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array:23 [ "pii" => "S0034935613001680" "issn" => "00349356" "doi" => "10.1016/j.redar.2013.06.007" "estado" => "S300" "fechaPublicacion" => "2014-02-01" "aid" => "343" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Anestesiol Reanim. 2014;61:78-86" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 960 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 713 "PDF" => 240 ] ] "itemSiguiente" => array:18 [ "pii" => "S0034935613002272" "issn" => "00349356" "doi" => "10.1016/j.redar.2013.08.006" "estado" => "S300" "fechaPublicacion" => "2014-02-01" "aid" => "368" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Rev Esp Anestesiol Reanim. 2014;61:87-93" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3346 "formatos" => array:3 [ "EPUB" => 5 "HTML" => 2346 "PDF" => 995 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión</span>" "titulo" => "Anestesia regional intravenosa con anestésicos locales de larga duración. Actualización" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "87" "paginaFinal" => "93" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Intravenous regional anesthesia with long-acting local anesthetics. An update" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1474 "Ancho" => 2561 "Tamanyo" => 131569 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Tiempos de recuperación (mediana e intervalo) del bloqueo sensitivo y motor medido por estimulación eléctrica transcutánea y pinchazo (<span class="elsevierStyleItalic">pinprick</span>, sensitivo), así como fuerza de apretar el puño (<span class="elsevierStyleItalic">grip strength</span>, motor).</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Lat Antebr: nervio cutáneo antebraquial lateral; Med Antebr: nervio cutáneo antebraquial medial; TES: estímulo eléctrico transcutáneo.</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">*</span>p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05 versus levobupivacaína al 0,125%.</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Fuente: Atanassoff et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P.G. Atanassoff, A. Lobato, J.L. Aguilar" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P.G." "apellidos" => "Atanassoff" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Lobato" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Aguilar" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935613002272?idApp=UINPBA00004N" "url" => "/00349356/0000006100000002/v1_201401250029/S0034935613002272/v1_201401250029/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0034935613002922" "issn" => "00349356" "doi" => "10.1016/j.redar.2013.09.023" "estado" => "S300" "fechaPublicacion" => "2014-02-01" "aid" => "399" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Anestesiol Reanim. 2014;61:73-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1009 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 824 "PDF" => 177 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Incidence of intraneural needle insertion in ultrasound-guided femoral nerve block: A comparison between the out-of-plane versus the in-plane approaches" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "73" "paginaFinal" => "77" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incidencia de inserción intraneural en bloqueo femoral guiado por ecografía: comparación entre los enfoques en plano y fuera de plano" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1394 "Ancho" => 2167 "Tamanyo" => 216330 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demonstration of the needle placement and location of the injection with in-plane (A) and out-of-plane (B) needle insertion.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Ruiz, X. Sala-Blanch, J. Martinez-Ocón, M.J. Carretero, G. Sánchez-Etayo, A. Hadzic" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Ruiz" ] 1 => array:2 [ "nombre" => "X." "apellidos" => "Sala-Blanch" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Martinez-Ocón" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Carretero" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Sánchez-Etayo" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Hadzic" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935613002922?idApp=UINPBA00004N" "url" => "/00349356/0000006100000002/v1_201401250029/S0034935613002922/v1_201401250029/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Effects of inhalational anaesthesia with low tidal volume ventilation on end-tidal sevoflurane and carbon dioxide concentrations: prospective randomized study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "78" "paginaFinal" => "86" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. de la Matta-Martín, D. López-Herrera, J.C. Luis-Navarro, J.L. López-Romero" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "de la Matta-Martín" "email" => array:1 [ 0 => "mdlmattam@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "López-Herrera" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Luis-Navarro" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "López-Romero" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Anesthesia Department, General Hospital, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectos de la anestesia inhalatoria con baja concentración final de volumen corriente de sevoflurano y dióxido de carbono: estudio prospectivo aleatorizado" ] ] "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" => 3194 "Ancho" => 3446 "Tamanyo" => 467967 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Study flow chart.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The induction of inhalational anaesthesia by means of a constant inspired inhaled anaesthetic concentration (CI<span class="elsevierStyleInf">IA</span>) occurs by a gradual increase in the inhaled anaesthetic (IA) concentration in the alveoli (CA<span class="elsevierStyleInf">IA</span>) and a simultaneous increase in the arterial partial pressure (Pa<span class="elsevierStyleInf">IA</span>) and brain partial pressure.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> This phase of inhaled anaesthesia is characterized by its non-stationary nature, and depends on: (1) the inspired IA concentration; (2) the effective alveolar ventilation; (3) an appropriate alveolar-capillary IA exchange; and (4) the IA uptake in each compartment, including the plasma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">For a constant CI<span class="elsevierStyleInf">IA</span>, alveolar ventilation is the only variable that the anaesthesiologist can control to set the desired supply rate of IA molecules to the target organ. CA<span class="elsevierStyleInf">IA</span> monitoring is performed by measuring end-tidal IA concentration (ET<span class="elsevierStyleInf">IA</span>). Thus, the minimum alveolar concentration (MAC) (represented by ET<span class="elsevierStyleInf">IA</span>) is a widely accepted parameter for monitoring the clinical effect of the IA.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">For ET<span class="elsevierStyleInf">IA</span> values to correctly account for the MAC of the inhaled anaesthetic, the ET<span class="elsevierStyleInf">IA</span> should accurately reflect IA concentration in the alveoli. We know that a portion of the tidal volume does not participate in gas exchange because it does not contact the pulmonary capillary blood flow and represents the physiological dead space or dead volume.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> ET<span class="elsevierStyleInf">IA</span> values may not accurately represent the CA<span class="elsevierStyleInf">IA</span> in situations where ventilation is inadequate and result in ventilation of the dead space rather than ventilation of the alveoli, such as when using very low tidal volumes, which eventually leads to ventilation of the airway dead space (VD<span class="elsevierStyleInf">AW</span>). In the context of inducing anaesthesia while maintaining spontaneous ventilation, the probability of inadequate alveolar ventilation is very high, due to the presence of periods of airway obstruction, apnea, bradypnea or reduced tidal volumes.