Journal of clinical anesthesia
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Review Meta Analysis
Efficacy and safety of haloperidol for delirium prevention in adult patients: An updated meta-analysis with trial sequential analysis of randomized controlled trials.
To identify the efficacy and safety of haloperidol prophylaxis in adult patients with a high risk for delirium. ⋯ The results of our meta-analysis suggested the use of prophylactic haloperidol compared with placebo had no beneficial impacts on incidence of delirium, duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay and mortality in adult patients. It appeared to have a positive effect on duration of delirium, while with a significant heterogeneity. These findings do not support the routine usage of haloperidol for delirium prevention.
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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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Factors that influence the occurrence of perioperative cardiac arrest (CA) and its outcomes in trauma patients are not well known. The novelty of our study lies in the performance of a systematic review conducted worldwide on the occurrence of perioperative CA and/or mortality in trauma patients. ⋯ Trauma is an important factor in perioperative CA and mortality, especially in young adult and adult males and in patients classified as having an ASA physical status ≥ III mainly due to uncontrollable bleeding after blunt and perforating injuries. Trauma is a global public health problem and has a strong impact on perioperative morbidity and mortality.
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The aim of this study is to evaluate the safety and efficacy of Viscoelastic Haemostatic Assays (VHA) to guide transfusions in patients undergoing surgical procedures. ⋯ Viscoelastic haemostatic assays are safe and efficacious for coagulation control in patients undergoing surgical procedures, therefore it should be considered for use in practice.