Articles: general-anesthesia.
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Meta Analysis Comparative Study
Intravenous versus inhalational anesthesia for pediatric inpatient surgery - A systematic review and meta-analysis.
General anesthesia is commonly used in pediatric inpatient surgery. It can be induced and maintained by either intravenous or volatile anesthetic agents. We aimed to elucidate whether intravenous or volatile anesthetic agents are superior with regards to preventing anesthesia-related complications. ⋯ Taken together, propofol increased the risk of oculocardiac reflex whereas PONV was less frequent following intravenous anesthetics compared to volatile anesthetics. The study results may help tailoring the use of either intravenous of volatile anesthetics onto the needs of pediatric inpatients. Given the clinical or statistical heterogeneity among the studies, we call for a scientific effort to increase the body of evidence on anesthetic agents in pediatric general anesthesia.
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Meta Analysis
Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis.
Use of processed-EEG monitoring to guide anaesthesia depth is associated with a 38% odds reduction of developing postoperative delirium.
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Induction of general anesthesia in patients with risk for aspiration needs special considerations to avoid the incidence and severity of complications. Since no evidence-based guidelines support the challenge for anesthesiologists various practical recommendations exist in clinical practice for rapid sequence induction and intubation (RSI). The aim of this systematic review is, to summarize the evidence and recommend a decision making process. ⋯ The consideration of all practical, clinical procedures in patients at risk for aspiration represents an effective prevention of pulmonary aspiration during the induction of anesthesia. These include the optimal drug pre-treatment with antacids (e. g. sodium citrate) for highly aspiration-endangered and proton pump inhibitors or H2 blockers in other patients the evening before. Each patient should be examined and explained prior to RSI according to the recommendations of the National German Society of Anesthesiology for preoperative evaluation. A RSI should be performed in patients with no 2h liquid and no 6h food fasting or acute vomiting, sub-ileus or ileus, or no protective reflexes or a gastrointestinal passenger disorder. In addition, RSI should be performed in pregnant women after the 3rd trimester and during birth. The expertise and competence of the physician before and during rapid sequence induction and intubation about the respective task distribution minimizes the risk of aspiration, as does the adequate equipment, as well as an optimized upper body elevation of the patient. Consistent pre-oxygenation with an FIO2 of 1.0 (FetO2-concentration > 0.9) and an oxygen flow > 10 l/min using a completely sealing respiratory mask with capnography should take 3-5 minutes. Fast enough deep anesthesia and muscle relaxation to avoid coughing and choking can be achieved by a combination of opioid, hypnotic and muscle relaxation. In addition, an opioid of choice, propofol, thiopental, etomidate and ketamine can be used as hypnotic and rocuronium with the availability of sugammadex should be used as muscle relaxant. If there are no contraindications, succinylcholine can also be used as a muscle relaxant. In case of an unexpected difficult airway, a 2nd generation extraglottic airway device should be used. During regurgitation or aspiration, intensive medical monitoring and fiber-optic bronchoscopy should be performed, depending on the degree of severity and an X‑ray thorax image or a CT scan should be performed if symptoms arise. Three factors reduce the risk of aspiration: expertise, support from an experienced anesthesiologist and close monitoring of an inexperienced anesthesiologist.
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An ideal induction drug for cesarean section (CS) must have quick action, with minimum side effects such as awareness, hemodynamic compromise, and neonatal depression. Thiopentone is frequently used; however, no reliable evidence is available to support its use as a dedicated hypnotic agent in this setting. ⋯ The evidence, based on sparse and relatively old trials, indicates that propofol and thiopentone are equally suited for CS. After 1 and 5 min, ketamine yields lower Apgar scores than thiopentone. Additional well-designed trials are needed to reach firmer conclusions.
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Review Meta Analysis
Isolated forearm technique: a meta-analysis of connected consciousness during different general anaesthesia regimens.
General anaesthesia should prevent patients from experiencing surgery, defined as connected consciousness. The isolated forearm technique (IFT) is the current gold standard for connected consciousness monitoring. We evaluated the efficacy of different anaesthesia regimens in preventing IFT responses. ⋯ Standard general anaesthesia regimens might not prevent connected consciousness. More accurate anaesthesia brain monitor methodology to reduce the likelihood of connected consciousness is desirable.