Journal of clinical anesthesia
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Meta Analysis
Labor epidural analgesia and the risk of postpartum depression: A meta-analysis of observational studies.
This study aims to systematically review the literature to evaluate the association between labor epidural analgesia (LEA) and postpartum depression (PPD). ⋯ Labor epidural analgesia was not shown to confer protection against developing PPD according to this meta-analysis. Future studies are needed to explore whether other aspects of LEA, beyond its presence or absence, influence the onset of PPD.
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Meta Analysis
Lumbar neuraxial procedures in thrombocytopenic patients across populations: A systematic review and meta-analysis.
There is currently no consensus regarding the minimum threshold platelet count to ensure safe neuraxial procedures. Numerous reports describe the safe performance of lumbar punctures in severely thrombocytopenic patients but reports of neuraxial anesthetic procedures in thrombocytopenic patients are limited. To date, the focus on specific populations in contemporary reviews has failed to include any actual hematoma cases. This systematic review aggregates reported lumbar neuraxial procedures from diverse thrombocytopenic populations to best elucidate the risk of spinal epidural hematoma. ⋯ Spinal epidural hematoma in thrombocytopenic patients is rare. In this sample of patients, an inflection point and narrow confidence intervals are observed near a platelet count of 75,000 × 106/L or above, reflecting an estimated low spinal epidural hematoma event rate with more certainty given a larger sample size and inclusion of spinal epidural hematoma cases. Thrombocytopenic patients should be monitored, particularly in the first 48 h, and educated about symptoms concerning for spinal epidural hematoma.
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Melatonin is an endogenous hormone, which regulates circadian rhythms and promotes sleep. In recent years, several randomised controlled trials examining the prophylactic use of melatonin to prevent delirium were published with conflicting findings. The primary aim of this review was to determine the effect of melatonin on the incidence of delirium in hospitalised patients. ⋯ CRD42019123546.
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Review Meta Analysis
The effectiveness of BIS monitoring during electro-convulsive therapy: A systematic review and meta-analysis.
Electroconvulsive therapy (ECT) has been shown to be highly effective in patients suffering from treatment-resistant depression. ECT procedure is performed under general anesthesia but the impact of anesthesia depth on seizure characteristics and clinical outcome remains unclear. We aimed to study the effects of BIS monitoring on electric and clinical response to ECT treatment. ⋯ High values of pre-ictal BIS are associated with improved seizure duration. The usefulness of systematic BIS monitoring during all ECT procedures should be further studied to better identify adequate BIS levels according to patient's characteristics.