.E. Kern" 1 => "J.O. Johnson" 2 => "D.R. Westenskow" 3 => "J.A. Orr" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "1994" "volumen" => "78" "paginaInicial" => "978" "paginaFinal" => "982" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8160999" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Corrugator Supercilii, not the orbicularis oculi, reflects rocuroniym neuromuscular blockade at the laryngeal adductor muscles" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Plaud" 1 => "B. Debaine" 2 => "F. Donati" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2001" "volumen" => "95" "paginaInicial" => "96" "paginaFinal" => "101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11465590" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006400000010/v1_201711240853/S234119291730152X/v1_201711240853/en/main.assets" "Apartado" => array:4 [ "identificador" => "34051" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006400000010/v1_201711240853/S234119291730152X/v1_201711240853/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119291730152X?idApp=UINPBA00004N"]

Statistics

Original article

Monitoring intraoperative neuromuscular blockade and blood pressure with one device (TOF-Cuff): A comparative study with mechanomyography and invasive blood pressure

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

G. Veiga Ruiza,

Corresponding author

gloriaveiga@gmail.com

Corresponding author.

, J. García Cayuelaa, J. Orozco Montesa, M. Parreño Caparrósa, B. García Rojoa, J.L. Aguayo Albasinib

a Servicio de Anestesiología, Reanimación y T. del dolor, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain

