Anesthesiology
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Meta Analysis Comparative Study
Desmopressin reduces transfusion needs after surgery: a meta-analysis of randomized clinical trials.
Perioperative pathologic microvascular bleeding is associated with increased morbidity and mortality and could be reduced by hemostatic drugs. At the same time, safety concerns regarding existing hemostatic agents include excess mortality. Numerous trials investigating desmopressin have lacked power to detect a beneficial effect on transfusion of blood products. The authors performed a meta-analysis of 38 randomized, placebo-controlled trials (2,488 patients) investigating desmopressin in surgery and indicating at least perioperative blood loss or transfusion of blood products. ⋯ Desmopressin slightly reduced blood loss (almost 80 ml per patient) and transfusion requirements (almost 0.3 units per patient) in surgical patients, without reduction in the proportion of patients who received transfusions. This meta-analysis suggests the importance of further large, randomized controlled studies using desmopressin in patients with or at risk of perioperative pathologic microvascular bleeding.
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Meta Analysis Comparative Study
How much does pharmacologic prophylaxis reduce postoperative vomiting in children? Calculation of prophylaxis effectiveness and expected incidence of vomiting under treatment using Bayesian meta-analysis.
The authors calculated the effect size for treatments recommended for the pediatric population in the new Guidelines for the Management of Postoperative Nausea and Vomiting that should be implemented with the help of a new risk scale developed for children. ⋯ The authors' tables list the expected incidence of postoperative vomiting with each treatment for each risk category, and the expected relative risks that can be used with baseline risk values from any source.
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Randomized Controlled Trial Comparative Study
Thoracic epidural analgesia with low concentration of bupivacaine induces thoracic and lumbar sympathetic block: a randomized, double-blind clinical trial.
Clinical benefits of thoracic epidural anesthesia (TEA) are partly ascribed to thoracic sympathetic block. However, data regarding sympathetic activity during TEA are scarce and contradictory. This prospective, randomized, double-blind study evaluated the segmental propagation of sympathetic block after low-concentration, high-volume TEA using digital thermography. ⋯ TEA with 10 ml bupivacaine, 0.25%, induced thoracic and lumbar sympathetic block that precedes and exceeds sensory block. Caudal limit of sympathetic block could not be demonstrated in this study.
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Comparative Study
Effects of supervision by attending anesthesiologists on complications of emergency tracheal intubation.
Emergent intubation is associated with a high complication rate. These intubations are often performed by resident physicians in teaching hospitals. The authors evaluated whether supervision by an anesthesia-trained intensivist decreases complications of emergent intubations. ⋯ Supervision by an attending anesthesiologist was associated with a decreased incidence of complications during emergent intubations.