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BMJ Open Aug 2017To evaluate the optimal dose of succinylcholine for laryngeal mask airway (LMA) insertion and all related morbidities. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To evaluate the optimal dose of succinylcholine for laryngeal mask airway (LMA) insertion and all related morbidities.
DESIGN
Systematic review, meta-analysis and metaregression of randomised controlled trials (RCTs).
DATA SOURCE AND STUDY ELIGIBILITY CRITERIA
A comprehensive search of RCTs in the PubMed, Embase, the Cochrane Library and the ClinicalTrials.gov registry up to July 2016 and articles that evaluated the use of succinylcholine chloride for LMA insertion were included in the analyses. The relative risk (RR) and the corresponding 95% CIs were determined.
INTERVENTION
Succinylcholine as the coinduction agent and the doses were divided into mini (≤0.3 mg/kg) and low (0.3-1.0 mg/kg) doses for dose-dependent effect analyses.
PRIMARY AND SECONDARY OUTCOMES
The primary outcome was the first-attempt LMA insertion failure rate. Secondary outcomes included all related adverse events.
RESULTS
Data from 10 RCTs comprising 625 participants showed that succinylcholine reduced the first-attempt LMA insertion failure rate (RR, 0.22; 95% CI 0.12 to 0.43), coughing and gagging (RR, 0.26; 95% CI 0.15 to 0.45) and laryngospasm (RR, 0.14; 95% CI 0.05 to 0.39). The use of succinylcholine did not result in a significant increase of postoperative myalgia (RR, 2.58; 95% CI 0.79 to 8.44) and did not reduce the risk of postoperative sore throat (RR, 0.76; 95% CI 0.55 to 1.03). Subgroup analysis further showed that low-dose succinylcholine reduced the LMA insertion failure rate and its related coughing and gagging when compared with mini dose.
CONCLUSION
The use of succinylcholine compared with none can facilitate LMA insertion and reduce insertion-related reflexes without significant postoperative myalgia. However, additional prospective studies with a larger sample size are required to fully evaluate the dose-dependent effect and complications of succinylcholine for LMA insertion.
Topics: Cough; Dose-Response Relationship, Drug; Gagging; Humans; Intubation, Intratracheal; Laryngeal Masks; Neuromuscular Depolarizing Agents; Pain, Postoperative; Pharyngitis; Randomized Controlled Trials as Topic; Succinylcholine; Treatment Outcome
PubMed: 28780538
DOI: 10.1136/bmjopen-2016-014274 -
Journal of the American Association of... Jan 2015To systematically review the evidence related to the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake... (Review)
Review
PURPOSE
To systematically review the evidence related to the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) used for the treatment of vasomotor symptoms in perimenopausal and postmenopausal women.
DATA SOURCES
Medline, CINAHL, and the Cochrane Library databases were searched to identify randomized controlled trials (RCTs). Eighteen trials met the criteria for review.
CONCLUSIONS
Results from these trials indicate that paroxetine, citalopram, escitalopram, venlafaxine, and desvenlafaxine are effective in reducing the frequency and severity of hot flashes. Fluoxetine and sertraline appear to be less effective and should be considered second-line options for treatment.
IMPLICATIONS FOR PRACTICE
The SSRIs and SNRIs can reduce hot flashes by 65% and begin working within the first week. Patient response is variable and if one drug does not improve hot flashes, another can be tried after a 1- to 2-week drug trial. Paroxetine, citalopram, and escitalopram appear to have the fewest adverse effects. Considering cost, paroxetine and citalopram are the most cost-efficient.
Topics: Adult; Aged; Citalopram; Desvenlafaxine Succinate; Female; Fluoxetine; Hot Flashes; Humans; Menopause; Middle Aged; Paroxetine; Serotonin and Noradrenaline Reuptake Inhibitors; Sertraline; Vasomotor System; Venlafaxine Hydrochloride
PubMed: 24944075
DOI: 10.1002/2327-6924.12137 -
International Urogynecology Journal Oct 2021The aim of this study is to report cognitive dysfunction with commonly used antimuscarinic overactive bladder medications in patients suffering from overactive bladder...
