Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisTechniques for preventing hypotension during spinal anaesthesia for caesarean section.
Maternal hypotension is the most frequent complication of spinal anaesthesia for caesarean section. Most workers define hypotension as a maternal systolic blood pressure below 70-80% of baseline recordings and/or an absolute value of < 90 - 100mmHg. Hypotension is often associated with nausea and vomiting and, if severe, poses serious risks to mother (unconsciousness, pulmonary aspiration) and baby (hypoxia, acidosis and neurological injury). Several strategies are currently used to prevent or minimise hypotension but there is no established ideal technique. ⋯ No intervention reliably prevents hypotension during spinal anaesthesia for caesarean section. No conclusions are drawn regarding rare adverse effects of interventions due to their probable low incidence and the small numbers of women studied. Further trials are recommended, in particular assessing a combination of the beneficial interventions, ie colloid or crystalloid preloading, ephedrine administration and leg compression with bandages, stockings or inflatable boots.
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Cochrane Db Syst Rev · Jan 2002
ReviewHypertonic versus isotonic crystalloid for fluid resuscitation in critically ill patients.
Hypertonic solutions are considered to have a greater ability to expand blood volume and thus elevate blood pressure and can be administered as a small volume infusion over a short time period. On the other hand, the use of hypertonic solutions for volume replacement may also have important disadvantages. ⋯ This review does not give us enough data to be able to say whether hypertonic crystalloid is better than isotonic crystalloid for the resuscitation of patients with trauma, burns, or those undergoing surgery. However, the confidence intervals are wide and do not exclude clinically significant differences. Further trials are needed comparing hypertonic to isotonic crystalloid. Trials need to be large enough to detect a clinically important difference.
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Cochrane Db Syst Rev · Jan 2002
Review Comparative StudyRadiofrequency thermal ablation versus other interventions for hepatocellular carcinoma.
Hepatocellular carcinoma (HCC) is one of the most common malignant diseases worldwide. The only possibly curative therapeutic option is surgical resection. Due to impaired liver function and/or anatomical reasons only a low percentage of patients can be treated surgically. For the remainder, several non-surgical treatment approaches have been developed. In addition to percutaneous ethanol injection, transarterial interventions, and several medical interventions, radiofrequency thermal ablation has been investigated in coagulating HCC lesions. ⋯ At present, radiofrequency thermal ablation is an insufficiently studied intervention for HCC.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisCalcium antagonists for aneurysmal subarachnoid haemorrhage.
Secondary ischaemia is a frequent cause of poor outcome in patients with subarachnoid haemorrhage. Its pathogenesis has not been elucidated yet, but may be related to vasospasm. Experimental studies have indicated that calcium antagonists can prevent or reverse vasospasm. Calcium antagonists have been studied in several trials, but data are conflicting. There is no overview concerning all available calcium antagonists. ⋯ Calcium antagonists reduce the proportion of patients with poor outcome and ischaemic neurological deficits after aneurysmal SAH. The results for 'poor outcome' are statistically robust, but depend largely on one large trial with oral nimodipine; the evidence for nicardipine and AT877 is inconclusive. The evidence for nimodipine is not beyond every doubt, but given the potential benefits and modest risks associated with this treatment, against the background of a devastating natural history, oral nimodipine (60 mg every 4 hours) is indicated in patients with aneurysmal SAH. Intravenous administration of calcium antagonists cannot be recommended on the basis of the present evidence. For oral nimodipine uncertainty remains regarding the (dis)advantages in patients in poor clinical condition on admission or in patients with established cerebral ischaemia, the optimal dose and time window, the question whether other types of calcium antagonists offer better protection and the intermediate factors through which nimodipine exerts its beneficial effect after aneurysmal SAH.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisAntibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding.
Bacterial infections are a frequent complication in patients with cirrhosis and gastrointestinal bleeding. Antibiotic prophylaxis seems to decrease the incidence of bacterial infections. Oral antibiotics, active against enteric bacteria, have been most often used as antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding. ⋯ Antibiotic prophylaxis for cirrhotic inpatients with gastrointestinal bleeding is efficacious in reducing the number of deaths and bacterial infections, are well tolerated, and should be advocated.