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em 3 classes &#40;<span class="elsevierStyleSmallCaps">i</span>&#44; <span class="elsevierStyleSmallCaps">ii</span> e <span class="elsevierStyleSmallCaps">iii</span>&#41;&#46; Os doentes s&#227;o classificados como pr&#233; obesos &#40;excesso de peso&#41; se o IMC variar entre 25- 29&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> e obesos quando &#233; superior ou igual a 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; Como a popula&#231;&#227;o de doentes obesos submetida a procedimentos cir&#250;rgicos tem vindo a crescer e a obesidade m&#243;rbida afeta a maioria dos &#243;rg&#227;os vitais&#44; o anestesiologista deve estar preparado para lidar com v&#225;rios desafios<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A obesidade tem varias consequ&#234;ncias fisiopatol&#243;gicas&#44; incluindo altera&#231;&#245;es na fun&#231;&#227;o respirat&#243;ria&#46; Como tal&#44; o manuseio perioperat&#243;rio pode afetar significativamente a posterior evolu&#231;&#227;o cl&#237;nica nesta popula&#231;&#227;o&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">O excesso de tecido adiposo metabolicamente ativo aumenta o trabalho nos m&#250;sculos de suporte&#59; consequentemente o consumo de oxig&#233;nio e a produ&#231;&#227;o de di&#243;xido de carbono tamb&#233;m se tornam superiores&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Outros efeitos importantes s&#227;o a disfun&#231;&#227;o do mioc&#225;rdio&#44; o aumento do trabalho respirat&#243;rio e a menor efic&#225;cia da ventila&#231;&#227;o devido ao aumento do esfor&#231;o associado &#224; insufla&#231;&#227;o pulmonar&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A compliance do sistema respirat&#243;rio e os volumes pulmonares&#44; especialmente a capacidade residual funcional &#40;CRF&#41;&#44; s&#227;o habitualmente inferiores nos doentes obesos<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; Consequentemente&#44; estes doentes apresentam geralmente frequ&#234;ncias respirat&#243;rias superiores compensando a diminui&#231;&#227;o do volume <span class="elsevierStyleItalic">corrente</span>&#46; O decl&#237;nio da CRF para valores inferiores ao valor de volume de oclus&#227;o &#40;das vias a&#233;reas&#41; pode afetar a oxigena&#231;&#227;o&#59; adicionalmente a hipox&#233;mia pode desenvolver-se no per&#237;odo p&#243;s-indu&#231;&#227;o&#44; possivelmente devido ao dist&#250;rbio da ventila&#231;&#227;o-perfus&#227;o nas bases pulmonares&#44; onde a incid&#234;ncia de microatelectasia &#233; superior&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">&#201; de salientar que no per&#237;odo p&#243;s-operat&#243;rio a obstru&#231;&#227;o aguda da via a&#233;rea &#233; mais prov&#225;vel e a diminui&#231;&#227;o das capacidades pulmonares pode ser esperada por pelo menos 5 dias&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A hipoxia ligeira e os eventos respirat&#243;rios adversos &#40;ERA&#41; no per&#237;odo p&#243;s-operat&#243;rio podem estar relacionados com a atelectasia pulmonar p&#243;s-operat&#243;ria e&#44; ao contr&#225;rio dos doentes n&#227;o obesos&#44; cuja recupera&#231;&#227;o pode ser mais r&#225;pida&#44; em doentes com obesidade m&#243;rbida a atelectasia pode persistir por mais de 24 horas<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O excesso de peso e a obesidade foram identificados como fatores de risco para complica&#231;&#245;es respirat&#243;rias no per&#237;odo p&#243;s-operat&#243;rio<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">O estudo de Healy et al&#46; demonstrou a associa&#231;&#227;o entre a obesidade e o risco aumentado de complica&#231;&#245;es respirat&#243;rias no per&#237;odo perioperat&#243;rio em doentes submetidos a esofagectomia<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; Em contraste&#44; outros estudos n&#227;o encontraram aumento do risco atribu&#237;vel &#224; obesidade&#44; mesmo em doentes com obesidade m&#243;rbida<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">O objetivo do presente estudo foi avaliar a evolu&#231;&#227;o cl&#237;nica e a incid&#234;ncia de ERA em doentes obesos durante a sua estadia na UCPA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Metodologia</span><p id="par0070" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pela comiss&#227;o de &#233;tica do Centro Hospitalar de S&#227;o Jo&#227;o&#44; tendo sido obtido o consentimento informado por escrito de todos os participantes&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Realizou-se um estudo prospetivo numa UCPA com capacidade de 12 camas durante o per&#237;odo de 3 semanas &#40;de 9 de maio a 27 de maio de 2011&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Os crit&#233;rios de exclus&#227;o englobaram os seguintes&#58; recusa do doente&#44; incapacidade de dar o consentimento informado&#44; score<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>25 no mini <span class="elsevierStyleItalic">mental state examination</span> &#40;MMSE&#41;&#44; idade inferior a 18 anos&#44; nacionalidade estrangeira&#44; doen&#231;a neuromuscular conhecida&#44; cirurgia urgente ou emergente&#44; cirurgia card&#237;aca&#44; neurocirurgia e outros procedimentos que implicassem hipotermia terap&#234;utica&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Para este trabalho foi realizado um <span class="elsevierStyleItalic">estudo caso-controlo</span> sendo a defini&#231;&#227;o dos <span class="elsevierStyleItalic">casos</span> realizada prospectivamente&#46; Durante o per&#237;odo em que se realizou o estudo todos os doentes obesos com IMC &#8805;<span class="elsevierStyleHsp" style=""></span>30 foram identificados e emparelhados com doentes selecionados <span class="elsevierStyleItalic">&#40;caso-controlo&#41;&#46;</span> Os <span class="elsevierStyleItalic">casos e controlo</span> foram identificados atrav&#233;s da recolha de dados em todos os doentes