INTRODUCTION AND HYPOTHESIS
The aim of this study is to report cognitive dysfunction with commonly used antimuscarinic overactive bladder medications in patients suffering from overactive bladder disorder with and without baseline neurologic conditions.
METHODS
We conducted an Ovid MEDLINE, Embase, and PsycINFO search from January 1998 to December 2018 using PRISMA guidelines. Eighteen studies met the inclusion criteria, including 5 randomized controlled trials and 13 observational studies.
RESULTS
Cognitive decline was reported with oxybutynin use (5 of 8 studies) and tolterodine use (4 of 7 studies) among patients with and without baseline cognitive impairment. Oxybutynin use was linked to functional, mental, and behavioral decline among patients with Alzheimer's disease (2 studies). No cognitive decline was detected among patients with and without baseline cognitive impairment taking trospium (6 studies), darifenacin (3 studies), imidafenacin (2 studies), and fesoterodine (1 study). Solifenacin was not associated with cognitive decline (2 studies) but was linked to an increased risk of dementia among patients with diabetes (1 study).
CONCLUSION
In this review, cognitive decline was reported with oxybutynin and tolterodine use and should be used with caution in adults over 65 years of age. Solifenacin, fesoterodine, and imidafenacin showed mixed results related to central nervous system effect. Trospium and darifenacin were not associated with cognitive decline among patients with and without baseline cognitive impairment.
Topics: Aged; Cognitive Dysfunction; Humans; Muscarinic Antagonists; Solifenacin Succinate; Tolterodine Tartrate; Urinary Bladder, Overactive
PubMed: 34213600
DOI: 10.1007/s00192-021-04909-5 -
Anesthesiology Jan 2019Although dantrolene effectively treats malignant hyperthermia (MH), discrepant recommendations exist concerning dantrolene availability. Whereas Malignant Hyperthermia...
BACKGROUND
Although dantrolene effectively treats malignant hyperthermia (MH), discrepant recommendations exist concerning dantrolene availability. Whereas Malignant Hyperthermia Association of the United States guidelines state dantrolene must be available within 10 min of the decision to treat MH wherever volatile anesthetics or succinylcholine are administered, a Society for Ambulatory Anesthesia protocol permits Class B ambulatory facilities to stock succinylcholine for airway rescue without dantrolene. The authors investigated (1) succinylcholine use rates, including for airway rescue, in anesthetizing/sedating locations; (2) whether succinylcholine without volatile anesthetics triggers MH warranting dantrolene; and (3) the relationship between dantrolene administration and MH morbidity/mortality.
METHODS
The authors performed focused analyses of the Multicenter Perioperative Outcomes Group (2005 through 2016), North American MH Registry (2013 through 2016), and Anesthesia Closed Claims Project (1970 through 2014) databases, as well as a systematic literature review (1987 through 2017). The authors used difficult mask ventilation (grades III and IV) as a surrogate for airway rescue. MH experts judged dantrolene treatment. For MH morbidity/mortality analyses, the authors included U.S. and Canadian cases that were fulminant or scored 20 or higher on the clinical grading scale and in which volatile anesthetics or succinylcholine were given.
RESULTS
Among 6,368,356 queried outcomes cases, 246,904 (3.9%) received succinylcholine without volatile agents. Succinylcholine was used in 46% (n = 710) of grade IV mask ventilation cases (median dose, 100 mg, 1.2 mg/kg). Succinylcholine without volatile anesthetics triggered 24 MH cases, 13 requiring dantrolene. Among 310 anesthetic-triggered MH cases, morbidity was 20 to 37%. Treatment delay increased complications every 10 min, reaching 100% with a 50-min delay. Overall mortality was 1 to 10%; 15 U.S. patients died, including 4 after anesthetics in freestanding facilities.
CONCLUSIONS
Providers use succinylcholine commonly, including during difficult mask ventilation. Succinylcholine administered without volatile anesthetics may trigger MH events requiring dantrolene. Delayed dantrolene treatment increases the likelihood of MH complications. The data reported herein support stocking dantrolene wherever succinylcholine or volatile anesthetics may be used.
