Haemodynamic response and effectiveness of tracheal intubation with Airtraq® versus Macintosh laryngoscope in paediatric patient undergoing elective surgery: Prospective, randomised and blind clinical trial | Revista Española de Anestesiología y Reanimación (English Edition)

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"apellidos" => "Medina-Vera" "email" => array:1 [ 0 => "veraadm@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología, Hospital General del Este «Dr. Domingo Luciani», Caracas, Venezuela" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta hemodinámica y efectividad de la intubación orotraqueal con Airtraq® versus laringoscopio Macintosh en pacientes pediátricos sometidos a cirugía electiva: estudio prospectivo, aleatorizado y ciego" ] ] "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" => 1789 "Ancho" => 2503 "Tamanyo" => 185596 ] ] "descripcion" => array:1 [ "en" => "CONSORT." ] ] ] "textoCompleto" => "IntroductionAirway management (AM) in paediatric patients is a challenge for the anaesthesiologist. The paediatric airway presents major anatomical and physiological differences that increase the complexity of the procedure, and both the equipment and dosages used are far smaller. In recent years, a number of devices have been created to guarantee safe management of the adult airway, but only some of these are suitable for children.<a class="elsevierStyleCrossRef" href="#bib0150">1</a>The Macintosh curved blade, described in 1941 by Robert Macintosh, is the blade most widely used in both paediatric and adult patients. The choice of blade size depends on the age and weight of the patient and the preference of the anaesthesiologist. However, the low success rate and multiple intubation attempts, airway injury, hypoxia, tachycardia, increased intracranial, intraocular and arterial pressure, aspiration and cardiac arrest have limited the routine use of this technique, and now other devices, such as videolaryngoscopes are recommended, particularly in patients with predictors of difficult airway.<a class="elsevierStyleCrossRef" href="#bib0155">2</a>The Airtraq® is a disposable rigid optical laryngoscope that was first marketed in 2005. It is designed to facilitate complete visualisation of the airway throughout the intubation process.<a class="elsevierStyleCrossRef" href="#bib0160">3</a> Its short learning curve and high success rate when compared to the conventional Macintosh laryngoscope make the Airtraq® a useful device in the hands of medical and paramedical personnel. Studies have shown that the Airtraq® requires fewer attempts to achieve correct intubation, shortens the overall time to intubation, requires fewer external manoeuvres to optimise vocal cord vision, and reduces the risk of injury.<a class="elsevierStyleCrossRefs" href="#bib0165">4–6</a>Paediatric Airtraq® devices have recently been released: sizes 1 and 0 for endotracheal tubes of between 3.5 and 5.5mm (with or without inflatable cuff) and 2.5 and 3.5mm internal diameter, respectively.<a class="elsevierStyleCrossRef" href="#bib0180">7</a> However, few studies have evaluated its use in children, and even fewer have described the efficacy and potential complications of this device in the paediatric population. Therefore, we asked the following question: in paediatric AM, is the Airtraq® more effective than the Macintosh laryngoscope, and does it attenuate intubation-induce haemodynamic changes?We hypothesised that the AM with the Airtraq® is more effective and causes less significant haemodynamic changes than the Macintosh laryngoscope in patients aged between 2 and 8 years undergoing scheduled surgery. The main objective of this study was to compare the haemodynamic response and effectiveness of orotracheal intubation using the Airtraq® and Macintosh laryngoscope to secure the airway of paediatric patients aged between 2 and 8 years undergoing scheduled surgery.Patients and methodsThis was a prospective, randomised, blinded study performed in a tertiary hospital. After obtaining the approval of the hospital's ethics committee and informed written consent, 84 ASA I and II patients aged between 2 and 8 years scheduled for laparoscopic cholecystectomy were recruited. All patients with signs of difficult airway (defined as a patient with more than 3 predictors) and with risk of bronchoaspiration were excluded.Patients were randomised to 1 of 2 groups: group M, in which a Macintosh laryngoscope was used for intubation, and group A, in which an Airtraq® device (Prodol Meditec SA, Vizcaya, Spain) was used. For randomisation, a computer generated list of blocks of random numbers was created and reviewed by the person in charge of performing the technique, placed in a sealed envelope, and attached to the patient's history until data collection was completed. The technique was performed by a single anaesthesiologist with more than 50 intubations performed with the Macintosh laryngoscope and Airtraq® device in children in the previous 2 years.Fifteen minutes before entering the operating room, the patients were premedicated with 0.5μgkg−1 clonidine and administered 10mlkg−1 of intravenous Ringer's lactate.On admission to the operating room, patients were monitored using electrocardiography, pulse oximetry, and non-invasive blood pressure, temperature, capnography. Neuromuscular function in the thumb adductor muscle was monitored using an accelerometer with monitor (TOF Watch®-SX monitor, Organon Ireland Ltd., Dublin, Ireland) placed on the ulnar nerve on the ventral side of the patient's left wrist. The chosen stimulus was train-of-four calibrated after 5s and 50Hz tetanic stimulation using the calibration mode, and square wave pulses of 200μs and four 2Hz stimuli at 15s intervals.Preoxygenation was achieved with 100% oxygen at 5l/min for 5min, and anaesthesia was induced with fentanyl 1.5μgkg−1, 1% lidocaine 1mgkg−1 and 2.5mgkg−1 intravenous propofol. With the patient under general anaesthesia, the TOF monitor was calibrated, and once the baseline values were obtained 0.6mgkg−1 rocuronium bromide was administered until TOF 0 was observed, at which time a suitable endotracheal tube (ET) was selected and intubation was performed using either the Macintosh laryngoscope or Airtraq®, according to the previously assigned random sequence. Data were collected by an independent observer, and the intraoperative anaesthetic management was at the discretion of the attending anaesthesiologist.The time to intubation, being the time from insertion of the blade into the patient's mouth until visual confirmation that the ET had passed through the vocal cords, was measured. Correct intubation was confirmed by capnography. We also measured the intubation success rate. A failed intubation was defined as failure to insert the ET into the trachea, or more than 120s to do so. We also measured blood oxygen (SO2), end tidal CO2 (EtCO2), heart rate (HR) and mean (MAP), systolic (SBP) and diastolic (DBP) blood pressure before intubation, and at 1, 2.5 and at 5min after intubation. Patients presenting intubation-induced complications were treated appropriately, and the treatment was recorded in the data collection form. The information was entered and tabulated in a Microsoft Excel version 2016 database.The sample size was calculated to test the primary hypotheses, and was based on a pilot study using the ANOVA test with a statistical power of 90% and an alpha of 0.01 for a total of 32 patients per group. Continuous variables were analysed using mean and standard deviation, and frequencies and percentages were used for nominal variables. The normality of continuous variables was tested using the Shapiro–Wilks test and variables were compared between groups using the non-parametric Mann–Whitney U test. Pearson's chi-square test was used to test nominal variables. Statistical significance was set at p<0.05. The data were analysed with JMP-SAS version 12.ResultsOf the 84 patients included in the study, 3 presented predictors of difficult airway and 1 did not comply with fasting requirements; these 4 subjects were excluded, bringing the final population to 80 patients, as shown in the CONSORT flow chart (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Groups were shown to be well matched in terms of sex, age, height and ASA class; therefore, data did not need to be adjusted for these variables when testing the study hypothesis (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>With regard to changes in haemodynamic parameters, HR was higher at the 1, 2.5 and 5-min post-intubation time points in the M group. This difference was statistically significant (p: 0.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarises SBP, DBP and MAP, showing elevated blood pressure levels in both groups. In the case of SBP, values were higher in the M group compared to the A group at the 1, 2.5 and 5-min time points. This difference was statistically significant (minute 1, p: 0.001; minute 2.5, p: 0.042; minute 5, p: 0.012). DBP was also higher in group M, with statistically significant differences at minutes 1 and 5 (minute 1, p: 0.001; minute 5, p: 0.002), but no difference between groups at minute 2.5 (group A: 57±5mmHg; group M: 57±6mmHg). MAP was higher in group M at minute 1 (group A: 71±6mmHg; group M: 81±4mmHg), but no statistically significant difference was observed at minutes 2.5 and 5.