admitidos na UCPA de modo consecutivo durante o per&#237;odo em que decorreu o estudo&#46; Os <span class="elsevierStyleItalic">casos</span> consistiram em doentes obesos e foram emparelhados com doentes semelhantes no que respeita ao sexo&#44; idade e tipo de cirurgia que foi definido como intra-abdominal&#44; m&#250;sculo esquel&#233;tica ou cirurgia de cabe&#231;a e pesco&#231;o&#46; Os doentes n&#227;o obesos com IMC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30 foram selecionados com base no emparelhamento de um para um com doentes obesos e foram selecionados consecutivamente de acordo com a presen&#231;a de caracter&#237;sticas de emparelhamento&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">As vari&#225;veis registadas na admiss&#227;o da UCPA foram as seguintes&#58; idade&#44; sexo&#44; tipo de cirurgia &#40;intrabdominal&#44; m&#250;sculo-esquel&#233;tica&#44; bari&#225;trica&#44; cabe&#231;a e pesco&#231;o&#41;&#44; IMC&#44; estado f&#237;sico da <span class="elsevierStyleItalic">American Society of Anesthesiologists &#40;EF-ASA&#41;</span> e as comorbilidades pr&#233;-hospitaliza&#231;&#227;o &#40;especificamente s&#237;ndrome de apneia obstrutiva do sono&#44; doen&#231;a card&#237;aca isqu&#233;mica&#44; insufici&#234;ncia card&#237;aca congestiva&#44; doen&#231;a cerebrovascular&#44; hipertens&#227;o&#44; insufici&#234;ncia renal&#44; diabetes insulinodependente&#44; dislipidemia e doen&#231;a pulmonar obstrutiva cr&#243;nica&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Os fatores de risco cl&#237;nicos &#40;hist&#243;ria de doen&#231;a card&#237;aca isqu&#233;mica&#44; hist&#243;ria de insufici&#234;ncia card&#237;aca pr&#233;via ou compensada&#44; hist&#243;ria de doen&#231;a cerebrovascular&#44; diabetes mellitus e insufici&#234;ncia renal&#41; foram avaliados de acordo com as recomenda&#231;&#245;es para avalia&#231;&#227;o do risco card&#237;aco pr&#233;-operat&#243;rio e abordagem cardiol&#243;gica peri-operat&#243;ria na cirurgia n&#227;o card&#237;aca da Sociedade Americana de Cardiologia&#47;<span class="elsevierStyleItalic">recomenda&#231;&#245;es</span> da <span class="elsevierStyleItalic">task force</span> da <span class="elsevierStyleItalic">American Heart Association</span><a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Antes da cirurgia ocorreu uma breve entrevista cl&#237;nica para obten&#231;&#227;o do consentimento&#44; da hist&#243;ria m&#233;dica do doente e para realizar o MMSE&#46; Durante a entrevista foi aplicado o question&#225;rio STOP-Bang<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Os doentes foram considerados de elevado risco de s&#237;ndrome de apneia obstrutiva do sono &#40;ER-SAOS&#41; sempre que o score STOP-Bang foi maior ou igual a 3&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Durante a cirurgia o anestesiologista respons&#225;vel pela sala desconhecia o envolvimento do doente no estudo&#46; A conduta anest&#233;sica e monitoriza&#231;&#227;o intra-operat&#243;ria foi realizada de acordo com os crit&#233;rios propostos pelos anestesiologistas respons&#225;veis seguindo os standards m&#237;nimos da institui&#231;&#227;o&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Os f&#225;rmacos relaxantes musculares foram usados para entuba&#231;&#227;o traqueal e foram efetuados b&#243;lus adicionais mediante as necessidades&#46; A decis&#227;o de monitorizar o bloqueio neuromuscular&#44; recorrendo &#224; utiliza&#231;&#227;o de neuroestimulador perif&#233;rico&#44; dependeu do crit&#233;rio do anestesiologista respons&#225;vel&#44; n&#227;o existindo diretrizes relativamente ao seu uso&#46; Para assegurar que os anestesiologistas permaneciam <span class="elsevierStyleItalic">cegos</span> quanto &#224; participa&#231;&#227;o dos doentes no estudo n&#227;o tomamos a iniciativa de observar a utiliza&#231;&#227;o ou a interpreta&#231;&#227;o do <span class="elsevierStyleItalic">Train of four &#40;TOF&#41;</span> durante a cirurgia&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">No final do procedimento cir&#250;rgico o anestesiologista tinha autonomia de optar por reverter ou n&#227;o o bloqueio neuromuscular com neostigmina&#46; Na nossa pr&#225;tica cl&#237;nica a administra&#231;&#227;o do f&#225;rmaco &#233; geralmente feita precocemente antes da extuba&#231;&#227;o traqueal quando a profundidade do bloqueio &#233; menor&#46; O doente &#233; geralmente extubado no bloco operat&#243;rio e transferido para a UCPA&#46; Os crit&#233;rios de extuba&#231;&#227;o inclu&#237;ram eleva&#231;&#227;o da cabe&#231;a sustentada ou aperto de m&#227;o por mais de 5<span class="elsevierStyleHsp" style=""></span>seg&#44; capacidade de cumprir ordens simples&#44; padr&#227;o ventilat&#243;rio est&#225;vel com satura&#231;&#227;o arterial de oxig&#233;nio aceit&#225;vel &#40;SpO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>95&#37;&#41; e ratio TOF superior a 0&#44;80&#46; Administrou-se oxig&#233;nio a 100&#37; a todos os doentes por m&#225;scara facial ap&#243;s extuba&#231;&#227;o traqueal&#46; A decis&#227;o de realizar oxigenoterapia durante a transfer&#234;ncia do doente da sala de bloco para a UCPA ficou ao crit&#233;rio do anestesiologista respons&#225;vel&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Ap&#243;s a chegada &#224; UCPA todos os doentes realizaram oxigenoterapia por c&#226;nula nasal ou m&#225;scara facial&#46; O bloqueio neuromuscular foi definido como TOF<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;9 e foi quantificado &#224; admiss&#227;o na UCPA atrav&#233;s da utiliza&#231;&#227;o de aceleromiografia no m&#250;sculo <span class="elsevierStyleItalic">adductor pollicis</span> &#40;TOF-Watch&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Os dados p&#243;s-operat&#243;rios registados inclu&#237;ram informa&#231;&#227;o relativa &#224; mortalidade e dura&#231;&#227;o do internamento hospitalar e na UCPA&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Complica&#231;&#245;es