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this study we emulated, under controlled conditions, these potential scenarios of alveolar hypoventilation during the initial phase of anaesthesia, in order to show the extent to which ineffective ventilation (airway dead space ventilation) can lead to alveolar hypoventilation (with the consequent increase in the arterial partial pressure of CO<span class="elsevierStyleInf">2</span> in arterial blood and an unreliable reading of alveolar sevoflurane concentration). We compared ET<span class="elsevierStyleInf">SEVO</span> and ETCO2 values in three groups of patients receiving controlled ventilation via facemasks with low, standard or high tidal volumes for a constant CI<span class="elsevierStyleInf">IA.</span> We registered ET<span class="elsevierStyleInf">SEVO</span> and ETCO2 values during facemask ventilation; after intubation and after controlled ventilation with a standard tidal volume (8<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>). Low tidal volume group was ventilated using volume slightly higher of VD<span class="elsevierStyleInf">AW</span>.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a prospective, randomized, cohort study approved by the ethical and research committee of our centre (Ethical Committee N° 2012PI/018), Hospital Universitario Virgen del Rocío, Seville, Spain – Chairperson Dr. J Bautista – Paloma – on 03 May 2012). We included 48 adult patients (aged ≥18 years) scheduled for lung resection (lobar or wedge resection) between 01 January and 31 October 2012. Informed consent was obtained from all patients.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Exclusion criteria were: ASA<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>IV; BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>; presence of major cardiovascular clinical risk factors (unstable or severe angina, recent myocardial infarction, decompensated heart failure, significant arrhythmias or severe valvular disease)<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>; severe obstructive or restrictive pulmonary disease (GOLD classification grade<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3)<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>; moderate to severely impaired renal function (plasma creatinine<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>dl<span class="elsevierStyleSup">−1</span>)<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>; previous lung resection surgery; carbon monoxide diffusing capacity related to alveolar volume (DLCO/V<span class="elsevierStyleInf">A</span>)<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>65% of the predicted value; and the presence of predictors of difficult airway including: previous difficult intubation; previous Cormack-Lehane grade<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3; Mallampati grade<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3; oral opening<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm; retrognathia; neck circumference<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>cm; anatomic neck alterations or presence of neck masses.</p><p id="par0035" class="elsevierStylePara elsevierViewall">To calculate the sample size we used data from the first 10 patients randomly assigned to groups1 and 2 (5 patients per group); using the means of the variable <span class="elsevierStyleItalic">ET</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">SEVO</span></span><span class="elsevierStyleItalic">stage 1</span>–<span class="elsevierStyleItalic">ET</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">SEVO</span></span><span class="elsevierStyleItalic">stage 2</span> in both groups. To achieve a 80% power to detect differences in the contrast of the null hypothesis H<span class="elsevierStyleInf">0</span>: <span class="elsevierStyleItalic">μ</span><span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">μ</span><span class="elsevierStyleInf">2</span> through bilateral Student's <span class="elsevierStyleItalic">t</span> test for two independent samples, considering a significance level of 5%, and assuming a reference group mean of 0.20 units, the mean of the experimental group of 0.70 units and the standard deviation of both groups of 0.50 units. We needed to include 16 patients in group 1 and 16 in group 2, adding a second control group (group 3) of the same size.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients were randomized to one of the three groups using a computer-generated random number sequence (Epidat 4.0).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients in groups 1, 2 and 3 received controlled ventilation during phase 1 with <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> of 2.2, 8 and 12<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>, based on corrected weight. We used the actual weight for patients with BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> when calculating the corresponding ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>and the <span class="elsevierStyleItalic">corrected weight</span> for patients with BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (the weight at an ideal BMI of 25<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>). We collected patients’ demographic and anthropometric data, history of toxic habits, and presence of comorbidities (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Study protocol</span><p id="par0050" class="elsevierStylePara elsevierViewall">We divided the study into four phases (phases 0–3). All patients received oral midazolam (0.07<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span> corrected body weight) 30<span class="elsevierStyleHsp" style=""></span>min before initiation of the procedure.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Phase 0: prior to anaesthesia induction</span><p id="par0055" class="elsevierStylePara elsevierViewall">We used a Dräger Primus anaesthetic circuit (Dräger Medical, Lübeck, Germany) and a new and fresh CO<span class="elsevierStyleInf">2</span> absorber (CLIC Absorber 800+, Dragër Medical) for each case. The circuit was primed with 3% sevoflurane and 80% oxygen using a fresh gas flow (FGF) of 6<span class="elsevierStyleHsp" style=""></span>L<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">−1</span>. We monitored inspired and expired gas concentrations using the gas analyzer of the anaesthesia workstation. Patients were monitored with 5-lead ECG continuous monitoring of the ST segment (Infinity Kappa XLT, Dräger Medical); SpO<span class="elsevierStyleInf">2</span> (Nellcor MAXA, Covidien Inc., Mansfield, MA, USA); non-invasive arterial blood pressure; and bispectral index (BIS Quatro, Covidien Inc., Norwood, MA, USA). After peripheral vein cannulation, an epidural or paravertebral catheter was placed with no bolus administration. With the patient under local anaesthesia and sedation with a remifentanil infusion adjusted for corrected body weight (0.05–0.1<span class="elsevierStyleHsp" style=""></span>mcg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">−1</span> for BIS<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>90), the radial artery was cannulated and baseline arterial blood gases and haemodynamic data were collected (<span class="elsevierStyleBold">Stage 0</span>).