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Changes in SO2 only differed significantly at minute 0, with p 0.019 (group A: 99.3±5mmHg; group M: 98.8±1.3%); EtCO2 showed significant changes at minutes 1 and 2.5, with higher values in group M relative to group A, with p of 0.001 (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows that time to intubation was shorter in group A than group M (18±4 vs 27±7s) and fewer attempts were required (92.7% success at the first attempt vs 40%). Both these differences were statistically significant.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>Complications was observed in 1 patient in group A and in 7 patients in group M, specifically, lesion on the lips and presence of blood residue on the device. However, these differences were not statistically significant.DiscussionOur results show that the Airtraq® optical laryngoscope offers advantages over the traditional Macintosh laryngoscope in the airway management of paediatric patients. The Airtraq® was seen to attenuate haemodynamic changes and to reduce both time to intubation and the number of attempts required. This was clinically significant, since the Airtraq® provoked fewer changes in SO2 and EtCO and fewer complications than the Macintosh.According to the latest (2013) American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway, videolaryngoscopes can be used in routine airway management, when a difficult airway is suspected, or when conventional intubation has failed.<a class="elsevierStyleCrossRef" href="#bib0185">8</a> The Airtraq® is an optical laryngoscope that improves visualisation of the vocal cords without the need to align the oral, pharyngeal and tracheal axes during intubation, and can therefore be used in AM.<a class="elsevierStyleCrossRefs" href="#bib0190">9,10</a>Intubation-induced haemodynamic changes have been widely studied in the literature. Mahjoubifar et al.<a class="elsevierStyleCrossRef" href="#bib0200">11</a> showed that intubation with a Glidescope videolaryngoscope in adults produces less significant changes in blood pressure than the Macintosh laryngoscope, but changes in HR were similar in both groups. Likewise, Maharaj et al.<a class="elsevierStyleCrossRefs" href="#bib0205">12,13</a> in 2 studies, showed that intubation with the Airtraq® in adults reduces haemodynamic stimulation compared to the Macintosh laryngoscope. Only 1 study performed in the paediatric population by Riad et al.<a class="elsevierStyleCrossRef" href="#bib0215">14</a> evaluated haemodynamic changes caused by Airtraq® vs the Macintosh laryngoscope in intubation in patients between 2 and 10 years of age. The study showed significant increases in HR, but no significant differences in blood pressure between groups. Our findings support those of Maharaj et al.,<a class="elsevierStyleCrossRefs" href="#bib0205">12,13</a> and Riad et al.,<a class="elsevierStyleCrossRef" href="#bib0215">14</a> insofar as HR was higher in patients in group M (106±6bpm) vs group A (99±2bpm).Intubation with the Macintosh laryngoscope is more stressful on the airway because greater force must be used to align the axes and improve visualisation of the glottis. This force is not required when using the Airtraq®, which therefore produces less stress response during intubation and attenuates intubation-induced haemodynamic changes, which are generally more exacerbated in the paediatric population.<a class="elsevierStyleCrossRefs" href="#bib0220">15,16</a> According to some studies, the most frequent haemodynamic response during intubation in paediatric patients is bradycardia, because the vagal response is greater in children than adults.<a class="elsevierStyleCrossRef" href="#bib0230">17</a> However, our results, like those of Maharaj et al.,<a class="elsevierStyleCrossRefs" href="#bib0205">12,13</a> and Riad et al.,<a class="elsevierStyleCrossRef" href="#bib0215">14</a> show that the most frequent response was tachycardia. This is probably because the study subjects did not receive succinylcholine as a neuromuscular relaxant, and the subjects were between 2 and 8 years, at which age the nervous system, and hence the sympathetic response, of children is similar to that of adults.With regard to blood pressure, our results are more similar to those of Mahjoubifar et al.,<a class="elsevierStyleCrossRef" href="#bib0200">11</a> and Maharaj et al.,<a class="elsevierStyleCrossRefs" href="#bib0205">12,13</a> who observed statistically significant differences during intubation using both techniques. In our study, we observed greater variations in SBG at 5min after intubation with the Macintosh laryngoscope (104.5±6.5mmHg vs 98±3mmHg); MAP and DBP also varied, but only in the first few minutes after intubation. This could be due to the fact that variations in SBP are more pronounced in the paediatric population, since this determines tissue perfusion.<a class="elsevierStyleCrossRef" href="#bib0235">18</a>Laryngoscopy and intubation produce reflex sympathetic stimulation and are associated with elevated plasma catecholamines, hypertension, bradycardia or tachycardia, myocardial ischaemia, depressed myocardial contractility, ventricular arrhythmias, and intracranial hypertension, which may be aggravated by hypoxia and hypercapnia. These responses may be particularly harmful in children with congenital heart disease, cardiomyopathies and valvulopathies, and can limit coronary reserve, resulting in ischaemia or myocardial dysfunction.<a class="elsevierStyleCrossRef" href="#bib0230">17</a>As can be seen, different studies in airway management in children report contradictory haemodynamic responses. Our main objective was to evaluate this variability, and we have found that response differs significantly between the Airtraq® and the Macintosh laryngoscope.None of our patients presented oxygen desaturation during intubation. This is because pre-oxygenation gave us a safety interval of up to 3min to perform the technique without reducing blood oxygen. In all cases, and irrespective of the intubation device used, the airway was secured within 45s.<a class="elsevierStyleCrossRef" href="#bib0240">19</a>EtCO2 values increased during the first minutes after intubation with the Macintosh laryngoscope (36.6±1.1mmHg vs 31.85±3.15mmHg). This is due to a longer period of apnoea during intubation with this technique vs the Airtraq®.<a class="elsevierStyleCrossRef" href="#bib0245">20</a>The time to intubation and number of attempts with the Airtraq® has been studied in numerous studies in adults and children,<a class="elsevierStyleCrossRefs" href="#bib0250">21–25</a> including manikin studies,<a class="elsevierStyleCrossRef" href="#bib0275">26</a> studies in patients with difficult airway,<a class="elsevierStyleCrossRef" href="#bib0280">27</a> and with craniofacial malformations.<a class="elsevierStyleCrossRef" href="#bib0285">28</a> In their meta-analysis comparing several videolaryngoscopes, including the Airtraq®, with direct laryngoscopy, Sun et al.<a class="elsevierStyleCrossRef" href="#bib0290">29</a> found quite favourable results with the former.The studies carried out by Riad et al.,<a class="elsevierStyleCrossRef" href="#bib0215">14</a> Ali et al.,<a class="elsevierStyleCrossRef" href="#bib0260">23</a> Szarpak et al.,<a class="elsevierStyleCrossRef" href="#bib0275">26</a> and Owada et al.<a class="elsevierStyleCrossRef" href="#bib0280">27</a> show shorter time to intubation with the Airtraq® compared to the Macintosh laryngoscope (22.8 vs 51.6s<a class="elsevierStyleCrossRef" href="#bib0215">14</a>; 34.4 vs 40.1s<a class="elsevierStyleCrossRef" href="#bib0260">23</a>; 17.8 vs 24.5s<a class="elsevierStyleCrossRef" href="#bib0275">26</a>; 40 vs 47s<a class="elsevierStyleCrossRef" href="#bib0280">27</a>), whereas Vlatten et al.,<a class="elsevierStyleCrossRef" href="#bib0265">24</a> and White et al.<a class="elsevierStyleCrossRef" href="#bib0270">25</a> obtained shorter time to intubation with conventional laryngoscopy (22.5 vs 18s<a class="elsevierStyleCrossRef" href="#bib0265">24</a>; 47.3 vs 33.2s<a class="elsevierStyleCrossRef" href="#bib0270">25</a>). In their meta-analysis, Sun et al.<a class="elsevierStyleCrossRef" href="#bib0290">29</a> concluded that time to intubation does not vary significantly between video and conventional laryngoscopy, but point out that their results may not apply to intubation performed under different circumstances. In our study, we observed that the time to intubation with the Airtraq® was significantly shorter than with the Macintosh laryngoscope (18 vs 27s); this is similar to the results reported by Riad et al.,<a class="elsevierStyleCrossRef" href="#bib0215">14</a> Ali et al.,<a class="elsevierStyleCrossRef" href="#bib0260">23</a> and Szarpak et al.,<a class="elsevierStyleCrossRef" href="#bib0275">26</a> while Qwada et al.