Articles: general-anesthesia.
-
Meta Analysis
The optimal dose of succinylcholine for rapid sequence induction: a systematic review and meta-analysis of randomized trials.
The evidence base for the widely accepted standard regimen of succinylcholine for rapid sequence induction (1.0 mg kg- 1) remains unclear. ⋯ With succinylcholine regimens ≤0.5 mg kg- 1, excellent intubating conditions are less likely and apnoea times are shorter, compared with 1 mg kg- 1. With 0.3 and 0.4 mg kg- 1, unacceptable intubating conditions are more common. Succinylcholine 1.5 mg kg- 1 does not produce more often excellent conditions compared with 1 mg kg- 1, while 2.0 mg kg- 1 does, but the database with these regimens is weak and apnoea times remain unknown. Limited information size and strong statistical heterogeneity decrease the certainty of the evidence.
-
Review Meta Analysis
Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis.
Cough: why care?
Although often minor, common post-operative complications have by definition a broad impact on the perioperative experience. Some common complications, such as coughing on extubation, can also have significant surgical consequences such as for neurosurgical or ophthalmic procedures.
Both coughing on extubation (reported incidence 15-94%) and post-operative sore throat (21-72%) are very common among surgical patients.
What did they do?
Yang and team performed a high-quality meta-analysis of RCTs investigating the effect of intravenous lidocaine/lignocaine on coughing at extubation. Many of these trials also looked at further secondary effects, such as post-operative sore throat. They included 16 trials, totalling 1,516 subjects. Although the trials demonstrated significant heterogeneity, subgroup analyses still confirmed the study's findings.
And they found...
There was significant reduction in cough RR 0.64 (0.48-0.86 & NNT=5), and post-operative sore throat RR 0.46 (0.32-0.67), though no difference in laryngospasm, adverse events or time to extubation with modern volatile agents.
Analysing various lidocaine timings (pre-operative vs intra-operative) and dose ranges (low <1.5mg/kg or high >1.5 mg/kg) yielded no evidence of clear advantage. Nonetheless the findings are consistent with previous reviews, such as from Clivio et al. (2019) showing lidocaine 1.5 mg/kg reduced cough (RR: 0.44; 0.33–0.58), and that the effect is probably dose responsive.
Ok, but how does lidocaine work?
The mechanism of action reducing cough is not understood, although several possibilities have been proposed, including...
"...the suppression of airway sensory C fibres, the reduction of neural discharge of peripheral nerve fibres, and the selective depression of pain transmission in the spinal cord."
Bottom-line
Peri-operative intravenous lignocaine effectively reduces coughing on extubation and reduces post-operative sore throat, without any increase in adverse events.
summary -
Atelectasis during general anaesthesia increases with age up to 50 years and BMI up to 30 kg/m2, but appears curiously limited beyond this.
pearl -
Review Meta Analysis
Transcutaneous electrical acupoint stimulation for preventing postoperative nausea and vomiting after general anesthesia: A meta-analysis of randomized controlled trials.
We performed this meta-analysis to evaluate the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) for preventing postoperative nausea and vomiting (PONV) after general anesthesia. ⋯ TEAS is a reasonable modality to incorporate into a multimodal management approach for the prevention of PONV, PON, POV and associated with lower numbers needing antiemetic rescue, lower incidence of adverse effects after general anesthesia.
-
J. Cardiothorac. Vasc. Anesth. · Jan 2020
Review Meta AnalysisGeneral Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis.
The choice of anesthetic technique in carotid endarterectomy (CEA) has been controversial. This study compared the outcomes of general anesthesia (GA) and local anesthesia (LA) in CEA. ⋯ The results from this study showed no inferiority of using LA to GA in patients undergoing CEA. Future investigations should be reported more systematically, preferably with randomization or propensity-matched analysis, and thus registries will facilitate investigation of this subject. Anesthetic choice in CEA should be individualized and encouraged where applicable.