respirat&#243;rias p&#243;s-operat&#243;rias</span><p id="par0135" class="elsevierStylePara elsevierViewall">Cada ERA p&#243;s-operat&#243;rio foi definido na folha de recolha de dados de acordo com os seguintes dados especificados por Murphy et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Obstru&#231;&#227;o da via a&#233;rea superior que motivou interven&#231;&#227;o &#40;eleva&#231;&#227;o da mand&#237;bula&#44; utiliza&#231;&#227;o de dispositivos de permeabiliza&#231;&#227;o da via a&#233;rea&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Hipoxemia ligeira a moderada &#40;satura&#231;&#227;o de O<span class="elsevierStyleInf">2</span> &#91;SpO<span class="elsevierStyleInf">2</span>&#93; entre 90-93&#37; com oxigenoterapia a 3l&#47;min por c&#226;nula nasal que n&#227;o melhorou ap&#243;s interven&#231;&#245;es ativas &#40;aumentar fluxo de O<span class="elsevierStyleInf">2</span> para<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3L&#47;min&#46; Aplica&#231;&#227;o de m&#225;scara facial de alto fluxo&#44; pedidos verbais para respirar profundamente&#44; estimula&#231;&#227;o t&#225;ctil&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Hipoxemia grave &#40;SpO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>90&#37;&#41; sob oxigenoterapia a 3L&#47;min com c&#226;nula nasal que n&#227;o melhorou ap&#243;s interven&#231;&#245;es ativas &#40;aumentar fluxo de O<span class="elsevierStyleInf">2</span> para<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3L&#47;min&#41;&#46; Aplica&#231;&#227;o de m&#225;scara facial de alto fluxo&#44; pedidos verbais para respirar profundamente&#44; estimula&#231;&#227;o t&#225;ctil&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Sinais de dificuldade respirat&#243;ria ou fal&#234;ncia ventilat&#243;ria &#40;frequ&#234;ncia respirat&#243;ria<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20 respira&#231;&#245;es por minuto&#44; uso dos m&#250;sculos acess&#243;rios&#44; esfor&#231;o traqueal&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Incapacidade de respirar profundamente quando solicitado pela equipa de enfermagem da UCPA&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Queixas sugestivas de fraqueza dos m&#250;sculos respirat&#243;rios ou da via a&#233;rea superior &#40;dificuldade em respirar&#44; deglutir&#44; falar&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Necessidade de reentuba&#231;&#227;o na UCPA&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Evid&#234;ncia cl&#237;nica ou suspeita de aspira&#231;&#227;o pulmonar ap&#243;s extuba&#231;&#227;o traqueal &#40;conte&#250;dos g&#225;stricos observados na orofaringe e hipoxemia&#41;&#46;</p></li></ul></p><p id="par0180" class="elsevierStylePara elsevierViewall">A equipa de enfermagem da UCPA foi instru&#237;da para rever a &#8216;cheklist&#8217; de cada doente ap&#243;s a admiss&#227;o na UCPA e para informar o investigador caso registasse algum ERA&#46; Caso tal se verificasse o investigador procedia &#224; examina&#231;&#227;o do doente para confirmar que apresentava pelo menos um dos crit&#233;rios de ERA&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lise estat&#237;stica</span><p id="par0185" class="elsevierStylePara elsevierViewall">An&#225;lise descritiva das vari&#225;veis foi usada para sumariar os dados e o teste de Mann-Whitney foi utilizado para compara&#231;&#227;o de vari&#225;veis cont&#237;nuas entre grupos de indiv&#237;duos&#59; o teste Chi quadrado e o teste exato de Fisher foram usados para comparar propor&#231;&#245;es entre grupos de indiv&#237;duos&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Todas as vari&#225;veis foram consideradas significativas quando p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Para avaliar os determinantes das complica&#231;&#245;es respirat&#243;rias realizou-se a an&#225;lise da regress&#227;o log&#237;stica univariada e as seguintes vari&#225;veis independentes&#58; tipo de cirurgia&#44; idade&#44; IMC&#44; IMC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; dura&#231;&#227;o da anestesia&#44; EF- ASA&#44; cirurgia de alto risco&#44; diabetes insulinodependente &#40;de acordo com score RCRI&#41;&#44; tipo de anestesia&#44; dura&#231;&#227;o da anestesia&#44; dura&#231;&#227;o do internamento hospitalar e na UCPA e presen&#231;a de bloqueio neuromuscular residual&#46; Log&#237;stica bin&#225;ria de regress&#227;o m&#250;ltipla com elimina&#231;&#227;o condicional foi usada para examinar as co-vari&#225;veis para cada fator com o objetivo de identificar os preditores independentes de ERA&#46; Neste modelo&#44; as co-vari&#225;veis com valores de p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;05 na respetiva an&#225;lise univariada foram inscritas&#46; O <span class="elsevierStyleItalic">software</span> estat&#237;stico SPSS para a vers&#227;o Windows 16&#46;0 &#40;SPSS&#44; Chicago&#44; IL&#41; foi usado para analisar os dados&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0200" class="elsevierStylePara elsevierViewall">No total&#44; 27 pares de doentes foram admitidos e estudados na UCPA durante o per&#237;odo de dura&#231;&#227;o do estudo&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta as caracter&#237;sticas dos doentes admitidos na UCPA e a compara&#231;&#227;o entre doente obesos e n&#227;o obesos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">A idade era semelhante em ambos os grupos&#59; o valor da mediana de idade do grupo de doentes obesos era de 47 anos e o valor desvio interquartil &#40;DIQ&#41; variou entre 35-63 anos&#44; em compara&#231;&#227;o com os doentes n&#227;o obesos cuja mediana era de 46 anos e DIQ entre 33-61 anos&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Os doentes obesos apresentavam um IMC superior &#40;mediana&#44; 41 vs 24&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; eram mais frequentemente doentes de ER-SAOS &#40;89 vs 