<a class="elsevierStyleCrossRef" href="#bib0280">27</a> reported far longer times. This could be due to the fact that they evaluated the variable in manikins with predictors of difficult airway, which complicates intubation. The longer time to intubation reported by Vlatten et al.,<a class="elsevierStyleCrossRef" href="#bib0265">24</a> and White et al.<a class="elsevierStyleCrossRef" href="#bib0270">25</a> could be due to lack of experience with the Airtraq® on the part of the attending anaesthesiologists.Our results with regard to the number of attempts to perform intubation are in line with most studies in which the Airtraq® proved to be superior to the Macintosh laryngoscope.<a class="elsevierStyleCrossRefs" href="#bib0260">23,26,27</a>Although complications with the Airtraq® were only observed in 1 patient, namely, blood residue on the device, 7 patients treated with the Macintosh laryngoscope presented complications (4 with lip lesions and 3 with blood residue on the laryngoscope). In our study, as in most others, this difference was not statistically significant.<a class="elsevierStyleCrossRefs" href="#bib0260">23,27–29</a>Our study has several limitations. First, it was not double blinded, because it is clearly impossible to blind the operator to the device used. Second, the study was conducted in children with normal airways, so the results cannot be extrapolated to those with predictors of difficult airway. Third, we did not evaluate visualisation of the glottis or the need for optimisation manoeuvres, since the operator performing the intubations was an anaesthesiologist with experience in the use of both devices. Therefore, further studies that include these variables are needed to evaluate the use of Airtraq® in other scenarios.In conclusion, the Airtraq® is a device that can be used for routine paediatric intubation, as it attenuates intubation-induced haemodynamic changes, reduces the number of attempts required and the time to intubation, and is associated with fewer complications than the Macintosh laryngoscope.Ethical disclosuresProtection of human and animal subjectsThe authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration.Confidentiality of dataThe authors declare that they have adhered to the protocols of their centre of work on patient data publication.Right to privacy and informed consentThe authors must have obtained the informed consent of the patients and /or subjects mentioned in the article. The author for correspondence must be in possession of this document.Conflict of interestThe authors declare they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres978744" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec947841" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres978745" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec947840" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack331999" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-04-19" "fechaAceptado" => "2017-07-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec947841" "palabras" => array:6 [ 0 => "Airway management" 1 => "Intubation" 2 => "Intratracheal" 3 => "Optical device Airtraq®" 4 => "Laryngoscope Macintosh" 5 => "Paediatrics" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec947840" "palabras" => array:6 [ 0 => "Manejo de la vía aérea" 1 => "Intubación" 2 => "Intratraqueal" 3 => "Dispositivo óptico Airtraq®" 4 => "Laringoscopio Macintosh" 5 => "Pediátricos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo compare the haemodynamic response and effectiveness of tracheal intubation with Airtraq® device and Macintosh laryngoscope, for airway management of patients between 2 and 8 years undergoing elective surgery. MethodsA prospective, comparative, randomised and blind clinical trial where the effectiveness of tracheal intubation in 80 paediatric patients undergoing elective surgery was determined. Patients were divided into 2 groups of 40 subjects each: group A, intubated with Airtraq® optical laryngoscope; and group M, intubated with Macintosh laryngoscope. Haemodynamic changes, time and number of attempts at intubation and its complications were evaluated in both. ResultsHeart rate was higher in group M from minute 1 to 5 with statistically significant difference (p: 0.001). The mean, systolic and diastolic blood pressure and EtCO2 values were higher in group M. There were no statistically significant differences in SO2. There was a statistically significant difference in time (group A: 18±4s, group M: 27±7s) and the number of attempts for intubation were lower for group A (p: 0.001). Seven patients in group M had post-intubation complications while only one subject had in group A. ConclusionIntubation with Airtraq® device is more effective than Macintosh laryngoscope in terms of reduction of haemodynamic changes, SO2, EtCO2, time and number of attempts for intubation and complications in paediatric patients undergoing elective surgery." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoComparar la respuesta hemodinámica y efectividad de la intubación orotraqueal mediante los dispositivos Airtraq® y laringoscopio Macintosh, para asegurar la vía aérea de pacientes entre 2 y 8 años sometidos a cirugía electiva. MétodosEstudio con diseño prospectivo, comparativo, aleatorizado y ciego, donde se determinó la efectividad de la intubación orotraqueal en 80 pacientes pediátricos programados para cirugía electiva. Los pacientes fueron divididos en dos grupos de 40 pacientes cada uno: grupo A, intubados con laringoscopio óptico Airtraq®; y, grupo M, intubados con laringoscopio Macintosh. Se evaluó en ambos la respuesta hemodinámica, tiempo y número de intentos para la intubación y sus complicaciones. ResultadosLa frecuencia cardíaca fue mayor en el grupo M del minuto 1 al 5 con diferencia estadísticamente significativa (p: 0,001). Los valores de presión arterial media, sistólica y diastólica y de EtCO2 fueron mayores en el grupo M. No hubo diferencias estadísticamente significativas en cuanto a la saturación de oxígeno. Hubo diferencia estadísticamente significativa en cuanto al tiempo de intubación (grupo A: 18±4 segundos; grupo M: 27±7 segundos) y el número de intentos siendo menor para el grupo A (grupo A: 92,7% y grupo M: 40% al primer intento; p: 0,001). Siete pacientes del grupo M y uno del grupo A presentaron complicaciones posteriores a la intubación. ConclusiónLa intubación con dispositivo Airtraq® es más efectiva que con laringoscopio Macintosh en cuanto a reducción de cambios hemodinámicos, SO2, EtCO2, tiempo y número de intentos para la intubación y complicaciones, en pacientes pediátricos sometidos a cirugía electiva." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Orozco JA, Rojas JL, Medina-Vera AJ. Respuesta hemodinámica y efectividad de la intubación orotraqueal con Airtraq® versus laringoscopio Macintosh en pacientes pediátricos sometidos a cirugía electiva: estudio prospectivo, aleatorizado y ciego. Rev Esp Anestesiol Reanim. 2018;65:24–30." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1789 "Ancho" => 2503 "Tamanyo" => 185596 ] ] "descripcion" => array:1 [ "en" => "CONSORT." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Age, weight and height expressed as mean±standard deviation. Sex and ASA class expressed as frequency and (percentage)." "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">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group A (n=40)</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group M (n=40)</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \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">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">5±2</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">4±2</td><td class="td" title="table-entry " align="left" valign="top">0.249 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Sex</td><td class="td" title="table-entry " align="left" valign="top">0.653 \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">Boys \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(52.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(57.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Girls \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(47.5%) \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><td class="td" title="table-entry " align="left" valign="top">(42.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">17±4</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">18±4</td><td class="td" title="table-entry " align="left" valign="top">0.176 \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">Height (m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">1.05±0.12</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">1.04±0.13</td><td class="td" title="table-entry " align="left" valign="top">0.630 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">ASA</td><td class="td" title="table-entry " align="left" valign="top">0.160 \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">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(72.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(57.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(27.5%) \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><td class="td" title="table-entry " align="left" valign="top">(42.