Topics: Humans; Dantrolene; Databases, Factual; Malignant Hyperthermia; Muscle Relaxants, Central; Neuromuscular Depolarizing Agents; Succinylcholine
PubMed: 30550426
DOI: 10.1097/ALN.0000000000002490 -
Frontiers in Public Health 2022Mixed urinary incontinence increasingly undermines women's quality of life. Previous studies showed some effects of acupuncture for MUI, but no systematic review has...
BACKGROUND
Mixed urinary incontinence increasingly undermines women's quality of life. Previous studies showed some effects of acupuncture for MUI, but no systematic review has been done to evaluate the efficacy and safety of acupuncture for MUI in women.
OBJECTIVE
To systematically review the efficacy and safety of acupuncture for women with MUI.
METHODS
Ten databases (i.e., PubMed, Web of Science, Embase, ClinicalTrials.gov, the Cochrane Library, CBM, Scoups, CNKI, VIP and WANFANG DATA) were searched up to July 19th, 2021, using tailored search strategies with keywords not limited to "female," "mixed urinary incontinence," "acupuncture," and "randomized controlled trial," etc. RCTs and quasi-RCTs were included if investigating effect of any type of acupuncture for female patients with MUI. Data were extracted from eligible studies, and risks of bias were assessed according to the Cochrane Handbook from seven aspects using the RevMan 5.4 software.
RESULTS
A total of three randomized studies with 591 women were included. The risk of bias among the studies varied, with major concerns on blinding of participants and outcome assessor. Liu's study (497) mainly showed that electroacupuncture's effect on reduction of numbers of incontinence, urgency, nocturia episodes, and amount of urine leakage etc. was not inferior to that of PFMT-Solifenacin group at 12, 24, and 36 weeks. Zhan's study (60) showed that electroacupuncture reduced significantly more amount of urine leakage than Tolterodine at 8 weeks, with no data on incontinence episodes frequency. All 3 studies reported that acupuncture significantly increased the quality of life assessed by ICIQ score. In addition, incidence of acupuncture-related adverse events was rare, while antimuscarinic agents related adverse events were common in two studies.
CONCLUSION
Although acupuncture showed some benefit for women with MUI, more evidences were required to draw a solid conclusion of effectiveness and safety of acupuncture for women with MUI.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021224600.
Topics: Acupuncture Therapy; Female; Humans; Quality of Life; Randomized Controlled Trials as Topic; Solifenacin Succinate; Urinary Incontinence
PubMed: 35372235
DOI: 10.3389/fpubh.2022.827853 -
World Journal of Urology Nov 2017Ureteral stenting is associated with various morbidity and reduced quality of life. We systematically evaluated the efficacy and safety of solifenacin as monotherapy, or... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Ureteral stenting is associated with various morbidity and reduced quality of life. We systematically evaluated the efficacy and safety of solifenacin as monotherapy, or combined therapy with tamsulosin versus control or tamsulosin monotherapy in stent-related symptoms (SRSs).
MATERIALS AND METHODS
Randomized controlled trials evaluating solifenacin or its combination with tamsulosin for the treatment of SRSs were identified via a comprehensive search of Pubmed, Embase, Ovid, The Cochrane Library and relevant sources up to February 2017. Ureteral stent symptom questionnaire (USSQ) and drug-related complications were pooled for meta-analysis. Mean difference and risk difference were calculated as appropriate for each outcome to determine the cumulative effect size.
RESULTS
There were 10 studies involving 1786 participants finally eligible in the quantitative analysis. Solifenacin monotherapy significantly reduced the total score of USSQ [MD -14.90; 95% CI (-25.19, -4.60); P = 0.005], as well as indexes of urinary symptoms, body pain, general health, sexual performance, and hematuria (P = 0.02, P = 0.009, P = 0.004, P = 0.02, P = 0.02, respectively), but the differences were insignificant when compared with tamsulosin except improved sexual performance (P = 0.004). Combined therapy of solifenacin and tamsulosin showed no beneficial effects in all indexes of USSQ over solifenacin monotherapy. Only slightly higher incidence of dry mouth (P = 0.02) was found with solifenacin versus control.
CONCLUSIONS
The result demonstrates the safety and efficacy of solifenacin in reducing SRSs, but no significant advantage was found over tamsulosin. In addition, combination of solifenacin and tamsulosin did not show beneficial effects over solifenacin monotherapy. More high quality trials are warranted to further address this issue, however.