b Servicio de Cirugía General, Hospital General Morales Meseguer, Murcia, Spain

Read

Times
was read the article

Total PDF

Total HTML

Share statistics

 array:24 [
  "pii" => "S234119291730152X"
  "issn" => "23411929"
  "doi" => "10.1016/j.redare.2017.09.002"
  "estado" => "S300"
  "fechaPublicacion" => "2017-12-01"
  "aid" => "819"
  "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
  "copyrightAnyo" => "2017"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 2017;64:560-7"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0034935617301068"
      "issn" => "00349356"
      "doi" => "10.1016/j.redar.2017.03.013"
      "estado" => "S300"
      "fechaPublicacion" => "2017-12-01"
      "aid" => "819"
      "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Esp Anestesiol Reanim. 2017;64:560-7"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 175
        "formatos" => array:2 [
          "HTML" => 146
          "PDF" => 29
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Monitorizaci&#243;n intraoperatoria del bloqueo neuromuscular y la presi&#243;n arterial con un solo dispositivo &#40;TOF-Cuff&#41;&#58; estudio comparativo con la mecanomiograf&#237;a y la presi&#243;n arterial invasiva"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "560"
            "paginaFinal" => "567"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Monitoring intraoperative neuromuscular blockade and blood pressure with one device &#40;TOF-Cuff&#41;&#58; A comparative study with mechanomyography and invasive blood pressure"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 540
                "Ancho" => 1600
                "Tamanyo" => 139392
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Manguito TOF-Cuff y monitor con 3 canales de entrada&#58; PANI&#44; monitorizaci&#243;n neuromuscular mediante TOF-Cuff y MMG&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "G&#46; Veiga Ruiz, J&#46; Garc&#237;a Cayuela, J&#46; Orozco Montes, M&#46; Parre&#241;o Caparr&#243;s, B&#46; Garc&#237;a Rojo, J&#46;L&#46; Aguayo Albasini"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "G&#46;"
                "apellidos" => "Veiga Ruiz"
              ]
              1 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Garc&#237;a Cayuela"
              ]
              2 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Orozco Montes"
              ]
              3 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Parre&#241;o Caparr&#243;s"
              ]
              4 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "Garc&#237;a Rojo"
              ]
              5 => array:2 [
                "nombre" => "J&#46;L&#46;"
                "apellidos" => "Aguayo Albasini"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S234119291730152X"
          "doi" => "10.1016/j.redare.2017.09.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119291730152X?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617301068?idApp=UINPBA00004N"
      "url" => "/00349356/0000006400000010/v1_201711141119/S0034935617301068/v1_201711141119/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2341192917301555"
    "issn" => "23411929"
    "doi" => "10.1016/j.redare.2017.09.005"
    "estado" => "S300"
    "fechaPublicacion" => "2017-12-01"
    "aid" => "824"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 2017;64:568-76"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2
      "PDF" => 2
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Ultrasound-guided genicular nerve block for pain control after total knee replacement&#58; Preliminary case series and technical note"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "568"
          "paginaFinal" => "576"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Bloqueo ecoguiado de los nervios geniculados en el manejo analg&#233;sico de la artroplastia de rodilla&#58; descripci&#243;n de la t&#233;cnica y resultados cl&#237;nicos preliminares"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1846
              "Ancho" => 2486
              "Tamanyo" => 125524
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Postoperative pain scores according to the numerical scale in the postanaesthesia care unit &#40;PACU&#41; after complete reversal of the subarachnoid block &#40;chart A&#41; and at 12<span class="elsevierStyleHsp" style=""></span>h &#40;chart B&#41;&#46; Data shown as percentage of patients with each pain score&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "V&#46; Gonz&#225;lez Sotelo, F&#46; Macul&#233;, J&#46; Minguell, R&#46; Berg&#233;, C&#46; Franco, X&#46; Sala-Blanch"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Gonz&#225;lez Sotelo"
            ]
            1 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Macul&#233;"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Minguell"
            ]
            3 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Berg&#233;"
            ]
            4 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Franco"
            ]
            5 => array:2 [
              "nombre" => "X&#46;"
              "apellidos" => "Sala-Blanch"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0034935617301111"
        "doi" => "10.1016/j.redar.2017.04.001"
        "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/S0034935617301111?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917301555?idApp=UINPBA00004N"
    "url" => "/23411929/0000006400000010/v1_201711240853/S2341192917301555/v1_201711240853/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2341192917301622"
    "issn" => "23411929"
    "doi" => "10.1016/j.redare.2017.09.012"
    "estado" => "S300"
    "fechaPublicacion" => "2017-12-01"
    "aid" => "817"
    "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 2017;64:550-9"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Clinical residual symptomatology and associated factors in multiple organ failure survivors&#58; A long-term mortgage"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "550"
          "paginaFinal" => "559"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Sintomatolog&#237;a cl&#237;nica residual y factores asociados en supervivientes de un fracaso multiorg&#225;nico&#58; una hipoteca a largo plazo"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2989
              "Ancho" => 2233
              "Tamanyo" => 469008
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Study flow chart&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S&#46; Rodr&#237;guez-Villar, J&#46;L&#46; Rodr&#237;guez-Garc&#237;a, J&#46; Ar&#233;valo-Serrano, M&#46; S&#225;nchez-Casado, H&#46; Fletcher"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Rodr&#237;guez-Villar"
            ]
            1 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "Rodr&#237;guez-Garc&#237;a"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Ar&#233;valo-Serrano"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "S&#225;nchez-Casado"
            ]
            4 => array:2 [
              "nombre" => "H&#46;"
              "apellidos" => "Fletcher"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0034935617301044"
        "doi" => "10.1016/j.redar.2017.03.011"
        "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/S0034935617301044?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917301622?idApp=UINPBA00004N"
    "url" => "/23411929/0000006400000010/v1_201711240853/S2341192917301622/v1_201711240853/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Monitoring intraoperative neuromuscular blockade and blood pressure with one device &#40;TOF-Cuff&#41;&#58; A comparative study with mechanomyography and invasive blood pressure"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "560"
        "paginaFinal" => "567"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "G&#46; Veiga Ruiz, J&#46; Garc&#237;a Cayuela, J&#46; Orozco Montes, M&#46; Parre&#241;o Caparr&#243;s, B&#46; Garc&#237;a Rojo, J&#46;L&#46; Aguayo Albasini"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "G&#46;"
            "apellidos" => "Veiga Ruiz"
            "email" => array:1 [
              0 => "gloriaveiga&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Garc&#237;a Cayuela"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Orozco Montes"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Parre&#241;o Caparr&#243;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "B&#46;"
