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Sánchez-Guillén, R. López, M.A. Calle, A.B. Diez-Lobo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Sánchez-Guillén" "email" => array:1 [ 0 => "inessanchezguillen@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.A." "apellidos" => "Calle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A.B." "apellidos" => "Diez-Lobo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Centro Internacional de Oftalmología Avanzada Profesor Fernández-Vigo, Badajoz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital General de Segovia, Segovia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General de Segovia, Segovia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Remifentanilo: una ayuda en la cirugía tópica del estrabismo" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Remifentanil is a powerful and selective agonist of μ-opioid receptors of ultra-short duration and sedative effect approved by the FDA in 1996 as an analgesic for inducing and maintaining anesthesia. The advantage of remifentanil over the rest of opioids is its complete metabolization by nonspecific sterases involved in a large range of metabolic processes, which leads to rapid clearing and infrequent accumulation in patients with organic dysfunctions. Other drugs utilized in topical strabismus surgery are benzodiazepines such as midazolam, or hypnotic drugs such as propofol. In comparison with said drugs, remifentanil provides higher analgesia and lower muscular relaxation, allowing patients to remain awake and cooperate during intra-surgery adjustments.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Strabismus surgery with topical anesthesia enables intra-surgery adjustments that could be cause of discomfort for the patient. The pharmacokinetic characteristics of remifentanil make it an adequate supplement for strabismus surgery as it enables surgery with topical anesthesia in addition to sedation-based analgesia for patients to maintain the ability to cooperate during intra-surgery adjustments.</p><p id="par0015" class="elsevierStylePara elsevierViewall">To date, very few studies have analyzed the usefulness of remifentanil in strabismus surgery or the dosages to be used and the side effects that could appear during surgery and in the immediate postop.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Accordingly, the present study analyzes the analgesic efficacy of remifentanil, its side effects and complications in topical strabismus surgery. It also analyzes objective and subjective postop surgical results.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Subjects, material and method</span><p id="par0025" class="elsevierStylePara elsevierViewall">A descriptive and retrospective study carried out in the General Hospital of Segovia. The study included all strabismus surgeries carried out with topical anesthesia and sedation-based analgesia during the 9-year interval. Overall, surgery was performed on 72 muscles of 48 eyes of 39 patients.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study included only patients who underwent strabismus surgery with topical anesthesia and remifentanil sedation and excluded patients who received other hypnotic and/or sedative drugs.</p><p id="par0035" class="elsevierStylePara elsevierViewall">All patients had an ophthalmological examination prior to surgery that comprised anamnesis, far and near visual acuity with best correction, anterior pole study with slitlamp and ocular fundus under pharmacological midriasis. Ocular motility was explored measuring far and near ocular deviation with prisms in the 9 diagnostic gaze positions as well as binocularity and stereopsis tests with the Worth test and TNO. Patients with diplopia also had a diplopia chart and Hess Lancaster screen. After establishing surgical indication, the patient was explained the surgical and anesthetic technique in full detail as well as the risks and benefits of surgery. Finally, all patients were assessed by the Anesthetics Department.</p><p id="par0040" class="elsevierStylePara elsevierViewall">All patients signed an informed consent and the study protocol was designed following the ethical standards described in the Helsinki declaration for biomedical research.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The sedation-based analgesia technique with remifentanil comprises an initial administration of 1<span class="elsevierStyleHsp" style=""></span>mg of intravenous midazolam followed by remifentanil with continuous infusion pump at a dose of 0.05–0.2<span class="elsevierStyleHsp" style=""></span>μg/kg/min, beginning with a minimum dose which was increased according to patient requirements. During surgery, 2% lidocaine eyedrops were instilled when patients referred pain during surgery.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Before initiating surgery, tetracaine chlorhydrate and oxybuprocaine drops (Anestésico doble<span class="elsevierStyleSup">®</span>, Alcon<span class="elsevierStyleSup">®</span>, Fort Worth, Texas, USA) and Iodine povidone (Betadine solución dérmica<span class="elsevierStyleSup">®</span>, Meda<span class="elsevierStyleSup">®</span>, Solna, Sweden) diluted at 50% with physiological serum.