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Phase 1: controlled ventilation via face mask after induction</span><p id="par0060" class="elsevierStylePara elsevierViewall">Prior to induction, patients were oxygenated for 2<span class="elsevierStyleHsp" style=""></span>min with 100% O<span class="elsevierStyleInf">2</span> with spontaneous breathing via face-mask with a Mapleson C system (Anaesthesia Breathing System, Mapleson C 22F, 2<span class="elsevierStyleHsp" style=""></span>L bag, Intersurgical, Berkshire, UK) connected to an oxygen tank independent of the anaesthesia circuit with an FGF of 10<span class="elsevierStyleHsp" style=""></span>L<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">−1</span>. Anaesthesia was induced using propofol (1<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>), remifentanil 0.05–0.1<span class="elsevierStyleHsp" style=""></span>mcg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">−1</span> and cisatracurium 0.15–0.2<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span> (all dosages based on corrected body weight). When the patient reached a BIS level<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>65, an oropharyngeal airway was inserted (Guedel airway). We then connected the Y-piece of the anaesthesia circuit primed with 3% sevoflurane to the facemask and adjusted the tidal volume to the corrected body weight according to the study group. An independent observer assessed the adequacy of ventilation. If adequate ventilation was not achieved (i.e., the monitored expired tidal volume showed gas leaks or inefficient ventilation, or the anaesthesia circuit analyzer failed to detect expired gas), the patient was excluded from the study. In all cases we used a FGF of 6<span class="elsevierStyleHsp" style=""></span>L<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">−1</span>; a ventilatory rate of 12<span class="elsevierStyleHsp" style=""></span>breaths/min; an I:E ratio of 1:2; an inspiratory pause of 30%; and a PEEP of 6<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O. Variables were recorded 3<span class="elsevierStyleHsp" style=""></span>min after ventilation with the tidal volume assigned to each study group (<span class="elsevierStyleBold">Stage 1</span>).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Phase 2: orotracheal intubation and resuming ventilation with 8<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span></span><p id="par0065" class="elsevierStylePara elsevierViewall">Three minutes after controlled ventilation was initiated, we undertook direct laryngoscopy and intubate the trachea with an appropriately sized double lumen endotracheal tube (Mallinckrodt-Covidien, Mansfield, MA, USA), setting the anaesthesia circuit to standby mode with the Y-piece closed. Sevoflurane was maintained at 3% throughout phases 0–3. After intubation, <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> was reset to 8<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span> in all patients; the remainder of the ventilation parameters were not modified; the circuit was connected to the endotracheal tube; and controlled ventilation was resumed. We excluded patients requiring ><span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>s for intubation. Alveolar ventilation was considered adequate and data were recorded when the circuit was connected to the endotracheal tube and the spirometer of the anaesthesia circuit showed that the expired <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> matched the fixed <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span>. ET<span class="elsevierStyleInf">SEVO</span> and ETCO2 values were calculated as the mean of the values obtained during the first three adequate ventilation cycles with a <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> of 8<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span> (<span class="elsevierStyleBold">Stage 2</span>).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Phase 3: controlled ventilation with a <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> of 8<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span></span><p id="par0070" class="elsevierStylePara elsevierViewall">After 2<span class="elsevierStyleHsp" style=""></span>min of controlled ventilation, data were collected, including arterial blood gas values (<span class="elsevierStyleBold">Stage 3</span>).</p><p id="par0075" class="elsevierStylePara elsevierViewall">In all phases, a reduction in systolic blood pressure (SBP) of >15% from baseline values was treated with boluses of ephedrine and/or phenylephrine, according to the clinical characteristics of the patients and the heart rate. On completion of the study, correct positioning of the orotracheal tube was confirmed with a fibreoptic bronchoscope. All patients were interviewed 24 hours after the procedures to determine if they had any memories of the intervention.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">We used the SPSS software system, version 16.0 (SPSS Inc., Chicago, IL, USA) for data collection and analysis. The normality of quantitative data distribution was assessed using the Shapiro–Wilk test. The homogeneity of variances was estimated using Levene's test, and the distribution of variables was analyzed using the analysis of asymmetry and kurtosis. When the variables studied showed normal distribution, we used the ANOVA and Chi-square tests to analyze the difference in the means, medians and proportions of quantitative and qualitative variables in relation to the intervention group. We used the Bonferroni method to perform a post hoc study of the difference in means obtained by ANOVA. We used a paired Student's <span class="elsevierStyleItalic">t</span>-test for intra-group comparison of the following variables: ET<span class="elsevierStyleInf">SEVO</span>, ETCO2, blood pressure (BP), heart rate (HR), and BIS over time.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 57 patients were recruited and randomized. Nine patients were excluded. Seven patients did not achieve adequate manual ventilation and all but one of these patients was toothless. We excluded two patients due to orotracheal intubation time ><span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>s. The surgery was successfully performed in all cases. The flow diagram is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The distribution of anthropometric variables, the history of substance abuse and comorbidities were similar in the three groups, except for a higher incidence of ischaemic heart disease in group 2. No differences were observed in baseline BIS, blood pressure, heart rate and PaCO2 values in the three groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). No significant differences were observed in the duration of intubation with a median time of 38<span class="elsevierStyleHsp" style=""></span>s, (range, 33–55<span class="elsevierStyleHsp" style=""></span>s); 42<span class="elsevierStyleHsp" style=""></span>s (31–50<span class="elsevierStyleHsp" style=""></span>s); and 45<span class="elsevierStyleHsp" style=""></span>s (range, 35–57<span class="elsevierStyleHsp" style=""></span>s) for groups 1, 2 and 3, respectively. We observed significant differences in the ET<span class="elsevierStyleInf">SEVO</span> values and in the ET<span class="elsevierStyleInf">SEVO</span>/CI<span class="elsevierStyleInf">SEVO</span> ratio in the three groups in stages 1, 2 and 3 (paired Student's <span class="elsevierStyleItalic">t</span>-test) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We also found significant differences in the ET<span class="elsevierStyleInf">SEVO</span> between group 1 and the other groups in all stages. Group 1's ET<span class="elsevierStyleInf">SEVO</span>/CI<span class="elsevierStyleInf">SEVO</span> values were significantly higher than those of group 2 and 3 in stage 1, and significantly lower than those of group 2 and 3 in stage 2 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The ETCO2 values were significantly lower in group 1 three minutes after initiation of controlled facemask ventilation (stage 1) and significantly greater in stages 2 and 3 than in the other groups. No significant differences were observed between