            "apellidos" => "Garc&#237;a Rojo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "J&#46;L&#46;"
            "apellidos" => "Aguayo Albasini"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Anestesiolog&#237;a&#44; Reanimaci&#243;n y T&#46; del dolor&#44; Hospital General Universitario Santa Luc&#237;a&#44; Cartagena&#44; Murcia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Cirug&#237;a General&#44; Hospital General Morales Meseguer&#44; Murcia&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Monitorizaci&#243;n intraoperatoria del bloqueo neuromuscular y la presi&#243;n arterial con un solo dispositivo &#40;TOF-Cuff&#41;&#58; estudio comparativo con la mecanomiograf&#237;a y la presi&#243;n arterial invasiva"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 697
            "Ancho" => 950
            "Tamanyo" => 120016
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Placement of MMG for NMB monitoring&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Neuromuscular monitoring plays a key role in ensuring the safety of perioperative neuromuscular blocking agents &#40;NMBA&#41; and in reducing the associated respiratory complications&#46; It can be used to determine the timing of tracheal intubation&#44; to adjust the level of neuromuscular blockade &#40;NMB&#41; to the needs of the patient and the type of surgery&#44; to guide the use of NMBA<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reversal agents&#44; and to prevent residual neuromuscular blockade &#40;RNMB&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The only reliable method of measuring neuromuscular function is to stimulate an accessible peripheral motor nerve and measure the evoked response of the skeletal muscle thus innervated&#46; Response can be assessed either mechanically and electrically &#40;quantitative monitoring&#41; using&#44; for example&#44; mechanomiography &#40;MMG&#41; &#40;evoked muscle contraction&#41;&#44; electromyography &#40;muscle action potential&#41;&#44; and acceleromyography &#40;AMG&#41; &#40;thumb acceleration&#41;&#44; or by visual or tactile means &#40;subjective or qualitative monitoring&#41;&#46; Although MMG at the adductor pollicis is the gold standard&#44; it is impractical in routine surgical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Nevertheless&#44; all quantitative NMB measurement methods are validated in relation to MMG&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Targets</span><p id="par0015" class="elsevierStylePara elsevierViewall">The following objectives were established for our study&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0020" class="elsevierStylePara elsevierViewall">To compare and validate the neuromuscular relaxation values obtained with TOF-Cuff &#40;modified pressure cuff with stimulation electrodes&#41; against those obtained with MMG &#40;control method&#41; during reversal of NMB &#40;main variable&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">To compare and validate the non-invasive blood pressure measurements &#40;NIBP&#41; obtained with the TOF-Cuff device against invasive blood pressure measured in the radial artery&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">To verify that the TOF-Cuff does not cause injuries or side effects&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A single-centre&#44; open label&#44; case-controlled clinical trial in 32 patients scheduled for elective surgery under general anaesthesia in the supine position lasting at least 30<span class="elsevierStyleHsp" style=""></span>min and requiring administration of NMBAs&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The TOF-Cuff device was also validated for NIBP monitoring compared to invasive blood pressure at the radial artery &#40;control method&#41; in an additional study in 17 patients&#46; This study was conducted after the foregoing trial&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study was approved by the hospital&#39;s Clinical Research Ethics Committee &#40;EC 2013-03 TOF-CUFF-01&#46;doc&#41; and was conducted between October 2013 and March 2014&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Inclusion criteria&#58; patients age 18&#8211;65 years&#44; ASAI-III&#44; who had previously given their consent by reading and signing the information sheet&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Exclusion criteria&#58; patients who refused to give informed consent&#59; patients with concomitant disease that could prevent adherence to study protocol&#59; patients with predicted difficult airway&#59; pregnant women&#59; lactating women&#59; patients receiving drugs that affect neuromuscular transmission&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The study consisted of 2 visits&#58; a screening visit that coincided with the preoperative visit&#44; and on the day of surgery&#44; which included pre-anaesthesia workup&#44; anaesthesia follow-up&#44; and a post-anaesthetic visit in the PACU&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">On the day of surgery&#44; NMB was monitored simultaneously with the TOF-Cuff method and MMG &#40;control method&#41;&#44; placing the TOF-Cuff with the electrodes on the brachial plexus at humeral level&#44; and the MMG on the contralateral arm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">During anaesthesia induction&#44; both methods were used simultaneously to evoke muscle response&#44; according to the following pattern&#58; single twitch &#40;ST&#41; delivered at a frequency of 1<span class="elsevierStyleHsp" style=""></span>Hz for 1<span class="elsevierStyleHsp" style=""></span>min&#44; followed by automatic calibration to determine the intensity of the supramaximal stimulus&#44; and then periodic TOF stimulation every 20<span class="elsevierStyleHsp" style=""></span>s with an intensity 5<span class="elsevierStyleHsp" style=""></span>mA higher than the supramaximal stimulus&#46; At that time&#44; the NMBA intubation dose was administered&#44; and endotracheal intubation was performed at maximum blockade&#46; TOF stimulation was continued throughout the intervention&#44; and post-tetanic count was applied manually during the deep NMB phase &#40;TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41;&#44; at the discretion of the anaesthesiologist&#46; At the end of surgery&#44; when NMB was moderate &#40;TOF &#8805; 2&#41; o superficial &#40;TOF<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#41;&#44; an NMB reversal agent &#40;neostigmine or sugammadex&#41; was administered&#46; At TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#44; the patients were extubated&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The anaesthetic technique used was&#58; premedication with IV midazolam 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mg and&#47;or fentanyl 0&#46;5&#8211;1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg<span class="elsevierStyleSup">&#8722;1</span>&#46; SatO<span class="elsevierStyleInf">2</span>&#44; NIBP&#44; ECG and entropy were monitored&#46; Anaesthesia was induced with propofol 2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg<span class="elsevierStyleSup">&#8722;1</span> and rocuronium 0&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;kg<span class="elsevierStyleSup">&#8722;1</span>&#44; and intubation was performed when optimal conditions were achieved &#40;TOF<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&#41;&#46; Anaesthesia was maintained with sevofluorane in 50&#37; oxygen&#47;air&#44; with a 1&#8211;2&#37; end-tidal concentration and a fresh gas flow of 1&#8211;2<span class="elsevierStyleHsp" style=""></span>L&#44; or with target controlled infusion of propofol balanced with remifentanil at 0&#46;1&#8211;0&#46;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg<span class="elsevierStyleSup">&#8722;1</span>&#47;min<span class="elsevierStyleSup">&#8722;1</span>&#44; as required by each patient&#44; to maintain the entropy level between 40 and 60&#46; Boluses of 0&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg<span class="elsevierStyleSup">&#8722;1</span> rocuronium were administered if neuromuscular monitoring with MMG showed the need for additional relaxation&#46; Mechanical ventilation was adjusted to maintain normocarbia with an end tidal CO<span class="elsevierStyleInf">2</span> of 30&#8211;35<span class="elsevierStyleHsp" style=""></span>mm Hg&#46; After surgery&#44; and when NMB was moderate or superficial&#44; sugammadex or neostigmine was administered