European journal of anaesthesiology
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One approach to clinical decision-making requires the integration of the best available research evidence with individual clinical expertise and patient values, and is known as evidence-based medicine (EBM). In clinical decision-making with the current best evidence, systematic reviews have an important role. This review article covers the basic principles of systematic reviews and meta-analyses, and their role in the process of evidence-based decision-making. ⋯ The relevant steps in writing a systematic review from the formulation of an initial research question to sensitivity analyses in conjunction with the combined analysis of the pooled data are described. Important issues that need to be considered when appraising a systematic review or meta-analysis are outlined. Some of the terms that are used in the reporting of systematic reviews and meta-analyses, such as relative risk, confidence interval, Forest plot or L'Abbé plot, will be introduced and explained.
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Randomized Controlled Trial Multicenter Study
Short-term effectiveness of different volume replacement therapies in postoperative hypovolaemic patients.
To examine the kinetics of volume loading with crystalloid and colloid infusions in critically ill patients after major surgery, using the pulse contour cardiac output (PiCCO) monitoring technique. ⋯ In postoperative hypovolaemic patients, lactated Ringer's solution can significantly improve haemodynamics at the end of volume loading, but this effect completely disappears at 120 min. Ten millilitres per kilogram of colloid bolus (especially HES) improved the haemodynamics at 120 min; however, this was by only 5-25% compared with baseline. The colloids caused significantly larger AUCs than lactated Ringer's solution, but only in the cardiac index, GEDVI and DO2I, plus human albumin in the SVV.
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Nonsteroidal anti-inflammatory drugs have peripheral analgesic effects. We compared the efficacy of peritonsillar infiltration versus intravenous (i.v.) lornoxicam on pain relief after tonsillectomy in adults. ⋯ Peritonsillar infiltration or i.v. lornoxicam enhanced postoperative analgesia after tonsillectomy in adults. However, the analgesic efficacy of locally applied lornoxicam is not superior to the i.v. administration.
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Randomized Controlled Trial
Deep anaesthesia reduces postoperative analgesic requirements after major urological procedures.
There is evidence from previous studies that deeper anaesthetic levels reduce postoperative pain along with analgesic requirements. The aim of this study was to confirm this observation during major urological procedures under sevoflurane anaesthesia. ⋯ The results show that intraoperative deep anaesthetic levels during major urological procedures, achieved with high sevoflurane concentrations, lead to reduced postoperative analgesic requirements.