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1658213.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics of the sample." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Values of categorical variables: mean=beats/min; SD=standard deviation; time=min." "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Time \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group A (n=40)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group M (n=40)</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th></tr><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">Mean \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">SD \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 \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">SD \t\t\t\t\t\t\n \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.262 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 \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><td class="td" title="table-entry " align="char" valign="top">113 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 \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><td class="td" title="table-entry " align="char" valign="top">106 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1658210.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient characteristics, by group." ] ] 3 => 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" => "Values of categorical variables: mean=mmHg; SD=standard deviation; time=min." "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Time \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group A (n=40)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group M (n=40)</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th></tr><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">Mean \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">SD \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 \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">SD \t\t\t\t\t\t\n \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Systolic blood pressure</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 \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><td class="td" title="table-entry " align="char" valign="top">98 \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><td class="td" title="table-entry " align="char" valign="top">0.911 \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">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">111 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \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">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.042 \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">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 \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><td class="td" title="table-entry " align="char" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Diastolic blood pressure</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 \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><td class="td" title="table-entry " align="char" valign="top">0.061 \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">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \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">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.968 \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">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Mean arterial pressure</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.154 \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">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \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">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.301 \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">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.088 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1658211.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Changes in blood pressure, by group." ] ] 4 => 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" => "Values of categorical variables: mean blood oxygen=percentage; mean end tidal carbon dioxide mean=mmHg; SD=standard deviation; time=min." "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Time \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group A (n=40)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group M (n=40)</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th></tr><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">Mean \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">SD \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 \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">SD \t\t\t\t\t\t\n \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Blood oxygen</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.3 \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">98.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019 \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">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.4 \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">0.233 \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">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.1 \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">0.203 \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">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.4 \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><td class="td" title="table-entry " align="char" valign="top">98.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.146 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">End tidal carbon dioxide</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.253 \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">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \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">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \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">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.215 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1658212.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Changes in blood oxygen levels and end tidal carbon dioxide, by groups." ] ] 5 => 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:2 [ "leyenda" => "Time to intubation expressed as mean±standard deviation. Number of attempts and intubation-related complications expressed as frequency and (percentage)." "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">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group A (n=40)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group M (n=40)</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \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">Time to intubation (s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">18±4</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">27±7</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Number of intubation attempts</td><td class="td" title="table-entry " align="char" valign="top">0.001 \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">One \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(92.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(40%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Two \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">(7.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Three \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(0.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Four \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(10%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Intubation-related complications</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Injury to lips \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(0.0%) \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">(10%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.124 \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">Blood on the device \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(2.5%) \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">(7.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.608 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1658214.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Number of attempts and presence of intubation-related complications, by groups." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric airway management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. 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Haemodynamic response and effectiveness of tracheal intubation with Airtraq® versus Macintosh laryngoscope in paediatric patient undergoing elective surgery: Prospective, randomised and blind clinical trial

Respuesta hemodinámica y efectividad de la intubación orotraqueal con Airtraq® versus laringoscopio Macintosh en pacientes pediátricos sometidos a cirugía electiva: estudio prospectivo, aleatorizado y ciego

J.A. Orozco, J.L. Rojas, A.J. Medina-Vera

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veraadm@gmail.com

Corresponding author.