in alternate patients&#46; Neostigmine was administered at a dose of 0&#46;03&#8211;0&#46;06<span class="elsevierStyleHsp" style=""></span>mg&#47;kg<span class="elsevierStyleSup">&#8722;1</span>&#44; while sugammadex was administered at a dose of 2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg<span class="elsevierStyleSup">&#8722;1</span>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">After the intervention&#44; patients were transferred to the PACU&#44; where they immediately underwent a preliminary evaluation for the presence of clinical signs of residual blockade&#44; erythema&#44; petechiae&#44; ecchymosis or erosions on the arm where the cuff had been placed&#44; and pain at that level was assessed using a visual analogue scale&#46; A second and final study evaluation was carried out at 4<span class="elsevierStyleHsp" style=""></span>h&#44; also in the PACU&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">TOF-Cuff specifications</span><p id="par0085" class="elsevierStylePara elsevierViewall">The study device consists of a modified blood pressure cuff attached to a portable monitor &#40;RGB Medical Devices&#44; Madrid&#44; Spain&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The cuff contains electrodes that stimulate the brachial plexus at the level of the humerus&#46; The electrodes are placed in contact with the skin on the inside of the arm&#44; directly on the path of the nerve branches of the brachial plexus at the level of the musculocutaneous&#44; median and radial nerves&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The portable monitor has 3 input ports for connection to the TOF-Cuff&#44; invasive blood pressure transducer and MMG&#44; a high resolution TFT screen for graphic and alphanumeric display of measurements&#44; an internal rechargeable battery&#44; and an output port for exporting data to a computer&#46; Stimulation and responses over time are recorded periodically in a log&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">The correlation between the measurements obtained with the study device and the control method was analysed using the Bland and Altman method&#44; which consists of graphically representing the difference between the means of each pair of values&#44; using the correlation coefficient to determine the level of agreement between the 2 methods&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">A total of 37 patients selected&#46; Three were excluded due to interference during monitoring &#40;involuntary movement of the MMG monitored arm&#41; and 2 due to incomplete data &#40;loss of connection with the PC&#41;&#59; 32 patients &#40;11 men and 21 women&#41; completed the study between October 2013 and March 2014&#46; The mean age was 49&#46;4 years and the mean BMI was 27&#46;2<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">&#8722;2</span>&#46; Four patients were ASA I&#44; 19 were ASA II&#44; and 9 were ASA III &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the results&#44; considering that the current criterion for safe extubation is TOF<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;9 with the TOF-Cuff method&#44; and TOF<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;7 with MMG &#40;main variable&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The specificity and the positive predictive value&#44; important indicators in the decision to extubate&#44; were 91&#37; and 84&#37;&#44; respectively&#46; Thus&#44; in 84&#37; of patients&#44; the TOF-Cuff extubation criteria &#40;TOF<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#41; would be a true value&#44; and in 91&#37; of cases TOF<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;9 on the TOF-Cuff would correspond to TOF<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;7 on MMG&#44; indicating a risk of RNMB and advising against extubation&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#44; the Bland&#8211;Altman plot shows the differences between TOF-Cuff and MMG measurements in respect of the means of both measurements&#46; The horizontal lines represent the mean error and the limits of agreement for a 95&#37; confidence level &#40;mean error<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;96 standard deviation&#41;&#46; With the TOF-Cuff method&#44; an average error of 4&#46;7 was obtained for TOF<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;7 &#40;limits of &#8722;19 and 28 for a 95&#37; confidence level&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The TOF ratio measured with TOF-Cuff was slightly higher that the MMG measurement&#44; both when sugammadex &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; and neostigmine &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41; were used to reverse NMB&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Nineteen patients were recruited to the complementary study of NIBP monitoring using the TOF-Cuff vs invasive blood pressure&#44; of whom 2 were excluded due to inability to place a radial artery line &#40;No&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&#46; In order to evaluate the accuracy of TOF-Cuff blood pressure values&#44; measurements were taken simultaneously with the study device&#44; using the invasive blood pressure device as the control method&#46; Slightly over half &#40;55&#37;&#41; of measurements were taken from men&#44; and 45&#37; from women&#46; The mean age was 49&#46;9 years and the mean BMI was 26&#46;2<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">&#8722;2</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Most patients were ASA II&#44; with an arm circumference of between 25 and 35<span class="elsevierStyleHsp" style=""></span>cm&#44; although in 2 patients the circumference was less than 25<span class="elsevierStyleHsp" style=""></span>cm and in other 2 it was greater than 35<span class="elsevierStyleHsp" style=""></span>cm&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Systolic and diastolic blood pressure values were compared&#46; Accuracy was determined by calculating the mean error and standard deviation&#46; <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the results obtained&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows the Bland&#8211;Altman plot for systolic blood pressure &#40;mean error 1&#46;6 and standard deviation 7<span class="elsevierStyleHsp" style=""></span>mmHg&#41; and diastolic blood pressure &#40;mean error &#8722;3&#46;4 and standard deviation 6&#46;3<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Objective&#44; routine monitoring of NMB is the best strategy for reducing incidence of RNMB and its associated respiratory complications&#44; and is widely recommended<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> provided NMBAs<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> are used&#46; However&#44; the practice is not widespread in routine clinical practice&#44; mainly due to technical difficulties and the need to optimise surgery times&#44; which do not take into account anaesthesia requirements&#46; The new TOF-Cuff is an easy-to-use&#44; inexpensive NMB monitoring device based on a modified blood pressure cuff&#46; As it does not require immobilisation of the arm&#44; it does not interfere with the surgical process&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The aim of this study has been to compare 2 neuromuscular monitoring methods&#44; irrespective of other aspects such as pharmacodynamic response to the NMBA&#46; We followed the same guidelines on monitoring depth of neuromuscular blockade used in most similar studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;11</span></a> and our methodology and statistical analysis is also comparable to these papers&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;12&#44;13</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Inter-individual response to NMBAs varies greatly&#44; and therefore monitoring NMB during anaesthesia induction can determine the best moment to perform intubation&#46; It also allows anaesthetists to adjust muscle relaxation to the requirements of each patient and each type of intervention&#46; In order to avoid complications&#44; patients should only be extubated once neuromuscular function has been recovered after surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">This study complements the study carried out in 2005 by Rodiera et al&#46; comparing a prototype TOF-Cuff device with a control