group 2 and 3 in any stage (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The PaCO2 values were significantly higher in group 1 in stage 3 than in the other groups. No significant differences were found in the PaCO2−ETCO2 gradient or the ETCO2/PaCO2 ratio in stage 3 in the three groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Patients in group 3 showed lower systolic BP values than the other groups following phase 1. No significant differences were observed in BP or heart rate between the three groups in the other stages (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). A significant BP decrease was observed in all groups after phase 1, followed by an increase after intubation in all groups and a significant decrease at two minutes of ventilation with standard tidal volume (paired Student's <span class="elsevierStyleItalic">t</span>-test) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). We also found significant changes in heart rate for all phases in group 1, and a significant increase after intubation in all groups (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Patients in group 3 showed a significant difference compared with the other groups in the incidence of a decrease in BP<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>20% over basal values.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Patients in group 1 required less vasoactive drug support than patients in groups 2 and 3 (7, 12 and 13 cases in groups 1, 2 and 3, respectively, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02), with a median dose of ephedrine and phenylephrine of 7.5<span class="elsevierStyleHsp" style=""></span>mg and 75<span class="elsevierStyleHsp" style=""></span>mcg; 7.5<span class="elsevierStyleHsp" style=""></span>mg and 100<span class="elsevierStyleHsp" style=""></span>mcg; 15<span class="elsevierStyleHsp" style=""></span>mg and 100<span class="elsevierStyleHsp" style=""></span>mcg in groups 1, 2 and 3, respectively. BIS values in stages 1 and 2 were also significantly higher in group 1 than in group 2. No differences were observed in BIS values in the three groups at 2<span class="elsevierStyleHsp" style=""></span>min in stage 3 (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). No episodes of intraoperative awareness were registered in the 24-h interview.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">We observed that patients receiving controlled ventilation via a facemask with a tidal volume approximating the VD<span class="elsevierStyleInf">AW</span> (Group 1) presented a greater ET<span class="elsevierStyleInf">SEVO</span> gradient between phases 1 and 2 (ET<span class="elsevierStyleInf">SEVO</span>1<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>ET<span class="elsevierStyleInf">SEVO</span>2) than normal and hyperventilated patients. Similarly, the ET<span class="elsevierStyleInf">SEVO</span>/CI<span class="elsevierStyleInf">SEVO</span> ratio in group 1 was significantly higher after the face-mask ventilation phase (stage 1), and significantly lower after intubation (stage 2) than in the other two groups. Group 1 had significantly lower ETCO2 values after stage 1 and significantly greater values after stage 2 than the other groups. The ETCO21−ETCO22 gradient was greater in group 1 than in the other groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Group 1 showed greater expired CO<span class="elsevierStyleInf">2</span> values than the other groups two minutes following tidal ventilation with 8<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Our initial hypothesis was that ventilation with tidal volumes approximating the VD<span class="elsevierStyleInf">AW</span> is poorly effective. In theory, exclusive ventilation of the VD<span class="elsevierStyleInf">AW</span> would have the following effects on sevoflurane and CO<span class="elsevierStyleInf">2</span>: (1) In a theoretical setting of non-effective alveolar ventilation, the inspired sevoflurane would be “retained” in the VD<span class="elsevierStyleInf">AW</span>. It would not fill the alveolar volume nor be transferred to the plasma compartment. In this case, the expired sevoflurane reading would tend to match the inspired sevoflurane, since we would be analyzing a gas sample that has not been “contaminated” by alveolar gas. (2) Similarly, the CO<span class="elsevierStyleInf">2</span> reading would near zero as our gas analyzer would not collect alveolar CO<span class="elsevierStyleInf">2</span> samples because the alveoli are not being ventilated. In normal or effective alveolar ventilation, gas analysis at the end of expiration would approach the real gas concentration in the alveoli, which is directly correlated with gas concentration in plasma. Failure to consider the potential for non-effective ventilation may lead clinicians to misinterpret expired gas data.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Currently, it is widely accepted that a ventilation/perfusion (V/Q) mismatch in certain lung areas, caused by either the presence of atelectatic areas (decreased V/Q ratio) or alveolar dead space areas (increased V/Q ratio), induces an increase in the ET<span class="elsevierStyleInf">GAS</span><span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>Pa<span class="elsevierStyleInf">GAS</span> gradient and may lead clinicians to misinterpret expired gas data.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> To reduce the risk of atelectasis during anaesthesia induction, we used a FIO<span class="elsevierStyleInf">2</span> of 0.8 and a PEEP of 6<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O during controlled ventilation via a facemask.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13–15</span></a> However, the use of different tidal volumes during phase 1 in our sample created a possible influence on the risk of atelectasis. Nevertheless, it was not the purpose of this study to measure the potential risk of atelectasis associated with the use of tidal volumes approximating the VD<span class="elsevierStyleInf">AW</span>. In this regard, we found no differences in the three groups in the ETCO2−PaCO2 gradient and the ETCO2/PaCO2 ratio after two minutes of ventilation with a <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> of 8<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span> (stage 3). This finding does not agree with the results of previous studies that found differences according to the ventilation method.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a> The reason may be that intubation during phase 1 required disconnection from the pressurized circuit (PEEP of 6<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O), which would have neutralized a protective effect of ventilation with higher tidal volumes on the V/Q ratio in patients in groups 2 and 3. This factor, i.e. a <span class="elsevierStyleItalic">derecruitment</span> effect, together with the use of the same ventilation regimen in the three groups after intubation (<span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> of 8<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span> and PEEP of 6<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O) might have compensated for potential differences in the V/Q ratios generated during phase 1. Because we did not measure blood sevoflurane concentrations, we could not assess potential differences in the Pa<span class="elsevierStyleInf">SEVO</span><span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>ET<span class="elsevierStyleInf">SEVO</span> gradient in the three groups. Enekvist et al. reported that the use of high tidal volumes (12<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>) versus normal 5.7<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span> reduces the Pa<span class="elsevierStyleInf">SEVO</span><span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>ET<span class="elsevierStyleInf">SEVO</span> gradient.