Topics: Adrenergic alpha-1 Receptor Antagonists; Drug Therapy, Combination; Flank Pain; Health Status; Hematuria; Humans; Lower Urinary Tract Symptoms; Muscarinic Antagonists; Postoperative Complications; Quality of Life; Solifenacin Succinate; Stents; Sulfonamides; Tamsulosin; Ureter; Xerostomia
PubMed: 28550362
DOI: 10.1007/s00345-017-2051-3 -
Gastrointestinal Endoscopy Apr 2017EMR is being increasingly practiced for the removal of large colorectal polyps. A variety of solutions such as normal saline solution (NS) and other viscous and... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND AND AIMS
EMR is being increasingly practiced for the removal of large colorectal polyps. A variety of solutions such as normal saline solution (NS) and other viscous and hypertonic solutions (VS) have been used as submucosal injections for EMR. A systematic review and meta-analysis is presented comparing the efficacy and adverse events of EMR performed using NS versus VS.
METHODS
Two independent reviewers conducted a search of all databases for human, randomized controlled trials that compared NS with VS for EMR of colorectal polyps. Data on complete en bloc resection, presence of residual lesions, and adverse events were extracted using a standardized protocol. Pooled odds ratio (OR) estimates along with 95% confidence intervals (CI) were calculated using fixed effect or random effects models.
RESULTS
Five prospective, randomized controlled trials (504 patients) met the inclusion criteria. The mean polyp sizes were 20.84 mm with NS and 21.44 mm with VS. On pooled analysis, a significant increase in en bloc resection (OR, 1.91; 95% CI, 1.11-3.29; P = .02; I = 0%) and decrease in residual lesions (OR, 0.54; 95% CI, 0.32-0.91; P = .02; I = 0%) were noted in VS compared with NS. There was no significant difference in the rate of overall adverse events between the 2 groups.
CONCLUSIONS
Use of VS during EMR leads to higher rates of en bloc resection and lower rates of residual lesions compared with NS, without any significant difference in adverse events. Endoscopists could consider using VS for EMR of large colorectal polyps and NS for smaller polyps because there is no significant difference in the outcomes with lesions <2 cm.
Topics: Colonic Polyps; Endoscopic Mucosal Resection; Gelatin; Glucose Solution, Hypertonic; Humans; Hyaluronic Acid; Hydroxyethyl Starch Derivatives; Hypertonic Solutions; Injections; Intestinal Polyps; Odds Ratio; Sodium Chloride; Succinates; Viscosupplements
PubMed: 27940101
DOI: 10.1016/j.gie.2016.12.003 -
International Urology and Nephrology Apr 2024Tubulointerstitial nephritis and uveitis (TINU) syndrome is an uncommon disease. We present a confirmed case of TINU syndrome, and a systematic review of epidemiological...
PURPOSE
Tubulointerstitial nephritis and uveitis (TINU) syndrome is an uncommon disease. We present a confirmed case of TINU syndrome, and a systematic review of epidemiological characteristics, clinical manifestations, management, and outcomes in Chinese patients.
METHODS
A systematic search was carried out using defined terms and updated up to September 2022, in PubMed, Web of Science, Wanfang, CNKI, and VIP, to identify reported cases of TINU in China, according to PRISMA guidelines.
RESULTS
An 18-year-old boy presented with elevated serum creatinine and 24-h urine protein level of > 2 g. Inspection result revealed acute tubulointerstitial nephritis, and bilateral uveitis. The patient was diagnosed with TINU syndrome and received treatment with methylprednisolone sodium succinate, which resulted in a significant decrease in creatinine and urinary protein levels. Systematic review identified 35 publications that met the inclusion criteria. A total of 71 cases were included in this article, of which 70 were from publications and 1 was from our hospital. The median age at onset was 42 years and was significantly lower in males than females (P < 0.05). The symptoms of uveitis often occurred after kidney injury (54%) and most uveitis was anterior (55%) and bilateral (75%). Among the 51 patients who were followed up for more than 6 months, 24 had recurrent ocular symptoms or progression to chronic uveitis. Twenty patients experienced chronic or progressive kidney disease.