11&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e foram programados menos frequentemente para cirurgia de alto risco &#40;7 vs 41&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; e cirurgia major &#40;4 vs 15&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> sumaria a ocorr&#234;ncia de complica&#231;&#245;es respirat&#243;rias nos doentes obesos e n&#227;o obesos&#46; A incid&#234;ncia de complica&#231;&#245;es respirat&#243;rias no p&#243;s-operat&#243;rio no grupo de doentes obesos &#233; superior em compara&#231;&#227;o com o grupo de doentes n&#227;o obesos &#40;33 vs 7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46; A incapacidade de respirar profundamente foi a complica&#231;&#227;o mais comum &#40;26&#37; nos doentes obesos vs 4&#37; em doentes n&#227;o obesos&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">A dura&#231;&#227;o do internamento na UCPA foi superior no grupo de doentes obesos &#40;120<span class="elsevierStyleHsp" style=""></span> vs 84<span class="elsevierStyleHsp" style=""></span>min&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Na an&#225;lise univariada apenas a obesidade e o bloqueio neuromuscular residual ap&#243;s cirurgia foram considerados fatores significativos de risco para ERA &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Como demonstrado pela an&#225;lise de regress&#227;o log&#237;stica m&#250;ltipla&#44; estas 2 vari&#225;veis foram consideradas fatores de risco independente para a ocorr&#234;ncia de ERA na UCPA &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discuss&#227;o</span><p id="par0230" class="elsevierStylePara elsevierViewall">Os principais achados deste estudo s&#227;o os seguintes&#58; primeiro&#44; os doentes obesos apresentaram incid&#234;ncia superior de ERA em compara&#231;&#227;o com os doentes cir&#250;rgicos n&#227;o obesos com quem foram emparelhados&#59; segundo&#44; a incapacidade de respirar profundamente e a hipoxia leve&#47;moderada foram os ERA mais frequentes no per&#237;odo p&#243;s-operat&#243;rio imediato e foram mais frequentes nos doentes obesos &#40;classe <span class="elsevierStyleSmallCaps">ii</span> e <span class="elsevierStyleSmallCaps">iii</span>&#41;&#59; terceiro&#44; a obesidade e o bloqueio neuromuscular residual foram fatores de risco independentes para ERA na UCPA&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Apesar da dura&#231;&#227;o do internamento na UCPA ter sido superior&#44; a incid&#234;ncia de ERA n&#227;o teve impacto na dura&#231;&#227;o do internamento hospitalar&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">A obesidade &#233; conhecida por estar associada &#224; s&#237;ndrome de apneia obstrutiva do sono &#40;SAOS&#41;&#44; atelectasia&#44; assim como &#224; s&#237;ndrome de hipoventila&#231;&#227;o&#46; Tamb&#233;m est&#225; associada &#224; diminui&#231;&#227;o da capacidade vital&#44; capacidade residual funcional&#44; volume expirat&#243;rio for&#231;ado no 1&#46;&#176; segundo e tens&#227;o arterial de oxig&#233;nio&#46; Na nossa popula&#231;&#227;o de doentes&#44; determinamos que os doentes obesos tinham uma incid&#234;ncia superior de eventos respirat&#243;rios adversos&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">O nosso estudo verificou que a obesidade pode estar associada a ERA p&#243;s-cir&#250;rgicos e a incid&#234;ncia de eventos respirat&#243;rios na UCPA nos doentes obesos foi 4&#44;6 vezes maior em compara&#231;&#227;o com os doentes n&#227;o obesos&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Estudos pr&#233;vios tamb&#233;m demonstraram a correla&#231;&#227;o entre obesidade e complica&#231;&#245;es respirat&#243;rias&#58; na an&#225;lise retrospetiva de Kuduvalli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> a ventila&#231;&#227;o mec&#226;nica prolongada em doentes submetidos a cirurgia de bypass coron&#225;rio foi associada com IMC superior a 35&#59; Merkow et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> associou a obesidade e a ocorr&#234;ncia de tromboembolismo pulmonar no per&#237;odo p&#243;s-operat&#243;rio&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">N&#227;o &#233; surpreendente que o bloqueio neuromuscular residual seja um fator de risco independente para eventos respirat&#243;rios&#46; De facto&#44; o bloqueio neuromuscular tem sido observado frequentemente na UCPA quando f&#225;rmacos bloqueadores neuromusculares &#40;FBNM&#41; eram administrados durante a cirurgia<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a>&#46; Os eventos respirat&#243;rios p&#243;s- operat&#243;rios s&#227;o o resultado adverso mais frequentemente associado com a paralisia residual&#44; tanto em estudos cl&#237;nicos observacionais como em estudos randomizados<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Um estudo caso-controlo prospetivo realizado por Murphy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> concluiu que o bloqueio neuromuscular residual &#233; um fator importante para o desenvolvimento de ERA na UCPA&#46; Estudos em volunt&#225;rios t&#234;m vindo a demonstrar que os <span class="elsevierStyleItalic">fade ratios</span> do TOF menores que 0&#44;70-0&#44;90 est&#227;o associados a obstru&#231;&#227;o da via a&#233;rea superior<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#44; redu&#231;&#227;o da coordena&#231;&#227;o muscular far&#237;ngea&#44; aumento do risco de aspira&#231;&#227;o pulmonar<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> e resposta ventilat&#243;ria &#224; hipoxia diminu&#237;da<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Considerando que a preval&#234;ncia de complica&#231;&#245;es na popula&#231;&#227;o cir&#250;rgica com SAOS &#233; superior &#224; da popula&#231;&#227;o geral e varia em popula&#231;&#245;es diferentes&#44; utilizamos um question&#225;rio conciso e de f&#225;cil aplica&#231;&#227;o&#44; com elevada sensibilidade e valor preditivo negativo &#40;VPN&#41; para o rastreio de SAOS na