Servicio de Anestesiología, Hospital General del Este «Dr. Domingo Luciani», Caracas, Venezuela

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The choice of blade size depends on the age and weight of the patient and the preference of the anaesthesiologist&#46; However&#44; the low success rate and multiple intubation attempts&#44; airway injury&#44; hypoxia&#44; tachycardia&#44; increased intracranial&#44; intraocular and arterial pressure&#44; aspiration and cardiac arrest have limited the routine use of this technique&#44; and now other devices&#44; such as videolaryngoscopes are recommended&#44; particularly in patients with predictors of difficult airway&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The Airtraq<span class="elsevierStyleSup">&#174;</span> is a disposable rigid optical laryngoscope that was first marketed in 2005&#46; It is designed to facilitate complete visualisation of the airway throughout the intubation process&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> Its short learning curve and high success rate when compared to the conventional Macintosh laryngoscope make the Airtraq<span class="elsevierStyleSup">&#174;</span> a useful device in the hands of medical and paramedical personnel&#46; 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1&#37; lidocaine 1<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">&#8722;1</span> and 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">&#8722;1</span> intravenous propofol&#46; With the patient under general anaesthesia&#44; the TOF monitor was calibrated&#44; and once the baseline values were obtained 0&#46;6<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">&#8722;1</span> rocuronium bromide was administered until TOF 0 was observed&#44; at which time a suitable endotracheal tube &#40;ET&#41; was selected and intubation was performed using either the Macintosh laryngoscope or Airtraq<span class="elsevierStyleSup">&#174;</span>&#44; according to the previously assigned random sequence&#46; Data were collected by an independent observer&#44; and the intraoperative anaesthetic management was at the discretion of the attending anaesthesiologist&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The time to intubation&#44; being the time from insertion of the blade into the patient&#39;s mouth until visual confirmation that the ET had passed through the vocal cords&#44; was measured&#46; Correct intubation was confirmed by capnography&#46; We also measured the intubation success rate&#46; A failed intubation was defined as failure to insert the ET into the trachea&#44; or more than 120<span class="elsevierStyleHsp" style=""></span>s to do so&#46; We also measured blood oxygen &#40;SO<span class="elsevierStyleInf">2</span>&#41;&#44; end tidal CO<span class="elsevierStyleInf">2</span> &#40;EtCO<span class="elsevierStyleInf">2</span>&#41;&#44; heart rate &#40;HR&#41; and mean &#40;MAP&#41;&#44; systolic &#40;SBP&#41; and diastolic &#40;DBP&#41; blood pressure before intubation&#44; and at 1&#44; 2&#46;5 and at 5<span class="elsevierStyleHsp" style=""></span>min after intubation&#46; Patients presenting intubation-induced complications were treated appropriately&#44; and the treatment was recorded in the data collection form&#46; The information was entered and tabulated in a Microsoft Excel version 2016 database&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The sample size was calculated to test the primary hypotheses&#44; and was based on a pilot study using the ANOVA test with a statistical power of 90&#37; and an alpha of 0&#46;01 for a total of 32 patients per group&#46; Continuous variables were analysed using mean and standard deviation&#44; and frequencies and percentages were used for nominal variables&#46; The normality of continuous variables was tested using the Shapiro&#8211;Wilks test and variables were compared between groups using the non-parametric Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#46; Pearson&#39;s chi-square test was used to test nominal variables&#46; Statistical significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The data were analysed with JMP-SAS version 12&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Of the 84 patients included in the study&#44; 3 presented predictors of difficult airway and 1 did not comply with fasting requirements&#59; these 4 subjects were excluded&#44; bringing the final population to 80 patients&#44; as shown in the CONSORT flow chart &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Groups were shown to be well matched in terms of sex&#44; age&#44; height and ASA class&#59; therefore&#44; data did not need to be adjusted for these variables when testing the study hypothesis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">With regard to changes in haemodynamic parameters&#44; HR was higher at the 1&#44; 2&#46;5 and 5-min post-intubation time points in the M group&#46; This difference was statistically significant &#40;<span class="elsevierStyleItalic">p</span>&#58; 0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarises SBP&#44; DBP and MAP&#44; showing elevated blood pressure levels in both groups&#46; In the case of SBP&#44; values were higher in the M group compared to the A group at the 1&#44; 2&#46;5 and 5-min time points&#46; This difference was statistically significant &#40;minute 1&#44; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;001&#59; minute 2&#46;5&#44; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;042&#59; minute 5&#44; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;012&#41;&#46; DBP was also higher in group M&#44; with statistically significant differences at minutes 1 and 5 &#40;minute 1&#44; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;001&#59; minute 5&#44; <span class="elsevierStyleItalic">p</span>&#58; 0&#46;002&#41;&#44; but no difference between groups at minute 2&#46;5 &#40;group A&#58; 57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mmHg&#59; group M&#58; 57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46; MAP was higher in group M at minute 1 &#40;group A&#58; 71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mmHg&#59; group M&#58; 81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#44; but no statistically significant difference was observed at minutes 2&#46;5 and 5&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Changes in SO<span class="elsevierStyleInf">2</span> only differed significantly at minute 0&#44; with <span class="elsevierStyleItalic">p</span> 0&#46;019 &#40;group A&#58; 99&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mmHg&#59; group M&#58; 98&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&#37;&#41;&#59; EtCO<span class="elsevierStyleInf">2</span> showed significant changes at minutes 1 and 2&#46;5&#44; with higher values in group M relative to group A&#44; with <span class="elsevierStyleItalic">p</span> of 0&#46;001 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows that time to intubation was shorter in group A than group M &#40;18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 vs 27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>s&#41; and fewer attempts were required &#40;92&#46;7&#37; success at the first attempt vs 40&#37;&#41;&#46; Both these differences were statistically significant&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Complications was observed in 1 patient in group A and in 7 patients in group M&#44; specifically&#44; lesion on the lips and presence of blood residue on the device&#46; However&#44; these differences were not statistically significant&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Our results show that the Airtraq<span class="elsevierStyleSup">&#174;</span> optical laryngoscope offers advantages over the traditional Macintosh laryngoscope in the airway management of paediatric patients&#46; The Airtraq<span class="elsevierStyleSup">&#174;</span> was seen to attenuate haemodynamic changes and to reduce both time to intubation and the number of attempts required&#46; This was clinically significant&#44; since the Airtraq<span class="elsevierStyleSup">&#174;</span> provoked fewer changes in SO<span class="elsevierStyleInf">2</span> and EtCO and fewer complications than the Macintosh&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">According to the latest &#40;2013&#41; American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway&#44; videolaryngoscopes can be used in routine airway management&#44; when a difficult airway is suspected&#44; or when conventional intubation has failed&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> The Airtraq<span class="elsevierStyleSup">&#174;</span> is an optical laryngoscope that improves visualisation of the vocal cords without the need to align the oral&#44; pharyngeal and tracheal axes during intubation&#44; and can therefore be used in AM&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Intubation-induced haemodynamic changes have been widely studied in the literature&#46; Mahjoubifar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> showed that intubation with a Glidescope videolaryngoscope in