Articles: general-anesthesia.
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Review Meta Analysis
A quest to increase safety of anesthetics by advancements in anesthesia monitoring: scientometric analysis.
The aim of this study was to assess progress in the field of anesthesia monitoring over the past 40 years using scientometric analysis. The following scientometric indexes were used: popularity indexes (general and specific), representing the proportion of articles on either a topic relative to all articles in the field of anesthetics (general popularity index, GPI) or the subfield of anesthesia monitoring (specific popularity index, SPI); index of change (IC), representing the degree of growth in publications on a topic from one period to the next; and index of expectations (IE), representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000) biomedical journals covered by PubMed. Publications on 33 anesthesia-monitoring topics were assessed. ⋯ By the 2009-2013 period, among specific monitoring topics introduced after 1980, the SPI index had a meaningful magnitude (≥1.5) in 9 of 24 topics: Bispectral Index (7.8), Transesophageal Echocardiography (4.2), Electromyography (2.8), Pulse Oximetry (2.4), Entropy (2.3), Train-of-four (2.3), Capnography (1.9), Pulse Contour (1.9), and Electrical Nerve Stimulation for neuromuscular monitoring (1.6). Only one of these topics (Pulse Contour) demonstrated (in 2009-2013) high values for both IC and IE indexes (76 and 16.9, respectively), indicating significant recent progress. We suggest that rapid growth in the field of anesthetic monitoring was one of the most important developments to compensate for the intrinsically low margins of safety of anesthetic agents.
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Review Meta Analysis
The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis.
The purpose of this meta-analysis was to determine the efficacy of lidocaine in preventing laryngospasm during general anaesthesia in children. An electronic search of six databases was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to. ⋯ Subgroup analysis revealed that both intravenous lidocaine (RR 0.34, 95% CI 0.14-0.82) and topical lidocaine (RR 0.42, 95% CI 0.22-0.80) lidocaine are effective in preventing laryngospasm. The results were not affected by studies with a high risk of bias. We conclude that, both topical and intravenous lidocaine are effective for preventing laryngospasm in children.
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Cochrane Db Syst Rev · Nov 2014
Review Meta AnalysisAnaesthetic techniques for risk of malignant tumour recurrence.
Surgery remains a mainstay of treatment for malignant tumours; however, surgical manipulation leads to a significant systemic release of tumour cells. Whether these cells lead to metastases is largely dependent on the balance between aggressiveness of the tumour cells and resilience of the body. Surgical stress per se, anaesthetic agents and administration of opioid analgesics perioperatively can compromise immune function and might shift the balance towards progression of minimal residual disease. Regional anaesthesia techniques provide perioperative pain relief; they therefore reduce the quantity of systemic opioids and of anaesthetic agents used. Additionally, regional anaesthesia techniques are known to prevent or attenuate the surgical stress response. In recent years, the potential benefit of regional anaesthesia techniques for tumour recurrence has received major attention and has been discussed many times in the literature. In preparing this review, we aimed to summarize the current evidence systematically and comprehensively. ⋯ Currently, evidence for the benefit of regional anaesthesia techniques on tumour recurrence is inadequate. An encouraging number of prospective randomized controlled trials are ongoing, and it is hoped that their results, when reported, will add evidence for this topic in the near future.
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Meta Analysis
Dexmedetomidine as an anesthetic adjuvant for intracranial procedures: meta-analysis of randomized controlled trials.
This meta-analysis aimed to systematically collect the current evidence regarding the efficacy and safety of dexmedetomidine (DEX) as an anesthetic adjuvant for patients undergoing intracranial surgery. A systematic literature search of randomized controlled trials (RCT) was conducted to compare DEX with placebo or opioids in patients undergoing intracranial procedures. Hemodynamic data, opioid consumption, and recovery parameters were pooled. ⋯ Patients also had lower mean arterial pressure and heart rate when extubated (mean difference [MD]=-9.74 mm Hg, 95% CI -12.35 to -7.12, p<0.00001; and MD=-16.35 beats/minute, 95% CI -20.00 to -12.70, p<0.00001, respectively), a lower intraoperative additional fentanyl consumption (MD=-0.78 μg/kg, 95% CI -1.51 to -0.05, p=0.04), and lower postoperative antiemetic requests (RR=0.51, 95% CI 0.33-0.80, p=0.003). DEX may not increase extubation time, postoperative PaCO2, or the risk of perioperative bradycardia. Only a small number of RCT are available, but meta-analysis shows evidence that DEX as an anesthetic adjuvant during intracranial procedures leads to better perioperative hemodynamic control, less intraoperative opioid consumption, and fewer postoperative antiemetic requests.
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Anesthesia and analgesia · Sep 2014
Review Meta Analysis Comparative StudyNeuraxial Anesthesia for the Prevention of Postoperative Mortality and Major Morbidity: An Overview of Cochrane Systematic Reviews.