Anesthesiology
-
Review Meta Analysis Comparative Study
A meta-analysis of clinical screening tests for obstructive sleep apnea.
The purpose of this meta-analysis is to compare clinical screening tests for obstructive sleep apnea and establish an evidence base for their preoperative use. Diagnostic odds ratios were used as summary measures of accuracy, and false-negative rates were used as measures of missed diagnosis with each screening test in this review. ⋯ Test accuracy in repeated validation studies of the same screening test is variable, suggesting an underlying heterogeneity in either the clinical presentation of obstructive sleep apnea or the measured clinical elements of these models. Based on the false-negative rates, it is likely that most of the clinical screening tests will miss a significant proportion of patients with obstructive sleep apnea.
-
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.
-
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.
-
Review Meta Analysis
Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: a meta-analysis of randomized controlled trials.
Sevoflurane is a popular inhalational anesthetic for general anesthesia in children. The higher incidence of emergence agitation has been suspected after sevoflurane anesthesia as compared with halothane, whereas some controlled studies showed conflicting results. In this report, the authors performed a meta-analysis of randomized controlled trials to compare the incidence of emergence agitation in children after sevoflurane or halothane anesthesia. ⋯ This meta-analysis revealed that emergence agitation occurred more frequently with sevoflurane than with halothane anesthesia in children.
-
Review Meta Analysis Comparative Study
The effects of mild perioperative hypothermia on blood loss and transfusion requirement.
Anesthetic-induced hypothermia is known to reduce platelet function and impair enzymes of the coagulation cascade. The objective of this meta-analysis and systematic review was to evaluate the hypothesis that mild perioperative hypothermia increases surgical blood loss and transfusion requirement. ⋯ Even mild hypothermia (<1 degree C) significantly increases blood loss by approximately 16% (4-26%) and increases the relative risk for transfusion by approximately 22% (3-37%). Maintaining perioperative normothermia reduces blood loss and transfusion requirement by clinically important amounts.