adults produces less significant changes in blood pressure than the Macintosh laryngoscope&#44; but changes in HR were similar in both groups&#46; Likewise&#44; Maharaj et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12&#44;13</span></a> in 2 studies&#44; showed that intubation with the Airtraq<span class="elsevierStyleSup">&#174;</span> in adults reduces haemodynamic stimulation compared to the Macintosh laryngoscope&#46; Only 1 study performed in the paediatric population by Riad et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> evaluated haemodynamic changes caused by Airtraq<span class="elsevierStyleSup">&#174;</span> vs the Macintosh laryngoscope in intubation in patients between 2 and 10 years of age&#46; The study showed significant increases in HR&#44; but no significant differences in blood pressure between groups&#46; Our findings support those of Maharaj et al&#46;&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12&#44;13</span></a> and Riad et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> insofar as HR was higher in patients in group M &#40;106<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>bpm&#41; vs group A &#40;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>bpm&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Intubation with the Macintosh laryngoscope is more stressful on the airway because greater force must be used to align the axes and improve visualisation of the glottis&#46; This force is not required when using the Airtraq<span class="elsevierStyleSup">&#174;</span>&#44; which therefore produces less stress response during intubation and attenuates intubation-induced haemodynamic changes&#44; which are generally more exacerbated in the paediatric population&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#44;16</span></a> According to some studies&#44; the most frequent haemodynamic response during intubation in paediatric patients is bradycardia&#44; because the vagal response is greater in children than adults&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> However&#44; our results&#44; like those of Maharaj et al&#46;&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12&#44;13</span></a> and Riad et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> show that the most frequent response was tachycardia&#46; This is probably because the study subjects did not receive succinylcholine as a neuromuscular relaxant&#44; and the subjects were between 2 and 8 years&#44; at which age the nervous system&#44; and hence the sympathetic response&#44; of children is similar to that of adults&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">With regard to blood pressure&#44; our results are more similar to those of Mahjoubifar et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> and Maharaj et al&#46;&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12&#44;13</span></a> who observed statistically significant differences during intubation using both techniques&#46; In our study&#44; we observed greater variations in SBG at 5<span class="elsevierStyleHsp" style=""></span>min after intubation with the Macintosh laryngoscope &#40;104&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;5<span class="elsevierStyleHsp" style=""></span>mmHg vs 98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#59; MAP and DBP also varied&#44; but only in the first few minutes after intubation&#46; This could be due to the fact that variations in SBP are more pronounced in the paediatric population&#44; since this determines tissue perfusion&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Laryngoscopy and intubation produce reflex sympathetic stimulation and are associated with elevated plasma catecholamines&#44; hypertension&#44; bradycardia or tachycardia&#44; myocardial ischaemia&#44; depressed myocardial contractility&#44; ventricular arrhythmias&#44; and intracranial hypertension&#44; which may be aggravated by hypoxia and hypercapnia&#46; These responses may be particularly harmful in children with congenital heart disease&#44; cardiomyopathies and valvulopathies&#44; and can limit coronary reserve&#44; resulting in ischaemia or myocardial dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">As can be seen&#44; different studies in airway management in children report contradictory haemodynamic responses&#46; Our main objective was to evaluate this variability&#44; and we have found that response differs significantly between the Airtraq<span class="elsevierStyleSup">&#174;</span> and the Macintosh laryngoscope&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">None of our patients presented oxygen desaturation during intubation&#46; This is because pre-oxygenation gave us a safety interval of up to 3<span class="elsevierStyleHsp" style=""></span>min to perform the technique without reducing blood oxygen&#46; In all cases&#44; and irrespective of the intubation device used&#44; the airway was secured within 45<span class="elsevierStyleHsp" style=""></span>s&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">EtCO<span class="elsevierStyleInf">2</span> values increased during the first minutes after intubation with the Macintosh laryngoscope &#40;36&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1<span class="elsevierStyleHsp" style=""></span>mmHg vs 31&#46;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;15<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46; This is due to a longer period of apnoea during intubation with this technique vs the Airtraq<span class="elsevierStyleSup">&#174;</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The time to intubation and number of attempts with the Airtraq<span class="elsevierStyleSup">&#174;</span> has been studied in numerous studies in adults and children&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">21&#8211;25</span></a> including manikin studies&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> studies in patients with difficult airway&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> and with craniofacial malformations&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> In their meta-analysis comparing several videolaryngoscopes&#44; including the Airtraq<span class="elsevierStyleSup">&#174;</span>&#44; with direct laryngoscopy&#44; Sun et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> found quite favourable results with the former&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The studies carried out by Riad et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Ali et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> Szarpak et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> and Owada et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> show shorter time to intubation with the Airtraq<span class="elsevierStyleSup">&#174;</span> compared to the Macintosh laryngoscope &#40;22&#46;8 vs 51&#46;6<span class="elsevierStyleHsp" style=""></span>s<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a>&#59; 34&#46;4 vs 40&#46;1<span class="elsevierStyleHsp" style=""></span>s<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a>&#59; 17&#46;8 vs 24&#46;5<span class="elsevierStyleHsp" style=""></span>s<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a>&#59; 40 vs 47<span class="elsevierStyleHsp" style=""></span>s<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a>&#41;&#44; whereas Vlatten et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> and White et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> obtained shorter time to intubation with conventional laryngoscopy &#40;22&#46;5 vs 18<span class="elsevierStyleHsp" style=""></span>s<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a>&#59; 47&#46;3 vs 33&#46;2<span class="elsevierStyleHsp" style=""></span>s<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a>&#41;&#46; In their meta-analysis&#44; Sun et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> concluded that time to intubation does not vary significantly between video and conventional laryngoscopy&#44; but point out that their results may not apply to intubation performed under different circumstances&#46; In our study&#44; we observed that the time to intubation with the Airtraq<span class="elsevierStyleSup">&#174;</span> was significantly shorter than with the Macintosh laryngoscope &#40;18 vs 27<span class="elsevierStyleHsp" style=""></span>s&#41;&#59; this is similar to the results reported by Riad et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Ali et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> and Szarpak et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> while Qwada et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> reported far longer times&#46; This could be due to the fact that they evaluated the variable in manikins with predictors of difficult airway&#44; which complicates intubation&#46; The longer time to intubation reported by Vlatten et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> and White et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> could be due to lack of experience with the Airtraq<span class="elsevierStyleSup">&#174;</span> on the