method &#40;MMG&#41; for neuromuscular monitoring&#46; The authors found a high correlation between both methods&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">A TOF<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;9 measurement on the TOF-Cuff method obtained a specificity of 91&#37; and a positive predictive value of 84&#37;&#46; This is a good result&#44; and is consistent with the values found in NMB monitoring methods currently used in clinical practice &#40;AMG&#44; electromyography&#41;&#46; However&#44; much lower values are obtained for NMB reversal &#40;TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#41; &#40;specificity 66&#37; and positive predictive value 71&#37;&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Studies performed so far have compared the MMG method with AMG-based devices&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;15&#44;16</span></a> which are the most widely used in routine clinical practice&#46; These studies show a relatively low error but considerable variability in the recovery phase&#46; Other studies that have compared AMG and MMG<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and AMG and electromyography<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> have concluded that the same TOF ratio measured with all these devices cannot be used to detect RNMB&#44; since AMG overestimates reversal of NMB&#46; The authors recommend that anaesthesiologists confirm complete reversal using clinical signs before extubating&#46; Therefore&#44; since our study shows that the TOF-Cuff also overestimates TOF in NMB reversal&#44; as is the case when comparing AMG and MMG&#44; the TOF-Cuff device could be as safe as AMG in clinical practice&#44; although neither show the same measurements as MMG&#46; To ensure safe extubation&#44; both a TOF ratio of 0&#46;9 by AMG or TOF-Cuff and an assessment of the clinical situation of the patient should be taken into account&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">When neostigmine &#40;which is slower-acting than sugammadex&#41; is used for NMB reversal&#44; TOF-Cuff measurements are even higher than measurements in patients receiving sugammadex for reversal&#46; This could be related with the different position of the stimulation electrodes in both methods &#40;MMG is applied to the adductor pollicis&#44; while TOF-Cuff stimulates several muscles innervated by the brachial plexus&#41;&#44; since these muscle groups react differently to NMBAs&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Due to its ease of use&#44; simplicity and accessibility&#44; we expect this quantitative NMB monitoring method to become more widely used&#44; enabling such monitoring to become a part of routine surgical practice&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">No adverse events related to the use of the TOF-Cuff&#44; even on the skin in contact with the electrodes&#44; were observed in our patients&#44; and no patients reported pain after awakening&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">According to European standard 93&#47;42&#47;EEC&#44; a pressure measuring device must be accurate to within &#177;5<span class="elsevierStyleHsp" style=""></span>mmHg with a maximum standard deviation<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>mmHg&#46; In our study&#44; the accuracy of the TOF-Cuff was within this range&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0190" class="elsevierStylePara elsevierViewall">A TOF<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;9 quantified using the TOF-Cuff device showed good correlation with a TOF<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;7 measured with MMG&#44; suggesting that the TOF-Cuff can safely be used in clinical practice&#46; The ease of use and accessibility of the TOF-Cuff device could help to extend the routine use of neuromuscular monitoring&#44; and its use as part of standard operating room monitoring could improve patient safety by reducing the risk of residual blockage&#46; The TOF-Cuff is also valid for measuring NIBP&#44; and was not associated with any adverse events&#44; skin lesions or residual pain&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical responsibilities</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal rights</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed adhere to the ethical guidelines of the responsible committee on human experimentation and comply with the Declaration of Helsinki of the World Medical Association&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Data confidentiality</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of all patients and&#47;or subjects included in this manuscript&#46; The informed consent forms can be obtained from the author for correspondence&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interests</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres945434"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and method"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec918121"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres945435"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todo"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec918120"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Targets"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Material and methods"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "TOF-Cuff specifications"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Results"
        ]
        8 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
        ]
        9 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conclusions"
        ]
        10 => array:3 [
          "identificador" => "sec0045"
          "titulo" => "Ethical responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Protection of human and animal rights"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Data confidentiality"
            ]
            2 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflict of interests"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-09-28"
    "fechaAceptado" => "2017-03-30"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec918121"
          "palabras" => array:5 [
            0 => "TOF-Cuff"
            1 => "Neuromuscular monitoring"
            2 => "Neuromuscular blockade"
            3 => "Mechanomyography"
            4 => "Muscle relaxants"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec918120"
          "palabras" => array:5 [
            0 => "TOF-Cuff"
            1 => "Monitorizaci&#243;n neuromuscular"
            2 => "Bloqueo neuromuscular"
            3 => "Mecanomiograf&#237;a"
            4 => "Relajantes musculares"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The overall objective of the study is to determine the ability of TOF-Cuff device &#40;blood-pressure modified cuff&#44; including stimulation electrodes&#41; to monitor with the same device the non-invasive blood pressure &#40;NIBP&#41; and the depth of a neuromuscular blockade &#40;NMB&#41; induced pharmacologically&#44; by stimulation of the brachial plexus at the humeral level and recording evoked changes in arterial pressure&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical&#44; single-centre&#44; open-controlled study with 32 adult patients ASA I-III for scheduled elective surgery under general anaesthesia in supine position&#44; for the validation of neuromuscular monitoring&#44; comparing the values obtained from neuromuscular relaxation TOF-Cuff with those obtained by mechanomyography &#40;MMG&#41; &#40;control method&#41; during the recovery phase of NMB&#44; when a TOF ratio &#62;0&#46;7 and &#62;0&#46;9 &#40;primary endpoint&#41; were reached respectively&#46; And an additional consecutive study of 17 patients for validation of NIBP monitoring with TOF-Cuff device vs invasive blood pressure measured by an intra-arterial catheter&#46; All data were analysed using the Bland&#8211;Altman method&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Recovery from NMB measured with the TOF-Cuff was earlier compared to MMG&#46; Comparing TOF-ratio &#62;0&#46;9 measured with TOF-Cuff vs TOF-ratio &#62;0&#46;7 with MMG&#44; a specificity of 91&#37; and a positive predictive value of 84&#37; were obtained&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In NIBP measurement&#44; the mean error and standard deviation of both systolic blood pressure &#40;1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mmHg&#41; and