Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisAdjusting the pH of lidocaine for reducing pain on injection.
Lidocaine administration produces pain due to its acidic pH. ⋯ Increasing the pH of lidocaine decreased pain on injection and augmented patient comfort and satisfaction.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisHypertonic saline for peri-operative fluid management.
Fluid excess may place patients undergoing surgery at risk for various complications. Hypertonic saline (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium. ⋯ HS reduces the volume of intravenous fluid required to maintain patients undergoing surgery but transiently increases serum sodium. It is not known if HS effects patient survival and morbidity but it should be tested in randomized clinical trials that are designed and powered to test these outcomes.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisMedical treatments for incomplete miscarriage (less than 24 weeks).
Miscarriage occurs in 10% to 15% of pregnancies. The traditional treatment, after miscarriage, has been to perform surgery to remove any remaining pregnancy tissues in the uterus. However, it has been suggested that drug-based medical treatments, or expectant care (no treatment), may also be effective, safe and acceptable. ⋯ The available evidence suggests that medical treatment, with misoprostol, and expectant care are both acceptable alternatives to routine surgical evacuation given the availability of health service resources to support all three approaches. Women experiencing miscarriage at less than 13 weeks should be offered an informed choice.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisAntibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy.
Cholecystectomy is a common surgical procedure. In the open cholecystectomy area, antibiotic prophylaxis showed beneficial effects, but it is not known if its benefits and harms are similar in laparoscopic cholecystectomy. Some clinical trials suggest that antibiotic prophylaxis may not be necessary in laparoscopic cholecystectomy. ⋯ This systematic review shows that there is not sufficient evidence to support or refute the use of antibiotic prophylaxis to reduce surgical site infection and global infections in patients with low risk of anaesthetic complications, co-morbidities, conversion to open surgery, and infectious complications, and undergoing elective laparoscopic cholecystectomy. Larger randomised clinical trials with intention-to-treat analysis and patients also at high risk of conversion to open surgery are needed.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisInterval debulking surgery for advanced epithelial ovarian cancer.
Interval debulking surgery (IDS), following induction or neoadjuvant chemotherapy, may have a possible role in treating advanced epithelial ovarian cancer (stage III to IV) where primary debulking surgery is not an option. ⋯ No conclusive evidence was found to determine whether IDS between cycles of chemotherapy would improve or decrease the survival rates of women with advanced ovarian cancer, compared with conventional treatment of primary surgery followed by adjuvant chemotherapy. IDS appeared to yield benefit only in patients whose primary surgery was not performed by gynaecologic oncologists or was less extensive. Data on QoL and adverse events were inconclusive.