popula&#231;&#227;o cir&#250;rgica&#46; De facto&#44; os valores de sensibilidade do &#237;ndice de apneia-hipopneia obtido atrav&#233;s de <span class="elsevierStyleItalic">cutoffs</span> polisonogr&#225;ficos superiores a 5&#44; superiores a 15 e superiores a 30&#44; do inqu&#233;rito STOP-Bang descrito por Chung et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;23</span></a>&#44; foram de 83&#44;6 92&#44;9 e 100&#37;&#44; respetivamente&#44; e os valores correspondentes de VPN foram de 60&#44;8&#44; 90&#44;2 e 100&#37;&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Os doentes obesos foram mais frequentemente doentes com ER-SAOS e IMC superior&#44; tal como esperado pelo processo de emparelhamento&#46; A obesidade est&#225; associada ao aumento do risco de SAOS em 12-30 vezes em rela&#231;&#227;o &#224; popula&#231;&#227;o normal<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; Est&#225; bem estabelecido que a SAOS tem um impacto significativo na fun&#231;&#227;o cardiorrespirat&#243;ria aguda e cr&#243;nica<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; Sendo o dist&#250;rbio do sono mais prevalente<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#44; a SAOS tem uma elevada incid&#234;ncia entre doentes cir&#250;rgicos e afeta 2-26&#37; da popula&#231;&#227;o geral&#44; de acordo com o sexo&#44; idade e crit&#233;rios de diagn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; Existe uma evid&#234;ncia crescente na literatura que sugere a implica&#231;&#227;o da SAOS no desenvolvimento de doen&#231;as cardiorrespirat&#243;rias<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a>&#46; Apesar desta evid&#234;ncia&#44; no nosso estudo o ER-SAOS n&#227;o foi considerado fator de risco independente para eventos respirat&#243;rios p&#243;s-operat&#243;rios&#44; em concord&#226;ncia com os resultados de outros estudos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Reconhecemos no entanto que este estudo tem uma s&#233;rie de limita&#231;&#245;es importantes&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Primeiro&#44; os resultados devem ser como meras associa&#231;&#245;es e a causalidade n&#227;o pode ser implicada&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Segundo&#44; o processo de emparelhamento foi constru&#237;do de modo que a idade&#44; sexo&#44; tipo de cirurgia e data da cirurgia coincidissem&#46; No entanto&#44; este processo n&#227;o emparelhou as caracter&#237;sticas individuais dos doentes e os nossos resultados mostraram que os doentes obesos eram mais frequentemente submetidos a cirurgia bari&#225;trica e menos frequentemente a cirurgia major e de alto risco&#46; Assim&#44; a possibilidade do risco associado &#224; cirurgia de alto risco&#44; ao inv&#233;s do diagn&#243;stico de obesidade por si s&#243;&#44; poder contribuir para as taxas mais elevadas de complica&#231;&#245;es n&#227;o pode ser exclu&#237;da&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Terceiro&#44; baseamos a classifica&#231;&#227;o dos doentes como doentes de ER-SAOS na utiliza&#231;&#227;o no question&#225;rio STOP-Bang e n&#227;o realizamos estudos polisonogr&#225;ficos que s&#227;o o <span class="elsevierStyleItalic">gold-standard</span> para o diagn&#243;stico de SAOS&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Quarto&#44; a nossa defini&#231;&#227;o de ERA envolveu crit&#233;rios subjetivos&#44; o que pode influenciar o diagn&#243;stico&#46; Os ERA foram registados apenas durante o tempo de internamento na UCPA e as complica&#231;&#245;es que poderiam ter ocorrido ap&#243;s a alta desta unidade n&#227;o foram consideradas&#44; o que pode ser considerada uma limita&#231;&#227;o major do nosso trabalho&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Apesar das limita&#231;&#245;es acima referidas&#44; este estudo indica que os doentes obesos apresentaram uma eleva&#231;&#227;o na incid&#234;ncia de ERA p&#243;s-operat&#243;rios&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Responsabilidades &#233;ticas</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Prote&#231;&#227;o de pessoas e animais</span><p id="par0305" class="elsevierStylePara elsevierViewall">Os autores declaram que para esta investiga&#231;&#227;o n&#227;o se realizaram experi&#234;ncias em seres humanos e&#47;ou animais&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidencialidade dos dados</span><p id="par0310" class="elsevierStylePara elsevierViewall">Os autores declaram ter seguido os protocolos do seu centro de trabalho acerca da publica&#231;&#227;o dos dados de pacientes e que todos os pacientes inclu&#237;dos no estudo receberam informa&#231;&#245;es suficientes e deram o seu consentimento informado por escrito para participar nesse estudo&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Direito &#224; privacidade e consentimento escrito</span><p id="par0315" class="elsevierStylePara elsevierViewall">Os autores declaram que n&#227;o aparecem dados de pacientes neste artigo&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflito de interesses</span><p id="par0320" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A obesidade tem sido associada a eventos respirat&#243;rios e a maioria destes ocorrem no p&#243;s-operat&#243;rio imediato na unidade p&#243;s-anest&#233;sica &#40;UPA&#41;&#46; O objetivo deste estudo foi avaliar o &#171;outcome&#187; e a incid&#234;ncia de eventos adversos respirat&#243;rios &#40;ARE&#41; p&#243;s-operat&#243;rios em doentes com obesidade durante a sua perman&#234;ncia na UPA&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudo prospetivo caso-controlo com emparelhamento de 27 pares de adultos com obesidade e doentes com IMC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#44;0 &#40;n&#227;o-obesos&#59; grupo de controlo&#41; semelhantes quanto &#224; distribui&#231;&#227;o do sexo&#44; idade e tipo de cirurgia&#44; admitidos ap&#243;s cirurgia eletiva na UPA &#40;em maio de 2011&#41;&#46; Os