Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisPatient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery.
There are two common techniques for postoperative pain control after intra-abdominal surgery: patient-controlled analgesia (PCA) with intravenous opioids and continuous epidural analgesia (CEA). It is uncertain which method has better pain control and fewer adverse effects. ⋯ CEA is superior to opioid PCA in relieving postoperative pain for up to 72 hours in patients undergoing intra-abdominal surgery, but it is associated with a higher incidence of pruritus. There is insufficient evidence to draw comparisons about the other advantages and disadvantages of these two methods of pain relief.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisAir versus oxygen for resuscitation of infants at birth.
100% oxygen is the commonly recommended gas for the resuscitation of infants at birth. There is growing evidence from both animal and human studies that room air is as effective as 100% oxygen and that 100% oxygen may have adverse effects on breathing physiology and cerebral circulation. There is also the theoretical risk of tissue damage due to free oxygen radicals when 100% oxygen is given. The use of room air has, therefore, been suggested as a safer and possibly more effective alternative. ⋯ There is insufficient evidence at present on which to recommend a policy of using room air over 100% oxygen, or vice versa, for newborn resuscitation. A reduction in mortality has been seen in infants resuscitated with room air, and no evidence of harm has been demonstrated. However, the small number of identified studies and their methodologic limitations dictate caution in interpreting and applying these results. We note the use of back-up 100% oxygen in more than a quarter of infants randomised to room air. Therefore, on the basis of currently available evidence, if one chooses room air as the initial gas for resuscitation, supplementary oxygen should continue to be made available.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisInhaled tiotropium for stable chronic obstructive pulmonary disease.
Tiotropium is a new anticholinergic therapy for chronic obstructive pulmonary disease (COPD) that differs from ipratropium by its functional relative selectivity for muscarinic receptor subtypes and which allows once-per-day dosing. ⋯ Tiotropium reduced COPD exacerbations and related hospitalisations compared to placebo and ipratropium. It also improved health-related quality-of-life and symptom scores among patients with moderate and severe disease, and may have slowed decline in FEV1. Additional long-term studies are required to evaluate its effect on mortality and change in FEV1 to clarify its role in comparison to, or in combination with, long-acting ss2-agonists and to assess its effectiveness in mild and very severe COPD.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisShort term ambulatory oxygen for chronic obstructive pulmonary disease.
Ambulatory oxygen is defined as the use of supplemental oxygen during exercise and activities of daily living. Ambulatory oxygen therapy is often used for patients on long term oxygen therapy during exercise, or for non long term oxygen therapy users who achieve some subjective and/or objective benefit from oxygen during exercise. The evidence for the use of ambulatory oxygen therapy is extrapolated from two sources: longer term studies and single assessment studies. Longer term studies assess the impact of ambulatory oxygen therapy used at home during activities of daily living. Single assessment studies compare performance during an exercise test using oxygen with performance during an exercise test using placebo air. ⋯ This review provides some evidence from small, single assessment studies that ambulatory oxygen improves exercise performance in people with moderate to severe COPD. The results of the review may be affected by publication bias, and the small sample sizes in the studies. Although positive, the findings of the review require replication in larger trials with more distinct subgroups of participants. Maximal or endurance tests can be used in ambulatory oxygen assessment, but endurance tests may be more appropriate as they are more related to activities of daily living. Consideration should be given to the measurement of SaO2 and breathlessness at isotime as these provide important additional information. We recommend that these outcomes are included in the assessment for ambulatory oxygen. Future research needs to establish the level of benefit of ambulatory oxygen in specific subgroups of people with COPD.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisZonisamide add-on for drug-resistant partial epilepsy.
The majority of people with epilepsy have a good prognosis and their seizures can be well controlled with the use of a single antiepileptic agent, but up to 30% develop refractory epilepsy, especially those with partial seizures. In this review we summarize the current evidence regarding zonisamide, when used as an add-on treatment for drug-resistant partial epilepsy. ⋯ Zonisamide has efficacy as an add-on treatment in people with drug-resistant partial epilepsy. Minimum effective and maximum tolerated doses cannot be identified. The trials reviewed were of 12 week duration and results cannot be used to confirm longer periods of effectiveness in seizure control. The results cannot be extrapolated to monotherapy or to people with other seizure types or epilepsy syndromes.