CONCLUSION
TINU syndrome is prone to misdiagnosis because kidney damage may not occur simultaneously with uveitis. The incidence of kidney sequelae in children is lower than that in adults, and glucocorticoids are the preferred treatment.
INPLASY REGISTRATION NUMBER
INPLASY202350050.
Topics: Adolescent; Adult; Female; Humans; Male; China; Glucocorticoids; Nephritis, Interstitial; Uveitis
PubMed: 37755610
DOI: 10.1007/s11255-023-03797-6 -
Biological Research For Nursing Oct 2020Chronic pain is a significant public health problem in the United States, affecting approximately 100 million people. Yet there is a lack of robust biomarkers for...
BACKGROUND
Chronic pain is a significant public health problem in the United States, affecting approximately 100 million people. Yet there is a lack of robust biomarkers for clinical use in chronic pain conditions. Downstream effects of environmental, genomic, and proteomic variations in individuals with chronic pain conditions can be identified and quantified using a metabolomic approach.
AIM/DESIGN
The purpose of this systematic review was to examine the literature for reports of potential metabolomic signatures associated with chronic pain conditions.
METHODS
We searched relevant electronic databases for published studies that used various metabolomic approaches to investigate chronic pain conditions among subjects of all ages.
RESULTS
Our search identified a total of 586 articles, 18 of which are included in this review. The reviewed studies used metabolomics to investigate fibromyalgia ( = 5), osteoarthritis ( = 4), migraine ( = 3), musculoskeletal pain ( = 2), and other chronic pain conditions ( = 1/condition). Results show that several known and newly identified metabolites differ in individuals with chronic pain conditions compared to those without these conditions. These include amino acids (e.g., glutamine, serine, and phenylalanine) and intermediate products (e.g., succinate, citrate, acetylcarnitine, and N-acetylornithine) of pathways that metabolize various macromolecules.
CONCLUSION
Though more high-quality research is needed, this review provides insights into potential biomarkers for future metabolomics studies in people with chronic pain conditions.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Chronic Pain; Female; Humans; Male; Metabolomics; Middle Aged; United States
PubMed: 32666804
DOI: 10.1177/1099800420941105 -
The Journal of Clinical Endocrinology... Apr 2024Carriers of germline pathogenic variants (PV) in succinate dehydrogenase type B (SDHB) are at increased risk of developing pheochromocytomas and paragangliomas (PPGL)....
CONTEXT
Carriers of germline pathogenic variants (PV) in succinate dehydrogenase type B (SDHB) are at increased risk of developing pheochromocytomas and paragangliomas (PPGL). Understanding their outcomes can guide recommendations for risk assessment and early detection.
OBJECTIVE
We performed a systematic review and meta-analysis of the following outcomes in SDHB PV carriers: age-specific risk of developing tumors, metastatic progression, second primary tumor development, and mortality.
MATERIALS AND METHODS
Pubmed, MEDLINE and EMBASE were searched. Sixteen studies met the inclusion criteria and were sorted into four outcome categories: age-specific penetrance, metastatic disease, risk of second tumour and mortality. We assessed heterogeneity and performed a meta-analysis across studies using a random effects model with the DerSimonian and Laird method.
RESULTS
Penetrance of PPGL for non-proband/non-index SDHB PV carriers by age 20 was 4% (95% CI, 3%-6%), 11% (95% CI, 8%-15%) by age 40, 24% (95% CI, 19%-31%) by age 60 and 35% (95% CI, 25%-47%) by age 80. The overall risk of metastatic disease for non-proband/non-index carriers with PPGL was 9% (95% CI, 5-16%) per lifetime. In all affected cases (combining both proband/index and non-proband/non-index carriers with tumors), the risk of a second tumor was 24% (95% CI, 18-31%) and all cause 5-year mortality was 18% (95% CI 6-40%).
CONCLUSION
Penetrance for PPGL in SDHB PV carriers increases linearly with age. Affected carriers are at risk of developing and dying from metastatic disease, or of developing second tumors. Lifelong surveillance is appropriate.
PubMed: 38605204
DOI: 10.1210/clinem/dgae233