doentes foram classificados como tendo alto risco de s&#237;ndrome de apneia obstrutiva do sono &#40;HR-OSA&#41; quando tinham um score de STOP-BANG &#8805;<span class="elsevierStyleHsp" style=""></span>3&#46; Os ARE foram definidos como obstru&#231;&#227;o das vias a&#233;reas superiores&#44; hipox&#233;mia &#40;ligeira&#44; moderada e grave&#41;&#44; fal&#234;ncia respirat&#243;ria&#44; incapacidade de respirar profundamente&#44; fraqueza dos m&#250;sculos respirat&#243;rios&#44; reintuba&#231;&#227;o e aspira&#231;&#227;o pulmonar ap&#243;s extuba&#231;&#227;o traqueal&#46; Foi utilizada a an&#225;lise descritiva das vari&#225;veis e os testes de Mann-Whitney U&#44; Qui-quadrado e teste de Fisher foram utilizados para efetuar compara&#231;&#245;es&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">O grupo de doentes obesos apresentou uma frequ&#234;ncia superior de doentes com um score de STOP-BANG &#8805;<span class="elsevierStyleHsp" style=""></span>3 &#40;89 vs 11&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; foi submetido menos frequentemente a cirurgias consideradas de alto risco &#40;59 vs 0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; e a cirurgias major &#40;4 vs 15&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#46; Apresentou mais frequentemente eventos pulmonares adversos na UPA &#40;33 vs 7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46; O evento adverso pulmonar mais frequente foi a incapacidade de respirar profundamente&#44; que ocorreu mais frequentemente nos doentes obesos &#40;26 vs 4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41;&#46; A an&#225;lise multivariada identificou a obesidade e o bloqueio neuromuscular residual como fatores de risco independentes para a ocorr&#234;ncia de eventos respirat&#243;rios&#46; A dura&#231;&#227;o da estadia na UPA foi superior nos doentes obesos &#40;120<span class="elsevierStyleHsp" style=""></span>min vs 84<span class="elsevierStyleHsp" style=""></span>min&#44; p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A incapacidade de respirar profundamente foi o ARE mais frequente no per&#237;odo p&#243;s-operat&#243;rio imediato nos doentes obesos&#46; A obesidade foi considerada um fator de risco independente para ocorr&#234;ncia de ARE na UPA&#46; Os doentes obesos tiveram maior tempo de estadia na UPA mas n&#227;o tiveram maior tempo de internamento hospitalar&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Obesity has been associated with respiratory complications&#44; and the majority of these complications occur in the Post-Anesthesia Care Unit &#40;PACU&#41;&#46; The aim of this study was to evaluate the outcome and incidence of adverse respiratory events &#40;AREs&#41; in obese patients during their stay in the PACU</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We conducted a prospective control study that included 27 obese patients matched with an equal number of patients with body mass index &#40;BMI&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30 &#40;non-obese control group&#41;&#59; the 2 groups of patients were similar in respect to gender distribution&#44; age&#44; and type of surgery and had been admitted into the PACU after elective surgery &#40;May 2011&#41;&#46; The AREs were identified during PACU stay&#46; Descriptive analysis of variables was performed&#44; and the Mann-Whitney <span class="elsevierStyleItalic">U</span> test&#44; Chi-square test&#44; or Fisher&#39;s exact test were used for comparisons&#46; Associations with AREs were studied using univariate and multivariate logistic regression models&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">There was a higher frequency of STOP-BANG &#8805;<span class="elsevierStyleHsp" style=""></span>3 &#40;89&#37; vs&#46; 11&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; among obese patients and they were less frequently scheduled to undergo high-risk surgery &#40;7&#37; vs&#46; 41&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;005&#41; and major surgery &#40;4&#37; vs&#46; 15&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;008&#41;&#46; Obese patients had more frequent AREs in the PACU &#40;33&#37; vs&#46; 7&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;018&#41;&#46; Multivariate analysis identified obesity and residual neuromuscular blockade as independent risk factors for the occurrence of AREs&#46; Stay in the PACU was longer for obese patients &#40;120<span class="elsevierStyleHsp" style=""></span>min vs&#46; 84<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Obesity was considered an independent risk factor for AREs in the PACU&#46; Obese patients stayed longer in the PACU&#44; but they did not stay longer in the hospital&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ASA&#58; American Society of Anesthesiologists&#59; DIQ&#58;desvio interquartil&#59; DPOC&#58; doen&#231;a pulmonar obstrutiva cr&#243;nica&#59; UCPA&#58; Unidade de Cuidados P&#243;s-Anest&#233;sicos&#46;</p>"
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                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">Vari&#225;veis Mediana &#40;DIQ&#41; ou n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obesos N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#227;o-obesos N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Idade</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;35-63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;33-62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;796&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#40;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Local da Cirurgia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intra-abdominal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>M&#250;sculo-esquel&#233;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cabe&#231;a e pesco&#231;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">S&#237;ndrome de apneia obstrutiva do