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Muscle surgery was performed according to the standard technique depending on the surgical indication for each case. Before stitching the conjunctiva, the patient was asked to sit up as many times as necessary to verify that the surgery was satisfactory. Subsequently, the conjunctiva was sutured and the patient was taken to the reanimation room with antiemetic treatment with methylprednisolone (Urbason<span class="elsevierStyleSup">®</span> 4<span class="elsevierStyleHsp" style=""></span>mg tablets, Sanofi<span class="elsevierStyleSup">®</span>, Paris, France) and/or ondansetron (Ondansetron Ratiopharm<span class="elsevierStyleSup">®</span> 4<span class="elsevierStyleHsp" style=""></span>mg coated tablets, Ratiopharm<span class="elsevierStyleSup">®</span>, Ulm, Germany) and Analgesic treatment with dexketoprofene (Enantyum<span class="elsevierStyleSup">®</span> injectable solution 50<span class="elsevierStyleHsp" style=""></span>mg/2<span class="elsevierStyleHsp" style=""></span>ml, Menarini<span class="elsevierStyleSup">®</span>, Florence, Italy).</p><p id="par0060" class="elsevierStylePara elsevierViewall">Patients were released from the hospital on the surgery day with a topical treatment prescription of dexamethasone eyedrops (Colircusí Dexametasona eyedrops in solution 1<span class="elsevierStyleHsp" style=""></span>mg/ml<span class="elsevierStyleSup">®</span>, Laboratorios Alcon<span class="elsevierStyleSup">®</span>) and erythromycin cream (Oftalmolosa Cusi Eritromicina Pomada Oftálmica 5<span class="elsevierStyleHsp" style=""></span>mg/g<span class="elsevierStyleSup">®</span>, Laboratorios Alcon<span class="elsevierStyleSup">®</span>) every 6<span class="elsevierStyleHsp" style=""></span>h, lubrication with artificial tears and oral analgesia if necessary. Checkups were performed at post surgery day 4, month 1, month 3 and at 6-month intervals up to study completion.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The main objective of the study was to analyze the efficacy and safety of remifentanil as adjuvant in topical strabismus surgery. The secondary objectives were to analyze the results of muscular surgery in patients with strabismus as well as patient satisfaction.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Clinic records were systematically reviewed to collect data on anesthetic and surgical techniques. Additional data included medicaments and dosages for anesthesia, side effects and complications. The number of intervened muscles was analyzed in each case as well as the number of times that intra-surgery adjustments were required and intra-and post-surgery complications derived from the surgical technique. Pre-and post-surgery deviations were analyzed at month 1, 6 and 12 after surgery as well as at the last visit to the Ophthalmology consulting room. A post-surgical deviation angle was regarded as stable if the deviation angle variation was under 10 prism diopters (PD) during follow-up. A satisfactory result was defined as a residual deviation of 10 PD or less and/or correction of diplopia.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Finally, patient satisfaction with surgical results and anesthetic technique were also recorded. To analyze satisfaction with surgical results, patients took a satisfaction survey at the end of the study based on a subjective scale of 5 (unhappy, not satisfied and would accept re-intervention, not satisfied but accept re-intervention, happy or very happy). Patient satisfaction with the anesthetic technique was assessed asking them if they would choose again the same anesthetic technique if undergoing a second surgery.</p><p id="par0080" class="elsevierStylePara elsevierViewall">SPSS<span class="elsevierStyleSup">®</span> for Windows version 20.0 (IBM Incorporated, Armonk, NY, USA) was utilized for statistical analysis. Frequency tables and percentages were utilized for qualitative variables and exploratory analysis of quantitative variables with usual descriptors.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">Overall, 39 patients underwent surgery with topical anesthesia and analgesia based on remifentanil sedation. Of these, 54% were females and the mean age was 37.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.7<span class="elsevierStyleHsp" style=""></span>years (range 16–69<span class="elsevierStyleHsp" style=""></span>years). Mean follow-up time was 24.5<span class="elsevierStyleHsp" style=""></span>months (range 1–90<span class="elsevierStyleHsp" style=""></span>months).</p><p id="par0090" class="elsevierStylePara elsevierViewall">The reason for surgery was diplopia in 6 cases and esthetic reasons in the remaining 33 patients. Overall, 21 patients exhibited exotropia (8 intermittent, 8 secondary and 5 consecutive), 12 cases had endotropia (10 essential endotropia, one residual and one secondary), 4 cases of strabismus paresis (2 with VI cranial pair palsy and 2 cases of IV pair palsy) and 2 restrictive Duane syndrome strabismus. 15% of patients exhibited diplopia prior to surgery. Demographic data are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Thirteen patients had received previous treatment for correcting strabismus, 8 had previously undergone muscle surgery (1–2 surgeries per patient) and 5 had been treated with botulin toxin (1–3 botulin toxin injections). Pre-surgery data are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The initial dose of remifentanil in continuous infusion was 0.05<span class="elsevierStyleHsp" style=""></span>μg/kg/min, and in patients who referred pain during surgery the dose was progressively increased to 0.2<span class="elsevierStyleHsp" style=""></span>μg/kg/min. during surgery. Two patients had vomits which required momentary interruption of surgery, one patient cooperated poorly during intra-surgery adjustment due to excessive sedation and one patient referred clear pain despite the maximum sedative dose. In addition, one patient exhibited chest stiffness, with apnea and arterial hypertension episode that required suspension of the continuous remifentanil infusion until its effects diminished. After a few seconds, chest stiffness resolved spontaneously and blood pressure normalized, so surgery was continued without further complications. It was not necessary to convert any case to other types of anesthetics.