Anaesthesia and intensive care
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Anaesth Intensive Care · May 2008
Review Meta AnalysisUse of intrathecal midazolam to improve perioperative analgesia: a meta-analysis.
Intrathecal midazolam binds with gamma aminobutyric acid-A receptors in the spinal cord leading to an analgesic effect. Clinical studies suggested that intrathecal midazolam may also reduce nausea and vomiting when used as an adjunct to other spinal medications. However, the potential neurotoxic effect of intrathecal midazolam remains a concern. ⋯ The incidence of neurological symptoms after intrathecal midazolam was uncommon (1.8%) and did not differ from placebo (odds ratio 1.20, 95% CI 0.22 to 6.68, P=0.84). Based on the limited data available, intrathecal midazolam appears to improve perioperative analgesia and reduce nausea and vomiting during caesarean delivery. A multicentre registry or large randomised controlled study with a prolonged follow-up period would be useful to confirm the clinical safety of intrathecal midazolam.
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Anaesth Intensive Care · Feb 2005
Review Meta AnalysisUse of intrathecal neostigmine as an adjunct to other spinal medications in perioperative and peripartum analgesia: a meta-analysis.
Intrathecal neostigmine has been used as an adjunct to intrathecal local anaesthetic or opioid to prolong regional analgesia and improve haemodynamic stability, with variable results. This meta-analysis aims to evaluate the effectiveness and side-effects of intrathecal neostigmine in the perioperative and peripartum settings. The literature search was based on Cochrane Controlled Trials Register, EMBASE and MEDLINE (from 1966 to 14 November 2003) databases. ⋯ It did not affect the duration of motor blockade (3.5 min, 95% CI: -1.5 to 8.6; P=0.17) or the total amount of ephedrine required (-0.4 mg, 95% CI: -1.5 to 0.7; P=0.5). Adding intrathecal neostigmine to other spinal medications improves perioperative and peripartum analgesia marginally when compared with placebo. It is associated with significant side-effects and the disadvantages outweigh the minor improvement in analgesia achieved.
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Anaesth Intensive Care · Oct 2003
Meta AnalysisUse of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis.
Total hip or knee arthroplasty is associated with significant blood loss. Techniques such as the use of antifibrinolytics or desmopressin, or normovolaemic haemodilution have been used to reduce the need for allogeneic blood transfusion. Tranexamic acid has been used to reduce blood loss and transfusion requirement for total hip and knee arthroplasty, with variable results. ⋯ Tranexamic acid reduces the proportion of patients requiring allogeneic blood transfusion (OR 0.16, 95% CI: 0.09-0.26), total amount of blood loss (WMD 460 ml, 95% CI: 274-626 ml), and the total number of units of allogeneic blood transfused (WMD 0.85 unit, 95% CI: 0.36-1.33). Tranexamic acid does not increase the risk of thromboembolic complications such as deep vein thrombosis, pulmonary embolism, thrombotic cerebral vascular accident, or myocardial infarction (OR 0.98, 95% CI: 0.45-2.12). Intravenous tranexamic acid appears effective and safe in reducing allogeneic blood transfusion and blood loss in total hip and knee arthroplasty.
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Anaesth Intensive Care · Aug 2001
Meta AnalysisDo anaesthetists need to wear surgical masks in the operating theatre? A literature review with evidence-based recommendations.
Many operating theatre staff believe that the surgical face mask protects the healthcare worker from potentially hazardous biological infections. A questionnaire-based survey, undertaken by Leyland' in 1993 to assess attitudes to the use of masks, showed that 20% of surgeons discarded surgical masks for endoscopic work. Less than 50% did not wear the mask as recommended by the Medical Research Council. ⋯ Policies relating to the wearing of surgical masks by operating theatre staff are varied. This indicates some confusion about the role of the surgical mask in modern surgical and anaesthetic practice. This review was undertaken to collate current evidence and make recommendations based on this evidence.
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Anaesth Intensive Care · Dec 1999
Meta AnalysisThe effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative renal function: a meta-analysis.
The aim of this systematic review was to assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on post-operative renal function. Eight randomized placebo-controlled double-blinded trials (n = 345) were identified from searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register databases. The summary effect size and 95% confidence intervals (95% CI) were calculated by a weighted mean difference analysis using a random-effects model. ⋯ Urine volume did not change significantly at any time. There was therefore a clinically unimportant transient reduction in renal function. NSAIDs should not be withheld from patients with normal preoperative renal function because of concerns about postoperative renal impairment.