Anaesthesia
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Review Meta Analysis
Use of remifentanil as a sedative agent in critically ill adult patients: a meta-analysis.
This meta-analysis examined the benefits of using remifentanil as a sedative agent in critically ill patients. A total of 11 randomised controlled trials, comparing remifentanil with another opioid or hypnotic agent in 1067 critically ill adult patients, were identified from the Cochrane controlled trials register and EMBASE and MEDLINE databases, and subjected to meta-analysis. ⋯ Remifentanil was, however, not associated with a significant reduction in mortality (relative risk 1.01 (95% CI 0.67-1.52); p = 0.96), duration of mechanical ventilation, length of intensive care unit stay, and risk of agitation (relative risk 1.08 (95% CI 0.64-1.82); p = 0.77) when compared to an alternative sedative or analgesic agent. The current evidence does not support the routine use of remifentanil as a sedative agent in critically ill adult patients.
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Thyromental distance (TMD) measurement is commonly used to predict difficult intubation. We surveyed anaesthetists to determine how this test was being performed. Comparative accuracy of ruler measurement and other forms of measurement were also assessed in a meta-analysis of published literature. ⋯ In terms of distance, the minimum acceptable TMD was felt to be 6.5 cm by 55% of respondents. However, the actual width of three fingers was (range) 4.6-7.0 cm (mean 5.9 cm), with significant differences between genders and between proximal and distal interphalangeal joints. The meta-analysis showed ruler measurement increased test sensitivity (48% (95% CI 43-53) vs 16% (95% CI 14-19) without a ruler), when predicting difficult intubation.
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Review Meta Analysis
Meta-analysis on the effect of dopexamine on in-hospital mortality.
The objective of the study was to determine whether dopexamine alters in-hospital mortality. The following databases were searched, Embase (1974-July 2007), Medline (1950-July 2007), CINAHL, PubMed and Cochrane Clinical Register of Controlled Trials (CENTRAL). ⋯ Mortality was not significantly different with dopexamine treatment (relative risk 0.75, 95% confidence interval 0.48-1.18, p = 0.22). In conclusion, dopexamine does not improve in-hospital mortality in patients undergoing major abdominal surgery and in the critically ill.
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Review Meta Analysis
Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis.
Intrathecal morphine is often used for postoperative analgesia after surgery. We performed a meta-analysis to obtain more detailed information on the frequency of side-effects in patients receiving intrathecal morphine in combination with spinal anaesthesia compared with placebo treated patients. We clustered the analysis to patients receiving placebo, less than morphine 0.3 mg (M < 0.3), or equal to or more than morphine 0.3 mg (M > or = 0.3) and calculated the risk ratios of morphine vs placebo. ⋯ However, the higher dose of intrathecal morphine was associated with more episodes of respiratory depression (7/80) compared with the lower dose (2/247). Intrathecal morphine is associated with a mild increase in side-effects. With a dose < 0.3 mg we found there were no more episodes of respiratory depression than in placebo patients who received systemic opioid analgesia.
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Review Meta Analysis
A meta-analysis of the utility of C-reactive protein in predicting early, intermediate-term and long term mortality and major adverse cardiac events in vascular surgical patients.
We conducted a meta-analysis of the utility of pre-operative C reactive protein (CRP) in predicting early (< 30 days), intermediate (30-180 days) and long term (> 180 days) mortality and major adverse cardiac events (MACE; cardiac mortality and nonfatal myocardial infarction (MI) combined) following vascular surgery. Of 291 studies identified, ten prospective patient cohorts were identified. ⋯ Intermediate-term all-cause mortality, cardiac death and MACE showed a trend to a worse outcome (odds ratio (OR) 9.07, 95% confidence interval (CI) 0.86-96.28, p = 0.07; OR 8.71, 95% CI 0.5-153.1, p = 0.14 and OR 2.81, 95% CI 0.78-5.18, p = 0.15 respectively). Long term all cause mortality (OR 2.40, 95% CI 1.15-5.02, p = 0.02), cardiac death (OR 5.66, 95% CI 1.71-18.73, p = 0.005) and MACE (OR 2.76, 95% CI 1.38-5.55, p = 0.004) were significantly increased.