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The most frequent pre-surgery diagnostic was horizontal strabismus (95%), for which reason the most utilized surgical technique was retro-insertion and resection of horizontal rectus muscles. Overall, 48 eyes and 72 muscles were intervened (range 1–3). In addition, 77% of patients had muscle surgery in both eyes while 26% were operated in a single muscle, 64% in 2 and 10% in 3 muscles. Forty-six retro-insertion of horizontal rectus muscles were performed, 2 of vertical rectus, 23 resections of horizontal rectus muscles and one weakening of the inferior oblique muscle (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). After verification in the surgery room it was necessary to modify the initial approach in 36% of cases. Also, 8% of patients required more than one intra-surgery adjustment.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Similarly, 79% of patients obtained positive post-surgery results with deviation of 10<span class="elsevierStyleHsp" style=""></span>DP or less and/or disappearance of diplopia. Three patients exhibited post-surgery diplopia (8%), one case was corrected with spectacles with prisms, a further one was treated with botulin toxin and a third one did not require treatment because diplopia was adequately tolerated. Two patients had to be operated twice, one for exotropia and the second for endotropia caused by VI cranial pair paresis. Up to 3 surgeries were required in both cases to obtain satisfactory results.</p><p id="par0115" class="elsevierStylePara elsevierViewall">In what concerns patient satisfaction, 82% reported being satisfied or very satisfied with surgery results, 5 patients (12.8%) were not entirely satisfied (3 of which would accept a second surgery if necessary) and 2 patients (5%) were unhappy with the final results. Despite having a deviation under 10<span class="elsevierStyleHsp" style=""></span>DP, one patient was unhappy with the result of surgery and 3 patients with poor results were happy or very happy. Objective and subjective results are analyzed in a contingency table (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">In 1884, Koller<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a> introduced topical anesthesia for the first time in ophthalmological surgery. Even though it has been described for over a century, only upon the appearance of adjustable sutures described by Jampolsky<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> in 1979, topical anesthesia began to gain relevance in strabology. At present, topical anesthesia in strabismus surgery provides significant advantages over other types of anesthesia as it enables surgery with faster patient recovery, reducing the number of interventions due to intra-surgery adjustments and avoiding complications derived from other types of anesthetics such as general and retrobulbar anesthesia.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4,5</span></a> This type of topical anesthesia is particularly indicated in cases of diplopia, strabismus with unpredictable results<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6–8</span></a> and in patients with contraindication for general anesthesia.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> Due to its pharmacokinetic characteristics, remifentanil is an adequate adjuvant for strabismus surgery under topical anesthesia.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The present study included only patients who were intervened with topical anesthesia and analgesia based on sedation with remifentanil and excluded patients who were administered other hypnotic-sedative medicaments such as propofol, or muscle relaxants such as midazolam as main anesthetic drug. Midazolam was utilized only in a small dose at the beginning of surgery followed by remifentanil infusion.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Lidocaine 2% was utilized as topical anesthesia when the patient referred pain or discomfort during surgery. Topical lidocaine drops achieve good corneal anesthesia but are not as effective in the conjunctiva and the sclera.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> Descriptions in the literature reported cases in which patients referred pain during surgery with topical anesthesia, particularly during conjunctival or Tenon capsule incisions, or when isolating extraocular muscles with hooks.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">11–13</span></a> For these reasons, analgesia based on sedation with remifentanil could be of assistance in operations which require cooperation of the anesthetics team, who must understand the objectives pursued with this technique.