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Other authors have suggested that increases in the Pa<span class="elsevierStyleInf">IA</span><span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>ET<span class="elsevierStyleInf">IA</span> gradient could be induced by a shunt that could be partly countered by high tidal volumes, favouring alveolar recruitment.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> Previous results support our hypothesis that ventilation with poorly effective tidal volumes not only yields unreliable data on gas exchange and alveolar gas concentrations, but may also increase alveolar-arterial partial pressure gas gradients because of the shunt effect associated with alveolar collapse.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In our study, after excluding the hypoventilated patients (group 1), the mean ET<span class="elsevierStyleInf">SEVO</span>/CI<span class="elsevierStyleInf">SEVO</span> value two minutes after intubation was 0.74<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.04. These data are consistent with previous studies on sevoflurane pharmacokinetics in the initial stage of inhalational anaesthesia with ET<span class="elsevierStyleInf">SEVO</span> values increasing quickly and the ET<span class="elsevierStyleInf">SEVO</span>/CI<span class="elsevierStyleInf">SEVO</span> ratio reaching 0.8 only 10<span class="elsevierStyleHsp" style=""></span>min after sevoflurane administration and remaining constant thereafter.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,19</span></a> Enekvist et al. reported an ET<span class="elsevierStyleInf">SEVO</span>/CI<span class="elsevierStyleInf">SEVO</span> ratio of 0.75 at 5<span class="elsevierStyleHsp" style=""></span>min of sevoflurane administration in patients on both normal ventilation (<span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> of 5.7<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>) and hyperventilation (<span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> of 12<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Patients in group 1 showed greater BIS values than those in the other groups but the difference was significant only for groups 1 and 2 (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Although ET<span class="elsevierStyleInf">SEVO</span> correlates with the clinical effect of the inhaled anaesthetic during the maintenance phase of anaesthesia,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7,20</span></a> its correlation with plasma sevoflurane concentrations during the early stages of anaesthesia has a non-linear distribution.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,17</span></a> As soon as other variables affect the final sevoflurane concentration in the target organ during the initial stage, we consider that ET<span class="elsevierStyleInf">SEVO</span> may not be a good predictor of Pa<span class="elsevierStyleInf">SEVO</span>, especially when <span class="elsevierStyleItalic">alveolar ventilation</span> is not properly controlled for as a variable.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Previous studies of the management of the airway in patients undergoing general anaesthesia with sevoflurane or other halogenated agents under spontaneous ventilation have not examined the influence of the volume of effective alveolar ventilation on monitoring of expired gases, or have not properly assessed the adequacy of spontaneous ventilation.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21–23</span></a> The dangers of assuming that end tidal gas measurements are accurate reflections of alveolar concentrations under all circumstances are that patients might experience direct laryngoscopy while inadequately anesthetized and that hypoventilation might go unrecognized. There are several examples of clinical scenarios where the latter might be important. For a patient with a critically raised intracranial pressure, for example, prolonged hypercapnea could have deleterious effects on cerebral blood flow and result in brain injury. The results of this study could be applicable to situations where sevoflurane is used as a hypnotic agent for airway management in patients with spontaneous breathing. In this setting, the variable, <span class="elsevierStyleItalic">alveolar ventilation</span> is not directly controlled by the anaesthesiologist, but instead, depends on the patient's state of hypnosis. Pean et al. assessed the performance of fibroscopic intubation in a prospective randomized study with propofol versus sevoflurane in anaesthetized patients with spontaneous breathing. The authors reported BIS values<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>65 (medians, 66 (range, 53–85) and 77 (range, 62–96) for nasal and oral intubation, respectively) for ET<span class="elsevierStyleInf">SEVO</span> values of 3.8 (range, 2.7–5.3).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> These authors also reported a significantly high incidence of explicit memories (13%). Pean et al. used an 8% inspired fraction of sevoflurane to reach a Ramsey <span class="elsevierStyleItalic">score of 5</span> and maintain spontaneous breathing.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Sepúlveda et al. demonstrated that ET<span class="elsevierStyleInf">SEVO</span> is not a good predictor of the clinical effect of sevoflurane during inhaled anaesthesia induction at high concentrations (8%) in patients with assisted spontaneous breathing with tidal volume ventilation. Sepúlveda reported greater ET<span class="elsevierStyleInf">SEVO</span> values when the blink reflect was suppressed (ET<span class="elsevierStyleInf">SEVO</span> 5.7% (range, 2–8.6, median and interquartile range), compared with the moment when the evoked response was <40 (ET<span class="elsevierStyleInf">SEVO</span> 3.8%; range, 2.6–6.5), indicating a potential inconsistency between ET<span class="elsevierStyleInf">SEVO</span> and Pa<span class="elsevierStyleInf">SEVO</span>.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> One of the reasons for this inconsistency might be that when these authors monitored ET<span class="elsevierStyleInf">SEVO</span> values, they were actually monitoring VD<span class="elsevierStyleInf">AW</span> rather than alveolar gas volume. This explains why apparently high partial pressures of sevoflurane do not provide adequate levels of hypnosis; potentially because reduced tidal volumes cause alveolar hypoventilation, which worsens as the patient loses consciousness during spontaneous breathing. As the authors did not measure Pa<span class="elsevierStyleInf">SEVO</span>, PaCO2 and tidal volume values during the procedure, our explanation is only an hypothesis.</p><p id="par0135" class="elsevierStylePara elsevierViewall">One of the limitations of our study has been the lack of specific measure of cardiac output. Recent works have shown that changes in cardiac output up to 100% may be required to significantly affect the initial uptake of IA.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> As shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, changes in BP and HR followed a parallel distribution in the three groups throughout stages 0–4. We observed that BP and HR values decreased significantly in the three groups in stage 1, but only group 3 showed significant BP reduction >20% over baseline values (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Tracheal intubation was accompanied by an increase in BP and HR in the three groups (stage 2) followed by a reduction in BP at 2<span class="elsevierStyleHsp" style=""></span>min of normal ventilation (stage 3).