diastolic blood pressure &#40;&#8722;3&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;3&#41; were within the European accuracy requirements for medical devices&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The TOF-Cuff device has been shown to be valid and safe in the monitoring of NMB and in the measurement of NIBP&#44; with no patient presenting any adverse events&#44; skin-level lesions or residual pain&#46; It is not interchangeable with MMG&#44; having a TOF-ratio &#62;0&#46;9 quantified by the TOF-Cuff device&#44; a good correlation with a TOF-ratio &#62;0&#46;7 on MMG&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Determinar la capacidad del dispositivo TOF-Cuff &#40;manguito de presi&#243;n modificado que incluye electrodos de estimulaci&#243;n&#41; para monitorizar la presi&#243;n arterial no invasiva &#40;PANI&#41; y el nivel de bloqueo neuromuscular &#40;BNM&#41; inducido farmacol&#243;gicamente&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; prospectivo&#44; de 32 pacientes adultos ASA I-<span class="elsevierStyleSmallCaps">III</span> programados para cirug&#237;a bajo anestesia general&#44; para la validaci&#243;n de la monitorizaci&#243;n del BNM con el dispositivo TOF-Cuff vs&#46; mecanomiograf&#237;a &#40;MMG&#44; m&#233;todo control&#41; durante la fase de recuperaci&#243;n del BNM&#44; cuando se alcanz&#243; un TOF-ratio de 0&#44;9 con TOF-Cuff y de 0&#44;7 con la MMG &#40;variable principal&#41;&#46; Para completar el estudio principal se realiz&#243; un estudio adicional consecutivo al anterior y que incluy&#243; a 17 pacientes para validar el dispositivo TOF-Cuff en la monitorizaci&#243;n de la PANI en comparaci&#243;n con la presi&#243;n arterial invasiva a nivel de la arteria radial &#40;m&#233;todo control&#41;&#46; Los datos fueron analizados mediante el m&#233;todo de Bland-Altman&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se produjo un adelanto de la recuperaci&#243;n medida con TOF-Cuff respecto a la mecanomiograf&#237;a&#46; Al comparar un TOF-ratio<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;9 cuantificado mediante TOF-Cuff con un TOF-ratio<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;7 en la MMG tuvo una especificidad del 91&#37; y un valor predictivo positivo del 84&#37;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En la medici&#243;n de la PANI&#44; el error medio y la desviaci&#243;n est&#225;ndar tanto de la presi&#243;n arterial sist&#243;lica &#40;1&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mmHg&#41; como diast&#243;lica &#40;&#8722;3&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;3&#41; estuvieron dentro de los requisitos europeos de precisi&#243;n para aparatos sanitarios&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El dispositivo TOF-Cuff ha mostrado ser v&#225;lido y seguro en la monitorizaci&#243;n del BNM y en la medici&#243;n de la PANI&#44; no presentando ning&#250;n paciente acontecimientos adversos&#44; lesiones a nivel de la piel o dolor residual&#46; No es intercambiable con la MMG&#44; teniendo un TOF-ratio<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;9 cuantificado mediante el dispositivo TOF-Cuff&#44; una buena correlaci&#243;n con un TOF-ratio<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;7 en la MMG&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Veiga Ruiz G&#44; Garc&#237;a Cayuela J&#44; Orozco Montes J&#44; Parre&#241;o Caparr&#243;s M&#44; Garc&#237;a Rojo B&#44; Aguayo Albasini JL&#46; Monitorizaci&#243;n intraoperatoria del bloqueo neuromuscular y la presi&#243;n arterial con un solo dispositivo &#40;TOF-Cuff&#41;&#58; estudio comparativo con la mecanomiograf&#237;a y la presi&#243;n arterial invasiva&#46; Rev Esp Anestesiol Reanim&#46; 2017&#59;64&#58;560&#8211;567&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">This article is part of the Anaesthesiology and Resuscitation Continuing Medical Education Program&#46; An evaluation of the questions on this article can be made through the Internet by accessing the Education Section of the following web page&#58; <span class="elsevierStyleInterRef" id="intr2005" href="http://www.elsevier.es/redar">www&#46;elsevier&#46;es&#47;redar</span></p>"
      ]
    ]
    "multimedia" => array:9 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 697
            "Ancho" => 950
            "Tamanyo" => 120016
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Placement of MMG for NMB monitoring&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 540
            "Ancho" => 1600
            "Tamanyo" => 140143
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">TOF-Cuff and monitor with 3 input channels&#58; NIBP&#44; TOF-Cuff neuromuscular monitoring and MMG&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1174
            "Ancho" => 2177
            "Tamanyo" => 137750
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Bland&#8211;Altman plot of TOF values with TOF-Cuff and MMG&#44; when TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7 on MMG&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 821
            "Ancho" => 3031
            "Tamanyo" => 195797
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Bland&#8211;Altman plot of systolic and diastolic blood pressure measured with TOF-Cuff and invasive blood pressure measurements&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; BP&#58; blood pressure&#59; MMG&#58; mechanomiography&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MMG group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BP group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sample size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex &#40;men&#47;women&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#47;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">&#8722;</span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ASA I&#47;II&#47;III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;19&#47;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;10&#47;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arm circumference &#60;25<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arm circumference &#60;35<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1600638.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Patient demographics&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">&#43;LR&#58; positive likelihood ratio&#59; &#8722;LR&#58; negative likelihood ratio&#58; Ac&#58; accuracy&#59; MMG&#58; mechanomiography&#59; NPV&#58; negative predictive value&#59; PPV&#58; positive predictive value&#59; Sen&#59; sensitivity&#59; SP&#58; specificity&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sen &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ac &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#43;LR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8722;LR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sugammadex &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16 patients&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96 &#40;92&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;33&#8211;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;62&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93 &#40;88&#8211;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;53&#8211;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;87 &#40;3&#46;21&#8211;51&#46;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;57 &#40;0&#46;45&#8211;0&#46;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neostigmine &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16 patients&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;85&#8211;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;40&#8211;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;63&#8211;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;76&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;57&#8211;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;31 &#40;2&#46;80&#8211;6&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;60 &#40;0&#46;52&#8211;0&#46;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">All patients &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91 &#40;87&#8211;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;40&#8211;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;64&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;80&#8211;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;58&#8211;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;06 &#40;3&#46;35&#8211;7&#46;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;59 &#40;0&#46;52&#8211;0&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1600636.