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Only one patient referred pain during surgery although it was not necessary to switch anesthetic techniques because it sufficed to ease traction, perform slower movements and increase remifentanil dose. Chang et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> published a series of 71 patients who underwent surgery with only topical anesthetic drops and even though no pain was referred during the conjunctival incision, most patients reported discomfort when the muscle was taken for isolation and during disinsertion. Kim et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> also described that patients referred pain during the conjunctival incision and muscle manipulation. In addition, during the operation 2 patients had vomits and one patient displayed poor cooperation during intra-surgery adjustments due to excessive sedation although the adjustments was finally carried out.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Cases with pain have been described after interrupting remifentanil, which requires individual control of pain. Due to transitional analgesia with dexketoprofene prescribed at the end of surgery, none of the cases experienced pain upon termination of remifentanil infusion.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The most frequently described adverse effects with remifentanil were low arterial pressure, bradycardia, nausea and vomiting. Less frequent (9%) but more severe was muscular chest stiffness<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> which could appear when administering high doses of the drug.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> In the case described in this article, chest stiffness arose at a dose of 0.2<span class="elsevierStyleHsp" style=""></span>μg/kg/min as initial (not progressive) administration and receded a few minutes after terminating the continuous infusion of remifentanil. Subsequently, remifentanil infusion was resumed at a lower dose, which enabled successful surgery completion. The patient who exhibited excessive sedation and poor cooperation during adjustments was administered a higher than usual dose of midazolam (3<span class="elsevierStyleHsp" style=""></span>mg), which means that poor cooperation cannot be attributed entirely to remifentanil.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The only absolute contraindication for this type of anesthesia is lack of patient cooperation, above all in children. This technique is more complicated in patients with previous retina surgery, which gives rise to large fibrosis and frequent bleeding, as well as in patients with other previous strabological surgeries such as string surgery or long-evolution palsy with significant associated fibrosis. A small learning curve must be overcome with this technique to avoid sudden movements that could be painful for the patient as well as avoiding the use of hooks as much as possible as the patient must maintain a cooperative attitude.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In what concerns muscle surgery results, 79% of patients obtained good post-surgery results of the deviation angle. Said results are similar to those of other authors who published success rates between 67% and 95.8%.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6,7,11–13,17–19</span></a> These results remained stable during the follow-up time except in one patient whose post-surgery deviation variation exceeded 10<span class="elsevierStyleHsp" style=""></span>DP. Re-intervention rate with remifentanil was 5% (2 patients). Other studies with topical anesthesia reported re-intervention rates of 3.6% during a follow-up period of 10.4 months<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> and 50% in a 3-year period.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a> A study by Morales Bertrand et al.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> comprising patients with myopia magna, the deviation angle relapse rate was 22%, possibly due to the complexity of said cases. A paper published by Leffler et al.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> describes a re-intervention rate within the first year of 8.1% for the adjustable suture technique in comparison with 8.6% with the conventional technique, with re-interventions increasing with vertical when compared to horizontal muscles.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Overall, 82% of patients indicated they were satisfied or very satisfied with the obtained results. One patient with good post-surgery results was unhappy and 3 patients with objectively poor results said they were satisfied or very satisfied due to esthetic improvements. This evidences the psychological factor of ocular deviations in these patients. It can be concluded that it is very important to take into account patient expectations regarding surgery.</p><p id="par0165" class="elsevierStylePara elsevierViewall">To the knowledge of the authors, this is the first study that describes in detail the use of remifentanil in topical strabismus surgery and analyzes its efficacy and possible influence in surgical results in the authors’ environment.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Limitations of this study include the absence of a control group being administered only topical anesthesia to compare muscle surgery results and patient satisfaction of the anesthetic technique.</p><p id="par0175" class="elsevierStylePara elsevierViewall">It can be concluded that analgesia based on remifentanil infusion sedation could be a useful supplement for topical strabismus surgery as it diminishes pain during surgery and enables patient cooperation during intra-surgery adjustments because its effects disappear rapidly upon terminating the infusion due to its short mean life.