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">The greater reduction in systolic BP reached in group 3 in stage 1 is not exclusively attributable to a greater blood sevoflurane concentration, as ET<span class="elsevierStyleInf">SEVO</span> in this group was equal to that of group 2. We hypothesize that ventilation with high tidal volumes would create a PEEP-like effect, accompanied by an increase in intrathoracic pressure potentially compromising the preload. On the other hand, patients in group 1 required less amines support than patients in groups 2 and 3, which may be a potential result of the lower blood sevoflurane concentrations and its effect on systemic vascular resistances.</p><p id="par0145" class="elsevierStylePara elsevierViewall">We conclude that in cases of hypoventilation induced by the use of tidal volumes approximating the VD<span class="elsevierStyleInf">AW</span>, the ET<span class="elsevierStyleInf">SEVO</span> and ETCO2 fractions may not be effective for assessing sevoflurane and CO<span class="elsevierStyleInf">2</span> concentrations in the alveoli, and may lead to misinterpreted expired gas data. Further studies are required to define which tidal volume limits and which ventilation variables (inspiratory times, PEEP level, and recruitment manoeuvres) are associated with adequate and efficient alveolar ventilation during the early stages of inhalational anaesthesia.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres305313" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec288463" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres305314" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 4 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study protocol" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Phase 0: prior to anaesthesia induction" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Phase 1: controlled ventilation via face mask after induction" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Phase 2: orotracheal intubation and resuming ventilation with 8 ml kg" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Phase 3: controlled ventilation with a V of 8 ml kg" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] ] ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack73074" "titulo" => "Acknowledgements" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-04-16" "fechaAceptado" => "2013-06-04" "PalabrasClave" => array:1 [ "en" => array:2 [ 0 => array:3 [ "clase" => "keyword" "identificador" => "xpalclavsec288462" "palabras" => array:7 [ 0 => "Anestesia" 1 => "Inhalación" 2 => "Farmacocinética" 3 => "Volumen corriente" 4 => "Sevoflurano" 5 => "Espacio Muerto respiratorio" 6 => "Hipoventilación" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec288463" "palabras" => array:7 [ 0 => "Anaesthetics" 1 => "Inhalation" 2 => "Pharmacokinetics" 3 => "Tidal volume" 4 => "Sevoflurane" 5 => "Respiratory dead space" 6 => "Hypoventilation" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We investigated how ventilation with low tidal volumes affects the pharmacokinetics of sevoflurane uptake during the first minutes of inhaled anaesthesia.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Forty-eight patients scheduled for lung resection were randomly assigned to three groups. Patients in group 1, 2 and 3 received 3% sevoflurane for 3<span class="elsevierStyleHsp" style=""></span>min via face mask and controlled ventilation with a tidal volume of 2.2, 8 and 12<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>, respectively (Phase 1). After tracheal intubation (Phase 2), 3% sevoflurane was supplied for 2<span class="elsevierStyleHsp" style=""></span>min using a tidal volume of 8<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span> (Phase 3).</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">End-tidal sevoflurane concentrations were significantly higher in group 1 at the end of phase 1 and lower at the end of phase 2 than in the other groups as follows: median of 2.5%, 2.2% and 2.3% in phase 1 for groups 1, 2 and 3, respectively (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001); and 1.7%, 2.1% and 2.0% in phase 2, respectively (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). End-tidal carbon dioxide values in group 1 were significantly lower at the end of phase 1 and higher at the end of phase 2 than in the other groups as follows: median of 16.5, 31 and 29.5<span class="elsevierStyleHsp" style=""></span>mmHg in phase 1 for groups 1, 2 and 3, respectively (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001); and 46.2, 36 and 33.5<span class="elsevierStyleHsp" style=""></span>mmHg in phase 2, respectively (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">When sevoflurane is administered with tidal volume approximating the airway dead space volume, end-tidal sevoflurane and end-tidal carbon dioxide may not correctly reflect the concentration of these gases in the alveoli, leading to misinterpretation of expired gas data.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Investigamos cómo la ventilación controlada con volúmenes corrientes bajos afecta a la farmacocinética del sevoflurano durante los primeros minutos de anestesia inhalada.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cuarenta y ocho pacientes programados para cirugía de resección pulmonar fueron distribuidos al azar en tres grupos. Los pacientes del grupo 1, 2 y 3 recibieron sevoflurano al 3% durante 3 minutos mediante ventilación controlada a través de mascarilla con un volumen corriente de 2,2, 8 y 12<span class="elsevierStyleHsp" style=""></span>ml kg<span class="elsevierStyleSup">−1</span>, respectivamente (Fase 1). Después de la intubación traqueal (Fase 2), se administró sevoflurano al 3% durante 2 minutos usando un volumen corriente de 8<span class="elsevierStyleHsp" style=""></span>ml kg<span class="elsevierStyleSup">−1</span> (Fase 3).</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">las concentraciones finales de sevoflurano fueron significativamente superiores en el grupo 1 al final de la fase I e inferiores al final de la fase II con respecto a los otros grupos: mediana del 2,5%, 2,2% y 2,3% en la fase I para los grupos 1, 2 y 3, respectivamente (P<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), y 1,7%, 2,1% y 2,0% en la fase II, respectivamente (P <<span class="elsevierStyleHsp" style=""></span>0,001). Los valores de dióxido de carbono en el grupo 1 fueron significativamente inferiores al final de la fase I y superiores al final de la fase II frente a los otros grupos: mediana de 16,5, 31 y 29,5<span class="elsevierStyleHsp" style=""></span>mmHg en la fase I para los grupos 1, 2 y 3, respectivamente (P<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), y 46,2 36, y 33,5<span class="elsevierStyleHsp" style=""></span>mmHg en fase II, respectivamente (P<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001).</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Cuando el sevoflurano se administra mediante volúmenes corrientes cercanos al volumen de espacio muerto de la vía aérea, las concentraciones finales de sevoflurano y dióxido de carbono pueden no reflejar correctamente la concentración de estos gases en los alvéolos, lo que puede conducir a una interpretación incorrecta de los gases expirados.</p>" ] ] "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" => 3194 "Ancho" => 3446 "Tamanyo" => 467967 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Study flow chart.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1184 "Ancho" => 1755 "Tamanyo" => 94109 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Modification of end-tidal sevoflurane concentrations throughout phases 0–3.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1045 "Ancho" => 1703 "Tamanyo" => 110177 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Time course of blood pressure (stages 0–3).