Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jun 2015
Review Meta AnalysisThe effects of high perioperative inspiratory oxygen fraction for adult surgical patients.
High inspired oxygen concentrations intraoperatively do not reduce surgical site infections, and may potentially have detrimental effects.
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Cochrane Db Syst Rev · Jun 2015
Review Meta AnalysisParacetamol (acetaminophen) for prevention or treatment of pain in newborns.
Newborn infants have the ability to experience pain. Newborns treated in neonatal intensive care units are exposed to numerous painful procedures. Healthy newborns are exposed to pain if the birth process consists of assisted vaginal birth by vacuum extraction or by forceps and during blood sampling for newborn screening tests. ⋯ Paracetamol does not significantly reduce pain associated with heel lance or eye examinations. Paracetamol given after assisted vaginal birth may increase the response to later painful exposures. Paracetamol should not be used for painful procedures given its lack of efficacy and its potential for adverse effects. Paracetamol may reduce the total need for morphine following major surgery, and for this aspect of paracetamol use, further research is needed.
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Cochrane Db Syst Rev · Jun 2015
ReviewPropofol versus thiopental sodium for the treatment of refractory status epilepticus.
This is an updated version of the original Cochrane review published in Issue 8, 2012.Failure to respond to antiepileptic drugs in patients with uncontrolled seizure activity such as refractory status epilepticus (RSE) has led to the use of anaesthetic drugs. Coma is induced with anaesthetic drugs to achieve complete control of seizure activity. Thiopental sodium and propofol are popularly used for this purpose. Both agents have been found to be effective. However, there is a substantial lack of evidence as to which of the two drugs is better in terms of clinical outcome. ⋯ Since the last version of this review we have found no new studies.There is a lack of robust, randomised, controlled evidence that can clarify the efficacy of propofol and thiopental sodium compared to each other in the treatment of RSE. There is a need for large randomised controlled trials for this serious condition.
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Cochrane Db Syst Rev · Jun 2015
ReviewSurgery for the treatment of obesity in children and adolescents.
Child and adolescent overweight and obesity have increased globally, and are associated with significant short and long term health consequences. ⋯ Laparoscopic gastric banding led to greater body weight loss compared to a multi component lifestyle program in one small study with 50 patients. These results do not provide enough data to assess efficacy across populations from different countries, socioeconomic and ethnic backgrounds, who may respond differently. This systematic review highlights the lack of RCTs in this field. Future studies should assess the impact of the surgical procedure and post operative care to minimise adverse events, including the need for post operative adjustments and revisional surgery. Long-term follow-up is also critical to comprehensively assess the impact of surgery as participants enter adulthood.
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Cochrane Db Syst Rev · Jun 2015
Review Meta AnalysisAntibiotics for acute otitis media in children.
Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA, Canada and Australia. This is an update of a Cochrane review first published in The Cochrane Library in Issue 1, 1997 and previously updated in 1999, 2005, 2009 and 2013. ⋯ This review reveals that antibiotics have no early effect on pain, a slight effect on pain in the days following and only a modest effect on the number of children with tympanic perforations, contralateral otitis episodes and abnormal tympanometry findings at two to four weeks and at six to eight weeks compared with placebo in children with AOM. In high-income countries, most cases of AOM spontaneously remit without complications. The benefits of antibiotics must be weighed against the possible harms: for every 14 children treated with antibiotics one child experienced an adverse event (such as vomiting, diarrhoea or rash) that would not have occurred if antibiotics were withheld. Therefore clinical management should emphasise advice about adequate analgesia and the limited role for antibiotics. Antibiotics are most useful in children under two years of age with bilateral AOM, or with both AOM and otorrhoea. For most other children with mild disease in high-income countries, an expectant observational approach seems justified.