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">No conflicts of interests were declared in relation to this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres950337" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec922184" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres950338" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec922185" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Subjects, material and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-01" "fechaAceptado" => "2017-07-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec922184" "palabras" => array:4 [ 0 => "Topical anesthesia" 1 => "Remifentanil" 2 => "Strabismus surgery" 3 => "Analgesia-based sedation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec922185" "palabras" => array:4 [ 0 => "Anestesia tópica" 1 => "Remifentanilo" 2 => "Cirugía de estrabismo" 3 => "Analgesia basada en sedación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the analgesic effect of remifentanil, side effects and complications in topical strabismus surgery. To study the results of strabismus surgery with this type of anesthesia.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective descriptive study. We included 39 patients undergoing strabismus surgery with topical anesthesia and analgesia-based sedation with remifentanil. The data of the anesthetic and surgical technique, surgical results and stability of the deviation angle were analyzed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Thirty-nine patients (54% women) were included, the average age was 37.4 years old. The mean follow-up was 24.5 months. The preoperative diagnoses were exotropia (21 patients), esotropia (12), paresis strabismus (4) and Duane's Syndrome (2). 15% patients had preoperative diplopia and 13 had received previous treatments. The dose range of remifentanil used was 0.05–0.2<span class="elsevierStyleHsp" style=""></span>μg/kg/min. The side effects presented were 2 cases of vomit and one of bad collaboration during the intraoperative adjustment, one of the patient reported pain and one case of thoracic rigidity was reported. 79% of the patients obtained a good surgical result and 82% reported being satisfied with the results. The reintervention rate was 5%.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Analgesia-based sedation with remifentanil is an useful complement to topical strabismus surgery because it reduces pain during surgery and allows the patient to collaborate during intraoperative adjustment due to its pharmacokinetic characteristics.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar el efecto analgésico del remifentanilo, sus efectos secundarios y las complicaciones en la cirugía tópica del estrabismo. Estudiar los resultados de la cirugía del estrabismo con este tipo de anestesia.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo retrospectivo. Se incluyeron 39 pacientes intervenidos de cirugía de estrabismo con anestesia tópica y analgesia basada en sedación con remifentanilo. Se analizaron los datos sobre las técnicas anestésica y quirúrgica, los resultados quirúrgicos y la estabilidad del ángulo de desviación.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 39 pacientes (54% mujeres), con una edad media de 37,4 años. El tiempo medio de seguimiento fue de 24,5 meses. Los diagnósticos preoperatorios fueron exotropía (21 pacientes), endotropía (12), estrabismos paréticos (4) y estrabismo restrictivo por síndrome de Duane (2). El 15% de los pacientes presentaban diplopía prequirúrgica y 13 habían recibido tratamientos previos. El rango de dosis de remifentanilo utilizado fue de 0,05 a 0,2 μg/kg/min. Los efectos secundarios que se presentaron fueron 2 casos de vómitos y uno de mala colaboración durante el ajuste intraoperatorio, un paciente refirió dolor franco y se reportó un caso de rigidez torácica. El 79% de los pacientes obtuvieron buen resultado quirúrgico y el 82% refirieron estar contentos con los resultados. La tasa de reintervención fue del 5%.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La analgesia basada en la sedación con remifentanilo puede resultar un complemento útil en la cirugía tópica del estrabismo, ya que disminuye el dolor durante la cirugía permitiendo que el paciente colabore durante el ajuste intraoperatorio gracias a sus características farmacocinéticas.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez-Guillén I, López R, Calle MA, Diez-Lobo AB. Remifentanilo: una ayuda en la cirugía tópica del estrabismo. Arch Soc Esp Oftalmol. 2017;92:559–564.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.7 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Females 21 (54%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Males 18 (46%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="10" align="left" valign="top">Pre-surgery diagnostic</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Exotropia</td><td class="td" title="table-entry " align="left" valign="top">Intermittent 8 (20.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary 8 (20.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consecutive 5 (12.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Endotropía</td><td class="td" title="table-entry " align="left" valign="top">Essential 10 (26.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Residual 1 (2.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secundaria 1 (2.