part of the attending anaesthesiologists&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Our results with regard to the number of attempts to perform intubation are in line with most studies in which the Airtraq<span class="elsevierStyleSup">&#174;</span> proved to be superior to the Macintosh laryngoscope&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">23&#44;26&#44;27</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Although complications with the Airtraq<span class="elsevierStyleSup">&#174;</span> were only observed in 1 patient&#44; namely&#44; blood residue on the device&#44; 7 patients treated with the Macintosh laryngoscope presented complications &#40;4 with lip lesions and 3 with blood residue on the laryngoscope&#41;&#46; In our study&#44; as in most others&#44; this difference was not statistically significant&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">23&#44;27&#8211;29</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Our study has several limitations&#46; First&#44; it was not double blinded&#44; because it is clearly impossible to blind the operator to the device used&#46; Second&#44; the study was conducted in children with normal airways&#44; so the results cannot be extrapolated to those with predictors of difficult airway&#46; Third&#44; we did not evaluate visualisation of the glottis or the need for optimisation manoeuvres&#44; since the operator performing the intubations was an anaesthesiologist with experience in the use of both devices&#46; Therefore&#44; further studies that include these variables are needed to evaluate the use of Airtraq<span class="elsevierStyleSup">&#174;</span> in other scenarios&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In conclusion&#44; the Airtraq<span class="elsevierStyleSup">&#174;</span> is a device that can be used for routine paediatric intubation&#44; as it attenuates intubation-induced haemodynamic changes&#44; reduces the number of attempts required and the time to intubation&#44; and is associated with fewer complications than the Macintosh laryngoscope&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of human and animal subjects</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confidentiality of data</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to the protocols of their centre of work on patient data publication&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors must have obtained the informed consent of the patients and &#47;or subjects mentioned in the article&#46; The author for correspondence must be in possession of this document&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xack331999"
          "titulo" => "Acknowledgments"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-04-19"
    "fechaAceptado" => "2017-07-10"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec947841"
          "palabras" => array:6 [
            0 => "Airway management"
            1 => "Intubation"
            2 => "Intratracheal"
            3 => "Optical device Airtraq<span class="elsevierStyleSup">&#174;</span>"
            4 => "Laryngoscope Macintosh"
            5 => "Paediatrics"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec947840"
          "palabras" => array:6 [
            0 => "Manejo de la v&#237;a a&#233;rea"
            1 => "Intubaci&#243;n"
            2 => "Intratraqueal"
            3 => "Dispositivo &#243;ptico Airtraq<span class="elsevierStyleSup">&#174;</span>"
            4 => "Laringoscopio Macintosh"
            5 => "Pedi&#225;tricos"
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      "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">To compare the haemodynamic response and effectiveness of tracheal intubation with Airtraq<span class="elsevierStyleSup">&#174;</span> device and Macintosh laryngoscope&#44; for airway management of patients between 2 and 8 years undergoing elective surgery&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective&#44; comparative&#44; randomised and blind clinical trial where the effectiveness of tracheal intubation in 80 paediatric patients undergoing elective surgery was determined&#46; Patients were divided into 2 groups of 40 subjects each&#58; group A&#44; intubated with Airtraq<span class="elsevierStyleSup">&#174;</span> optical laryngoscope&#59; and group M&#44; intubated with Macintosh laryngoscope&#46; Haemodynamic changes&#44; time and number of attempts at intubation and its complications were evaluated in both&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Heart rate was higher in group M from minute 1 to 5 with statistically significant difference &#40;<span class="elsevierStyleItalic">p</span>&#58; 0&#46;001&#41;&#46; The mean&#44; systolic and diastolic blood pressure and EtCO<span class="elsevierStyleInf">2</span> values were higher in group M&#46; There were no statistically significant differences in SO<span class="elsevierStyleInf">2</span>&#46; There was a statistically significant difference in time &#40;group A&#58; 18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>s&#44; group M&#58; 27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>s&#41; and the number of attempts for intubation were lower for group A &#40;<span class="elsevierStyleItalic">p</span>&#58; 0&#46;001&#41;&#46; Seven patients in group M had post-intubation complications while only one subject had in group A&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intubation with Airtraq<span class="elsevierStyleSup">&#174;</span> device is more effective than Macintosh laryngoscope in terms of reduction of haemodynamic changes&#44; SO<span class="elsevierStyleInf">2</span>&#44; EtCO<span class="elsevierStyleInf">2</span>&#44; time and number of attempts for intubation and complications in paediatric patients undergoing elective surgery&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparar la respuesta hemodin&#225;mica y efectividad de la intubaci&#243;n orotraqueal mediante los dispositivos Airtraq<span class="elsevierStyleSup">&#174;</span> y laringoscopio Macintosh&#44; para asegurar la v&#237;a a&#233;rea de pacientes entre 2 y 8 a&#241;os sometidos a cirug&#237;a electiva&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio con dise&#241;o prospectivo&#44; comparativo&#44; aleatorizado y ciego&#44; donde se determin&#243; la efectividad de la intubaci&#243;n orotraqueal en 80 pacientes pedi&#225;tricos programados para cirug&#237;a electiva&#46; Los pacientes fueron divididos en dos grupos de 40 pacientes cada uno&#58; grupo A&#44; intubados con laringoscopio &#243;ptico Airtraq&#174;&#59; y&#44; grupo M&#44; intubados con laringoscopio Macintosh&#46; Se evalu&#243; en ambos la respuesta hemodin&#225;mica&#44; tiempo y n&#250;mero de intentos para la intubaci&#243;n y sus complicaciones&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La frecuencia card&#237;aca fue mayor en el grupo M del minuto 1 al 5 con diferencia estad&#237;sticamente significativa &#40;p&#58; 0&#44;001&#41;&#46; Los valores de presi&#243;n arterial media&#44; sist&#243;lica y diast&#243;lica y de EtCO<span class="elsevierStyleInf">2</span> fueron mayores en el grupo M&#46; No hubo diferencias estad&#237;sticamente significativas en cuanto a la saturaci&#243;n de ox&#237;geno&#46; Hubo diferencia estad&#237;sticamente significativa en cuanto al tiempo de intubaci&#243;n &#40;grupo A&#58; 18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 segundos&#59; grupo M&#58; 27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7 segundos&#41; y el n&#250;mero de intentos siendo menor para el grupo A &#40;grupo A&#58; 92&#44;7&#37; y grupo M&#58; 40&#37; al primer intento&#59; p&#58; 0&#44;001&#41;&#46; Siete pacientes del grupo M y uno del grupo A presentaron complicaciones posteriores a la intubaci&#243;n&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La intubaci&#243;n con dispositivo Airtraq<span class="elsevierStyleSup">&#174;</span> es m&#225;s efectiva que con laringoscopio Macintosh en cuanto a reducci&#243;n de cambios hemodin&#225;micos&#44; SO<span class="elsevierStyleInf">2</span>&#44; EtCO<span class="elsevierStyleInf">2</span>&#44; tiempo y n&#250;mero de intentos para la intubaci&#243;n y complicaciones&#44; en pacientes pedi&#225;tricos sometidos a cirug&#237;a electiva&#46;</p></span>"
