Journal of clinical anesthesia
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Review Meta Analysis Comparative Study
Levosimendan does not provide mortality benefit over dobutamine in adult patients with septic shock: A meta-analysis of randomized controlled trials.
Despite of advancement in intensive care medicine, sepsis and septic shock carry a high mortality. Levosimendan, an inodilator, may be promising for septic shock patients with myocardial dysfunction; however, firm evidence is lacking. In this meta- analysis of randomized controlled trials, levosimendan has been compared with dobutamine in adult patients with sepsis and septic shock. ⋯ There is no evidence that levosimendan is superior to dobutamine in adult patients with sepsis and septic shock. Further large randomized trials are necessary in this area.
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Review Meta Analysis Comparative Study
Remifentanil as an alternative to epidural analgesia for vaginal delivery: A meta-analysis of randomized trials.
Although epidural analgesia is considered the gold standard for labor pain management, its use may be restricted in some conditions due to clinical contraindications or availability, and suitable alternatives may be required. The objective of this meta-analysis was to determine whether evidence from randomized trials suggests remifentanil PCA (R-PCA) results in significant differences in maternal satisfaction, analgesic efficacy, and safety compared with conventional epidural analgesia (EA). ⋯ While no significant differences were detected for maternal satisfaction or for most clinical outcomes, this meta-analysis remains underpowered to rule out clinically-important differences due to the few existing randomized trials. For obstetric patients who are not candidates for EA, R-PCA may provide an alternative for analgesia in the peri-partum period, but caution is warranted particularly regarding hypoxemia, and suggests the need for increased surveillance and monitoring for R-PCA. Further adequately powered randomized trials with a focus on clinically-relevant maternal and neonatal outcomes are required to more accurately characterize the relative benefits and risks of R-PCA versus EA in this population.
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Review Meta Analysis Comparative Study
The sedative effects of the intranasal administration of dexmedetomidine in children undergoing surgeries compared to other sedation methods: A systematic review and meta-analysis.
Administration of intranasal dexmedetomidine for sedation is comfortable and effective in children who are afraid of needles, and it offers efficient sedation similar to that of intravenous administration. We performed a systematic review and meta-analysis to evaluate the clinical effects of the pre-procedural administration of intranasal dexmedetomidine. ⋯ This review suggests that intranasal dexmedetomidine is associated with better sedative effects than oral benzodiazepines without producing respiratory depression, but it had a significantly delayed onset of effects.
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Perioperative hypothermia is a common complication of anesthesia that can result in negative outcomes. The purpose of this review is to answer the question: Does the type of warming intervention influence the frequency or severity of inadvertent perioperative hypothermia (IPH) in surgical patients receiving neuraxial anesthesia? ⋯ During neuraxial anesthesia, AW reduces IPH more effectively than PW. Even with AW, IPH persists in some patients. Continued innovation in AW technology and additional comparative effectiveness research studying different AW methods are needed.
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Review Meta Analysis Comparative Study
Commonly-used versus less commonly-used methods in the loss of resistance technique for identification of the epidural space: A systematic review and meta-analysis of randomized controlled trials.
To summarize the efficacy of less-commonly used modern methods (e.g. epidrum, lidocaine, acoustic device, Macintosh balloon) compared to more commonly-used methods (i.e. air, saline, both) in the loss of resistance technique for identification of the epidural space. ⋯ Moderate-quality evidence shows that less commonly-used modern methods such as epidrum, lidocaine and acoustic devices, are more efficacious compared to more commonly-used methods (i.e. air, saline, both) in terms of the loss of resistance technique for identification of the epidural space. These findings should be explored further in the context of the clinical practice among anaesthesiologists.