Minerva anestesiologica
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Minerva anestesiologica · May 2019
Review Meta AnalysisIntraoperative monitoring of nociception for opioid administration: a meta-analysis of randomized controlled trials.
Under-dosage or over-dosage of intraoperative analgesia can cause harm to patients. Many studies have demonstrated the clinical advantages of nociception monitoring tools, but with some conflicting results. To clarify the issue, this meta-analysis compared the effects of Analgesia Nociception Index (ANI), Surgical Pleth Index (SPI), and pupillometry monitoring methods with those of analgesia management practices of intraoperative opioid administration. ⋯ Nociception monitoring devices seem to have an advantage over standard clinical practice on intraoperative management of analgesia during general anesthesia. Future research should focus on identifying appropriate indicators to objectively assess the degree of pain in children and perform large-scale multicenter trials to prove clinical advantages of nociception measurements during propofol anesthesia.
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Minerva anestesiologica · Apr 2019
Meta AnalysisBispectral index monitoring of sedation depth during endoscopy: a meta-analysis with trial sequential analysis of randomized controlled trials.
The Bispectral Index (BIS) provides an objective measure of the level of sedation and general anesthesia. We performed this meta-analysis and trial sequential analysis (TSA) of randomized clinical trials to clarify whether BIS monitoring is helpful in enhancing intraprocedual safety, shortening procedure duration or promoting recovery during sedation for endoscopic procedures. ⋯ More high-quality large-sampled RCTs are needed to confirm whether BIS monitoring for endoscopy sedation helps reduce intraprocedural hypoxia. BIS monitoring fails to shorten procedure duration, promote recovery or boost satisfaction among patients and endoscopists.
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Minerva anestesiologica · Jan 2019
Review Meta AnalysisComparative effectiveness of pharmacologic interventions to prevent shivering after surgery: a network meta-analysis.
Although many drugs have been studied to prevent postoperative shivering, their comparative effectiveness is unknown. We attempted to assess the comparative effectiveness of the pharmacologic strategies to prevent shivering after surgery including intravenous (IV) and intrathecal (IT) meperidine, IV and IT dexmedetomidine, IV and IT clonidine, nefopam, tramadol, ketamine, and serotonin receptor antagonists. ⋯ Nefopam was ranked best regarding both severity and incidence of postoperative shivering. In addition to nefopam, tramadol, meperidine IV and IT, and dexmedetomidine IV were ranked high. However, there was significant heterogeneity regarding the individual drug regimen and surgery type, precluding firm conclusion. Further randomized trials are required to compare the efficacy of the drugs with high rank.
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Minerva anestesiologica · Jun 2018
Meta AnalysisEffect of therapeutic hypothermia on survival and neurological outcome in adults suffering cardiac arrest: a systematic review and meta-analysis.
The aim of this review was to determine current evidence for the effect of therapeutic hypothermia (TH) on survival and neurological outcome in adults suffering cardiac arrest (CA). ⋯ Evidence from RCTs suggests TH does not improve survival or neurological outcome, while observational trials favor TH over normothermia. TH may be attended with higher risk for complications.
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Minerva anestesiologica · Mar 2018
Review Meta AnalysisEpidemiology of septic meningitis associated with neuraxial anesthesia: a historical review and meta-analysis.
Neuraxial anesthesia in the form of spinal and epidural are two of the most frequent forms of regional anesthesia. We aimed to describe and compare the relevant epidemiological, clinical and microbiological characteristics of all reported cases of septic meningitis associated with the use of spinal and epidural anesthetics. ⋯ While the true incidence remains speculative, this review suggests that given increasing indications for spinals and epidurals, septic meningitis remains an important associated with neuraxial anesthesia.