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">95&#37; confidence interval shown in parentheses&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Comparison between TOF<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;9 on TOF-Cuff and TOF<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> on MMG &#40;NMB reversal level&#41;&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; Dur<span class="elsevierStyleInf">25</span>&#58; time in minutes from administration of reversal agent to TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;25 on the measuring device&#59; Dur<span class="elsevierStyleInf">50</span>&#58; time in minutes from administration of reversal agent to TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;5 on the measuring device&#59; Dur<span class="elsevierStyleInf">70</span>&#58; time in minutes from administration of reversal agent to TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7 on the measuring device&#59; Dur<span class="elsevierStyleInf">90</span>&#58; time in minutes from administration of reversal agent to TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9 on the measuring device&#59; Dur<span class="elsevierStyleInf">25&#8211;70</span>&#58; time in minutes from TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;25 to TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7 measured on the same device&#59; MMG&#58; mechanomiography&#59; NMB&#58; neuromuscular blockade&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MMG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TOF-Cuff&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Error&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur<span class="elsevierStyleInf">25</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur<span class="elsevierStyleInf">50</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur<span class="elsevierStyleInf">70</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur<span class="elsevierStyleInf">90</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur<span class="elsevierStyleInf">25&#8211;70</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;1 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1600637.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Time to NMB reversal measured with TOF-Cuff and MMG using sugammadex as the reversal agent&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">CI&#58; Confidence interval&#59; Dur<span class="elsevierStyleInf">25</span>&#58; time in minutes from administration of reversal agent to TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;25 on the measuring device&#59; Dur<span class="elsevierStyleInf">50</span>&#58; time in minutes from administration of reversal agent to TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;5 on the measuring device&#59; Dur<span class="elsevierStyleInf">70</span>&#58; time in minutes from administration of reversal agent to TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7 on the measuring device&#59; Dur<span class="elsevierStyleInf">90</span>&#58; time in minutes from administration of reversal agent to TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9 on the measuring device&#59; Dur<span class="elsevierStyleInf">25&#8211;70</span>&#58; time in minutes from TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;25 to TOF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7 measured on the same device&#59; MMG&#58; mechanomiography&#59; NMB&#58; neuromuscular blockade&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MMG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TOF-Cuff&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Error&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur<span class="elsevierStyleInf">25</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8 &#40;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur<span class="elsevierStyleInf">50</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;7 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;6 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur<span class="elsevierStyleInf">70</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;0 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;8 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur<span class="elsevierStyleInf">90</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;0 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;5 &#40;9&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5 &#40;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur<span class="elsevierStyleInf">25&#8211;70</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;9 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;4 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1600634.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Time to NMB reversal measured with TOF-Cuff and MMG using neostigmine as the reversal agent&#46;</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of observations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean error &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Standard deviation &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Systolic pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diastolic pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1600635.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Comparison between TOF-Cuff and invasive blood pressure measurement&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:17 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Empleo cl&#237;nico de bloqueantes neuromusculares y su reversi&#243;n&#46; Recomendaciones del grupo de expertos de la Sociedad espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Tratamiento del Dolor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; &#193;lvarez-G&#243;mez"
                            1 => "J&#46;J&#46; Ari&#241;o Irujo"
                            2 => "C&#46;L&#46; Errando Oyonarte"
                            3 => "F&#46; Mart&#237;nez Torrente"
                            4 => "J&#46; Roige i Sole"
                            5 => "F&#46; Gilsanz Rodr&#237;guez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Anestesiol Reanim"
                        "fecha" => "2009"
                        "volumen" => "56"
                        "paginaInicial" => "616"
                        "paginaFinal" => "627"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20151524"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Residual neuromuscular block&#58; lessons unlearned&#46; Part II&#58; Methods to reduce the risk of residual weakness"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;J&#46; Brull"
                            1 => "G&#46;S&#46; Murphy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ANE.0b013e3181da8312"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2010"
                        "volumen" => "111"
                        "paginaInicial" => "129"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20442261"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postoperative residual curarization and evidence-based anaesthesia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Viby-Mogensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2000"
                        "volumen" => "84"
                        "paginaInicial" => "301"
                        "paginaFinal" => "303"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10793585"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuromuscular monitoring"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Viby-Mongensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Anesthesia"
                        "paginaInicial" => "1351"
                        "paginaFinal" => "1366"
                        "edicion" => "5th ed&#46;"
                        "serieFecha" => "2000"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Statistical methods for assessing agreement between two methods of clinical measurement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Bland"
                            1 => "D&#46;G&#46; Altman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2468-1253(16)30077-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1986"
                        "volumen" => "1"
