Journal of clinical anesthesia
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Review Meta Analysis Comparative Study
Liberal or restrictive fluid management during elective surgery: a systematic review and meta-analysis.
This article reviews if a restrictive fluid management policy reduces the complication rate if compared to liberal fluid management policy during elective surgery. The PubMed database was explored by 2 independent researchers. We used the following search terms: "Blood transfusion (MESH); transfusion need; fluid therapy (MESH); permissive hypotension; fluid management; resuscitation; restrictive fluid management; liberal fluid management; elective surgery; damage control resuscitation; surgical procedures, operative (MESH); wounds (MESH); injuries (MESH); surgery; trauma patients." A secondary search in the Medline, EMBASE, Web of Science, and Cochrane library revealed no additional results. ⋯ The total complication rate (RR, 0.57; 95% CI, 0.52-0.64), risk of infection (RR, 0.62; 95% CI, 0.48-0.79), and transfusion rate (RR, 0.81; 95% CI, 0.66-0.99) were also lower. The postoperative rebleeding did not differ in both groups: RR, 0.76 (95% CI, 0.28-2.06). We conclude that compared with a liberal fluid policy, a restrictive fluid policy in elective surgery results in a 35% reduction in patients with a complication and should be advised as the preferred fluid management policy.
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To assess the stability of pharmaceutical suxamethonium (succinylcholine) solution for injection by validated stability-indicating chromatographic method in vials stored at room temperature. ⋯ Storage of suxamethonium solution for injection vials at ambient temperature (22°C-26°C) for 17 days demonstrated that at least 95% of original suxamethonium concentration remained stable.
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Randomized Controlled Trial
Prophylactic phenylephrine infusion for the prevention of hypotension after spinal anesthesia in the elderly: a randomized controlled clinical trial.
Hypotension frequently occurs during spinal anesthesia (SA), especially in the elderly. Phenylephrine is effective to prevent SA-induced hypotension during cesarean delivery. The objective of this study was to evaluate the efficacy and safety of prophylactic infusion of phenylephrine after SA for orthopedic surgery in the elderly. ⋯ Prophylactic phenylephrine infusion is an effective method of reducing SA-induced hypotension in the elderly. Compared with a control group, it delays the time to onset of hypotension and decreases the number of hypotensive episodes per patient. More data are needed to evaluate clinical outcomes of such a strategy.
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Randomized Controlled Trial Comparative Study
A comparison of King Vision video laryngoscopy and direct laryngoscopy as performed by residents: a randomized controlled trial.
For more than 40 years, direct laryngoscopy (DL) has been used to assure the airway during endotracheal intubation. The King Vision video laryngoscope is one of the latest devices introduced for endotracheal intubation. We hypothesize that, relative to direct laryngoscopy, it improves the intubation success rate with fewer intubation attempts and no difference in intubation time or complications. ⋯ The use of KVVL by residents with less than 1 year of training (considered nonexperts) significantly improves visualization of the glottis in patients without predictors of difficult airway. The incidence of complications was too low to draw conclusions.
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Multicenter Study Comparative Study
Variability in anesthesiologists' approach to the preoperative management of asthmatic children.
No consensus guidelines exist for the preoperative treatment of asthmatic children referred for elective surgery. We investigated the attitude of pediatric anesthesiologists to this issue. ⋯ A wide variability exists in pediatric anesthesiologists' approach to the preoperative management of asthmatic children for most common case scenarios. This is probably explained by the heterogeneity of asthma, the type of surgery, the lack of guidelines, and the paucity of data. Similarities as well as differences exist between pediatric anesthesiologists and pulmonologists. Further studies and implementation of consensus guidelines are needed.