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            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Orozco JA&#44; Rojas JL&#44; Medina-Vera AJ&#46; Respuesta hemodin&#225;mica y efectividad de la intubaci&#243;n orotraqueal con Airtraq<span class="elsevierStyleSup">&#174;</span> versus laringoscopio Macintosh en pacientes pedi&#225;tricos sometidos a cirug&#237;a electiva&#58; estudio prospectivo&#44; aleatorizado y ciego&#46; Rev Esp Anestesiol Reanim&#46; 2018&#59;65&#58;24&#8211;30&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group A &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group M &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;57&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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"><span class="elsevierStyleHsp" style=""></span>Girls&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;47&#46;5&#37;&#41;&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><td class="td" title="table-entry  " align="left" valign="top">&#40;42&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group A &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group M &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;262&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&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><td class="td" title="table-entry  " align="char" valign="top">113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&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;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&#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">101&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><td class="td" title="table-entry  " align="char" valign="top">106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&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;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&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;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Values of categorical variables&#58; mean<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>mmHg&#59; SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>standard deviation&#59; time<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>min&#46;</p>"
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            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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group A &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group M &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><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">Mean&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">SD&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&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">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Systolic blood pressure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&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><td class="td" title="table-entry  " align="char" valign="top">98&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><td class="td" title="table-entry  " align="char" valign="top">0&#46;911&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"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&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;001&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"><span class="elsevierStyleHsp" style=""></span>2&#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">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&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;042&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"><span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&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><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&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;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Diastolic blood pressure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&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><td class="td" title="table-entry  " align="char" valign="top">0&#46;061&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"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&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;001&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"><span class="elsevierStyleHsp" style=""></span>2&#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">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&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;968&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"><span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&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;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Mean arterial pressure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&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;154&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"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&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;001&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"><span class="elsevierStyleHsp" style=""></span>2&#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">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&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;301&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"><span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&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;088&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Changes in blood pressure&#44; by group&#46;</p>"
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      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Values of categorical variables&#58; mean blood oxygen<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>percentage&#59; mean end tidal carbon dioxide mean<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>mmHg&#59; SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>standard deviation&#59; time<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>min&#46;</p>"
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              "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group A &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group M &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><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">Mean&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">SD&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&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">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Blood oxygen</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&#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">0&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">End tidal carbon dioxide</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Pediatric airway management"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Santillanes"
                            1 => "M&#46; Gausche-Hill"
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                      "titulo" => "Effectiveness of the C-MAC video laryngoscope in the management of unexpected failed intubations"
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                    0 => array:1 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intubaci&#243;n nasotraqueal con laringoscopio &#243;ptico Airtraq<span class="elsevierStyleSup">&#174;</span> en 2 casos de braquiterapia oral"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Casta&#241;eda"
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                            2 => "A&#46; Bilbao"
                            3 => "J&#46; Jimeno"
                            4 => "M&#46; Batllori"
                            5 => "E&#46; Hijosa"
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                    0 => array:1 [
                      "Revista" => array:5 [
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                      "titulo" => "Comparison of endotracheal intubation with the Airtraq Avant<span class="elsevierStyleSup">&#174;</span> and the Macintosh laryngoscope during intermittent or continuous chest compression&#58; a randomized&#44; crossover study in manikins"
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                            4 => "L&#46; Szarpak"
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                        "tituloSerie" => "Disaster Emerg Med J"
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                      "titulo" => "Comparison of the Airtraq laryngoscope versus the conventional Macintosh laryngoscope while wearing CBRN-PPE"
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                            3 => "E&#46; Sanche"
                            4 => "E&#46; Gervais"
                            5 => "C&#46; Roger"
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                      "doi" => "10.1097/MEJ.0000000000000220"
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                        "tituloSerie" => "Eur J Emerg Med"
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                        "volumen" => "23"
                        "paginaInicial" => "119"
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        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0175" class="elsevierStylePara elsevierViewall">We would particularly like to thank the entire faculty and residents of the Anaesthesiology Service for their continuous support during this study&#46;</p> <p id="par0180" class="elsevierStylePara elsevierViewall">Special thanks to Dr&#46; Antonio Aloisi&#44; who gave us his time&#44; guidance and help&#46; Thanks also go to all those who helped make this study possible&#46;</p>"
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Article information

ISSN: 23411929
Original language: English

DOI:10.1016/j.redare.2017.11.008

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