Sono</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#205;ndice massa corporal &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;38-44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;21-25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Estado f&#237;sico ASA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">I</span>&#47;<span class="elsevierStyleSmallCaps">II</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">III</span>&#47;<span class="elsevierStyleSmallCaps">IV</span>&#47;<span class="elsevierStyleSmallCaps">V</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Cirurgia de alto risco</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Doen&#231;a card&#237;aca isqu&#233;mica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Insufici&#234;ncia card&#237;aca congestiva</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Doen&#231;a c&#233;rebro-vascular</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes insulinotratada</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Creatinina s&#233;rica &#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2 mg&#47;dl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hipertens&#227;o arterial</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;260&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dislipidemia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;393&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">DPOC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Magnitude da cirurgia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Minor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Interm&#233;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Fluidoterapia intra-operat&#243;ria</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cristal&#243;ides intravenosos &#40;L&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000 &#40;1&#46;000-2&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000 &#40;1&#46;000-2&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Tipo de anestesia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Geral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Loco-regional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dura&#231;&#227;o da anestesia &#40;min&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110 &#40;80-180&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120 &#40;70-165&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;742&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dura&#231;&#227;o da cirurgia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;60-120&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;50-130&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;924&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Temperatura &#224; admiss&#227;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#44;3 &#40;35&#44;0-35&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#44;2 &#40;34&#44;8-35&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;071&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;248&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Bloqueio neuromuscular residual</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dura&#231;&#227;o do internamento na UCPA &#40;min&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120 &#40;76-140&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;61-110&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dura&#231;&#227;o do internamento hospitalar &#40;dias&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;2-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2-5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;725&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas e dados perioperat&#243;rios &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>54&#41;</p>"
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                  \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">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total &#37; &#40;95&#37;CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obesos N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#227;o-obesos N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Eventos Respirat&#243;rios Adversos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;4 &#40;9&#44;3-31&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Obstru&#231;&#227;o da via a&#233;rea superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hip&#243;xia ligeira&#47;moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;1 &#40;2&#44;5-19&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;096&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hip&#243;xia grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fal&#234;ncia respirat&#243;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Incapacidade de inspirar profundamente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;4 &#40;9&#44;3-31&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fraqueza muscular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;8 &#40;0-5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Reentuba&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Aspira&#231;&#227;o pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Eventos respirat&#243;rios adversos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>54&#41;</p>"
        ]
      ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ASA&#58; American Society of Anesthesiologists&#59; DIQ&#58; desvio interquartil&#59; UCPA&#58; Unidade de Cuidados P&#243;s-Anest&#233;sicos&#46;</p>"