</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Volume 1: 2.2, 8 and 12<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span> for groups 1–3; volume 2: 8<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span> in all cases; ASA: American Society of Anesthesiologists physical status; CAD: stable coronary artery disease; COPD: chronic obstructive pulmonary disease if ≤3 GOLD classification; OSAS: obstructive sleep apnea syndrome; DLCO/V<span class="elsevierStyleInf">A</span>: carbon monoxide diffusing capacity related to alveolar volume; HR: heart rate; NS: non statistical significance.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Values for quantitative variables represented as median with interquartile range within brackets or maximum and minimum values when specified. Values for qualitative variables represented as <span class="elsevierStyleItalic">n</span>.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group 1 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group 2 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group 3 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-Value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Volume</span> 1 (<span class="elsevierStyleItalic">min–max</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">168 (120–220)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">640 (420–720)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">855 (720–1080)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Volume</span> 2 (<span class="elsevierStyleItalic">min–max</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">640 (425–800) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">640 (420–720) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">590 (480–720) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex</span> (<span class="elsevierStyleItalic">male</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age</span> (<span class="elsevierStyleItalic">years</span>) (<span class="elsevierStyleItalic">min–max</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.5 (39–78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 (43–76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 (21–80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Weight</span> (<span class="elsevierStyleItalic">kg</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81 (62.5–84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 (64–92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.5 (65–87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Height</span> (<span class="elsevierStyleItalic">m</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.65 (1.57–1.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.68 (1.62–1.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.66 (1.59–1.70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">BMI</span> (<span class="elsevierStyleItalic">kg</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup">−2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.33 (24.3–30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.72 (24.4–32.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.97 (24.5–31.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Active smoking</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Smoking habit</span> (≥25 <span class="elsevierStyleItalic">pack-year</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ASA classification</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1–2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Hypertension</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Diabetes mellitus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">CAD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.013<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">COPD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Restrictive pulmonary disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">OSAS</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">DLCO/V</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">A</span></span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>80% <span class="elsevierStyleItalic">predicted</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">BIS basal</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97 (95–98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97 (95.7–98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98 (97–98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Basal systolic blood pressure</span> (<span class="elsevierStyleItalic">mmHg</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">134.5 (124–149) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">140 (124–151) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">135.5 (125–148) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Basal diastolic blood pressure</span> (<span class="elsevierStyleItalic">mmHg</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 (65–81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (65–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 (63–80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Basal HR</span> (<span class="elsevierStyleItalic">beats per minute</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 (66–84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 (64–79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 (65–88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Basal PaCO</span><span class="elsevierStyleInf">2</span> (<span class="elsevierStyleItalic">mmHg</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.3 (41.3–48.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.8 (37.6–45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.3 (41.2–47.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab451900.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Significant differences between the three groups (ANOVA).</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Significant differences in Chi-square test.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Anthropometric data, comorbidities and basal measurements.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ET<span class="elsevierStyleInf">SEVO</span>: end-tidal sevoflurane concentration; CI<span class="elsevierStyleInf">SEVO</span>: inspiratory sevoflurane concentration; ETCO2: end-tidal CO<span class="elsevierStyleInf">2</span> partial pressure; PaCO2: arterial CO<span class="elsevierStyleInf">2</span> partial pressure.</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Values represented as median and interquartile range.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Stage 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Stage 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Stage 3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ET</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">SEVO</span></span> (%)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 1<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 (2.4–2.6)<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">#</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.7 (1.62–1.87)<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">#</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1 (2.0–2.27)<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">#</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 2<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2 (2.2–2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1 (1.96–2.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 (2.2–2.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 3<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 (2.2–2.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 (1.90–2.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 (2.2–2.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ET</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">SEVO</span></span><span class="elsevierStyleItalic">/CI</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">SEVO</span></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 1<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82 (0.78–0.85) £ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.56 (0.52–0.59)<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">#</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.69 (0.66–0.74)<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 2<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.73 (0.68–0.77) £ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.68 (0.64–0.