                        "paginaInicial" => "307"
                        "paginaFinal" => "310"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28404201"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measurement error and correlation coefficients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Bland"
                            1 => "D&#46;G&#46; Altman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br Med J"
                        "fecha" => "1996"
                        "volumen" => "313"
                        "paginaInicial" => "41"
                        "paginaFinal" => "42"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of neuromuscular blockade in ambulatory patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;U&#46; Schreiber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACO.0000000000000134"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2014"
                        "volumen" => "27"
                        "paginaInicial" => "583"
                        "paginaFinal" => "588"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25251920"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Residual neuromuscular block should&#44; and can be a &#171;never event&#187;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; El-Orbany"
                            1 => "H&#46;H&#46; Ali"
                            2 => "A&#46; Baraka"
                            3 => "M&#46;R&#46; Salem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ANE.0000000000000091"
                      "Revista" => array:5 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2014"
                        "volumen" => "118"
                        "paginaInicial" => "691"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24557117"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monitorizaci&#243;n del bloqueo neuromuscular&#46; 1&#46;<span class="elsevierStyleSup">a</span> parte"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Ari&#241;o-Irujo"
                            1 => "A&#46; Calbet-Ma&#241;ueco"
                            2 => "P&#46;A&#46; de la Calle-Elguezabal"
                            3 => "J&#46;M&#46; Velasco-Barrio"
                            4 => "F&#46;M&#46; L&#243;pez-Timoneda"
                            5 => "J&#46;R&#46; Ortiz-G&#243;mez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Anestesiol Reanim"
                        "fecha" => "2010"
                        "volumen" => "57"
                        "paginaInicial" => "153"
                        "paginaFinal" => "160"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20422848"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The cuff method&#58; a pilot study of a new method of monitoring neuromuscular function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Rodiera"
                            1 => "A&#46; Serradell"
                            2 => "J&#46;A&#46; &#193;lvarez-G&#243;mez"
                            3 => "L&#46; Aliaga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-6576.2005.00777.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Scand"
                        "fecha" => "2005"
                        "volumen" => "49"
                        "paginaInicial" => "1552"
                        "paginaFinal" => "1558"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16223405"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current recommendations for monitoring depth of neuromuscular blockade"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;A&#46; Lien"
                            1 => "A&#46;F&#46; Kopman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACO.0000000000000132"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2014"
                        "volumen" => "27"
                        "paginaInicial" => "616"
                        "paginaFinal" => "622"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25251919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New equipment for neuromuscular transmission monitoring&#58; a comparison of the TOF-Guard with the Myograph 2000"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Kirkegaard-Nielsen"
                            1 => "H&#46;S&#46; Helbo-Hansen"
                            2 => "P&#46; Lindholm"
                            3 => "H&#46;S&#46; Pedersen"
                            4 => "J&#46;K&#46; Severinsen"
                            5 => "M&#46;B&#46; Schmidt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Monit Comput"
                        "fecha" => "1998"
                        "volumen" => "14"
                        "paginaInicial" => "19"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9641852"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuromuscular blockade for optimising surgical conditions during abdominal and gynaecological surgery&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;V&#46; Madsen"
                            1 => "A&#46;K&#46; Staehr-Rye"
                            2 => "M&#46;R&#46; G&#228;tke"
                            3 => "C&#46; Claudius"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/aas.12556"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Scand"
                        "fecha" => "2015"
                        "volumen" => "59"
                        "paginaInicial" => "1"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26059918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuromuscular blockade improves surgical conditions &#40;NISCO&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Blobner"
                            1 => "C&#46;G&#46; Frick"
                            2 => "R&#46;B&#46; St&#228;uble"
                            3 => "H&#46; Feussner"
                            4 => "S&#46;J&#46; Schaller"
                            5 => "C&#46; Unterbuchner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00464-014-3711-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Endosc"
                        "fecha" => "2015"
                        "volumen" => "29"
                        "paginaInicial" => "627"
                        "paginaFinal" => "636"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25125097"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arm-to-arm variation when evaluating neuromuscular block&#58; an analysis of the precision and the bias and agreement between arms when using mechanomyography or acceleromyography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Claudius"
                            1 => "L&#46;T&#46; Skovgaard"
                            2 => "J&#46; Viby-Mogensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aeq162"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "310"
                        "paginaFinal" => "317"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20595196"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An effectiveness study of a new piezoelectric sensor for train-of-four measurement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;E&#46; Kern"
                            1 => "J&#46;O&#46; Johnson"
                            2 => "D&#46;R&#46; Westenskow"
                            3 => "J&#46;A&#46; Orr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "1994"
                        "volumen" => "78"
                        "paginaInicial" => "978"
                        "paginaFinal" => "982"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8160999"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Corrugator Supercilii&#44; not the orbicularis oculi&#44; reflects rocuroniym neuromuscular blockade at the laryngeal adductor muscles"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Plaud"
                            1 => "B&#46; Debaine"
                            2 => "F&#46; Donati"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2001"
                        "volumen" => "95"
                        "paginaInicial" => "96"
                        "paginaFinal" => "101"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11465590"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23411929/0000006400000010/v1_201711240853/S234119291730152X/v1_201711240853/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "34051"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006400000010/v1_201711240853/S234119291730152X/v1_201711240853/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119291730152X?idApp=UINPBA00004N"
]