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                  \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">Vari&#225;veis mediana &#40;DIQ&#41; ou n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Com&#47;Sem eventos respirat&#243;rios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Odds ratio &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Idade</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;31-65&#41;&#47;43 &#40;34-62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;01 &#40;0&#44;97-1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;687&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#205;ndice massa corporal &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;35-41&#41;&#47;28 &#40;23-41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;07 &#40;0&#44;99-1&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#205;ndice massa corporal &#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">30 &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;82&#41;&#47;18 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;25 &#40;1&#44;20-32&#44;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">STOP- Bang &#8805;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;73&#41;&#47;18 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;70 &#40;0&#44;86-15&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;079&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Estado f&#237;sico ASA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;725&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">I</span>&#47;<span class="elsevierStyleSmallCaps">II</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">III</span>&#47;<span class="elsevierStyleSmallCaps">IV</span>&#47;<span class="elsevierStyleSmallCaps">V</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;18&#41;&#47;6 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;37 &#40;0&#44;24-7&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Cirurgia de alto risco</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;37&#41;&#47;9 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;46 &#40;0&#44;11-1&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;292&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes insulinotratada</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;9&#41;&#47;&#40;6 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;62 80&#44;66-5&#44;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;671&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Magnitude da cirurgia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;299&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Minor&#47;Interm&#233;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;27&#41;&#47;6 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;31 &#40;0&#44;48-11&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Cirurgia bari&#225;trica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;37&#41;&#47;9 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;22 &#40;0&#44;42-12&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;360&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dura&#231;&#227;o da anestesia &#40;min&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90 &#40;70-110&#41;&#47;125 &#40;80-180&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;99 &#40;0&#44;97-1&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dura&#231;&#227;o da cirurgia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70 &#40;50-70&#41;&#47;90 &#40;60-130&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;99 &#40;0&#44;97-1&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;089&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Tipo de anestesia</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Geral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;91&#41;&#47;38 &#40;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;36 &#40;0&#44;14-12&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;812&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Loco regional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;91&#41;&#47;1 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dura&#231;&#227;o do internamento na UCPA &#40;horas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;4 &#40;0&#44;9-2&#44;4&#41;&#47;1&#44;6 &#40;1&#44;1-2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;99 &#40;0&#44;99-1&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;906&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dura&#231;&#227;o do internamento hospitalar &#40;dias&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1-6&#41;&#47;3 &#40;2-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;94 &#40;0&#44;69-1&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;721&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Bloqueio neuromuscular residual</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;64&#41;&#47;11 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;09 &#40;1&#44;25-20&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Odds ratio &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;82&#41;&#47;18 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;58 &#40;1&#44;04-20&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Bloqueio neuromuscular residual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;64&#41;&#47;11 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;66 &#40;1&#44;03-31&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;044&nbsp;\t\t\t\t\t\t\n
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              "etiqueta" => "1"
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                      "titulo" => "Obesity"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;W&#46; Haslam"
                            1 => "W&#46;P&#46; James"
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                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(05)67483-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2005"
                        "volumen" => "366"
                        "paginaInicial" => "1197"
                        "paginaFinal" => "1209"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16198769"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of overweight and obesity in the United States&#44; 1999-2004"
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