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.74 (0.72–0.77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 3<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.78 (0.76–0.79) £ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.68 (0.65–0.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.74 (0.72–0.77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ETCO2 (<span class="elsevierStyleItalic">mmHg</span>)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 1<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.5 (13–20)<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">#</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.2 (41–48)<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">#</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.5 (38–46)<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">#</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 2<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (27–36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (35–38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.5 (33–38) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 3<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.5 (28–32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.5 (32–37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (32–37) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PaCO2 (<span class="elsevierStyleItalic">mmHg</span>)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 (49–54)<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">#</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.9 (39–46) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.2 (43–48) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PaCO2−ETCO2 (<span class="elsevierStyleItalic">mmHg</span>)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.1 (7–11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5 (6.4–11.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.3 (3.8–14.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ETCO2/PaCO2</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82 (0.77–0.85) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82 (0.75–0.85) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.79 (0.71–0.91) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab451901.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Significant differences intra-groups between stage 1 and stage 2; stage 2 and stage 3 (paired Student's <span class="elsevierStyleItalic">t</span>-test).</p>" ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Significant differences between group 1 and group 3 (ANOVA).</p> <p class="elsevierStyleNotepara" id="npar0025">£ Significant differences between the three groups (ANOVA).</p>" ] 2 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "#" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Significant differences between group 1 and the other groups (ANOVA).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Sevoflurane and CO<span class="elsevierStyleInf">2</span> concentrations in stages 1–3.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; BPM: beats per minute; BIS: bispectral index values.</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Values expressed as median and interquartile range.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Stage 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Stage 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Stage 3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">SBP/DBP</span> (<span class="elsevierStyleItalic">mmHg</span>)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 1<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">115 (101–133)/57 (51–69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">165 (134–180)/82 (74–91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">123 (125–146)/66 (51–71) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 2<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124 (96–150)<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">#</span></a>/65 (55–80)<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">#</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">159 (120–167)/83 (70–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">136 (114–150)/70 (56–80) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 3<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96 (86–107)<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">#</span></a>¶/50 (46–61)<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">#</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">139 (115–161)/73 (58–85) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">126 (101–149)/64 (54–75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">HR</span> (<span class="elsevierStyleItalic">BPM</span>)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 1<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 (61–76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 (65.75–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 (71–91) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 (51–98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (72.0–94.5)<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 (64–98.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 (56–76)¥ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 (68.0–85.6)<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 (70–86) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">BIS</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (37–53.5)$ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (40–56)$ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.5 (37–47)£ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (24–41)$ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (26–35.5)$ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (25–46.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (30–49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (28–52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (30–47) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab451899.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Intra-group differences between stage 0 and stage 1, stage 1 and stage 2; and stage 2 and stage 3 (paired Student's <span class="elsevierStyleItalic">t</span>-test).</p>" ] 1 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "#" "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Significant differences between groups 2 and 3 (ANOVA).</p> <p class="elsevierStyleNotepara" id="npar0045">¶ Significant differences between group 3 and others (ANOVA).</p> <p class="elsevierStyleNotepara" id="npar0050">¥ Intra-group significant differences between stage 0 and stage 1 (paired Student's <span class="elsevierStyleItalic">t</span>-test).</p>" ] 2 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Intra-group significant differences between stage 1 and stage 2 (paired Student's <span class="elsevierStyleItalic">t</span>-test).</p> <p class="elsevierStyleNotepara" id="npar0060">$ Significant differences between groups 1 and 2 (ANOVA).</p> <p class="elsevierStyleNotepara" id="npar0065">£ Intra-group significant differences between stage 2 and stage 3 (paired Student's <span class="elsevierStyleItalic">t</span>-test).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Blood pressure, heart rate and BIS values in stages 1–3.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Illustrations of inhaled anesthetic uptake, including intertissue diffusion to and from fat" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.I. 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