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Paresis</td><td class="td" title="table-entry " align="left" valign="top">VI cranial pair 2 (5.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV cranial pair 2 (5.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Duane syndrome</td><td class="td" title="table-entry " align="left" valign="top">Type I 1 (2.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Type II 1 (2.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pre-surgery diplopia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (15%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Botulin toxin 5 (12.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Muscle surgery 8 (20.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1609134.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Demographic data and diagnostics and pre-surgery treatments.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">IO: inferior oblique muscle; IR: inferior rectus muscle; LR: lateral rectus muscle; MR: middle rectus muscle: SR superior rectus muscle.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnostic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Muscles (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Eye/s (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical technique \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Intermittent exotropia</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion LR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion LR both eyes<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>resection MR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion LR<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>resection MR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion LR<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>weakening IO \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Secondary exotropia</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion LR<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>resection MR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion LR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Consecutive exotropia</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion LR both eyes<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>resection MR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion LR<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>resection MR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion LR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Essential endotropia</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion MR<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>resection LR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion MR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Residual endotropia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion MR both eyes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary endotropia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion MR<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>resection LR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paresis <span class="elsevierStyleSmallCaps">iv</span> pair \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion IR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion SR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paresis <span class="elsevierStyleSmallCaps">vi</span> pair \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resection LR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion MR<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>resection LR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duane syndrome I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion MR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duane syndrome II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroinsertion LR<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>resection MR \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1609133.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Executed surgical technique.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Objective results</th><th class="td" title="table-head " align="center" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Poor \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Good \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="10" align="left" valign="top">Subjective results</td><td class="td" title="table-entry " align="left" valign="top">Unhappy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">% within objective results \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not satisfied (would reject re-intervention) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">% within objective results \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not satisfied (would accept re-intervention) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">% within objective results \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Happy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">% within objective results \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Very happy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">% within objective results \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Total</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">% within objective results \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] 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Remifentanil: A help in topical strabismus surgery
Remifentanilo: una ayuda en la cirugía tópica del estrabismo