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Frontiers in Aging Neuroscience 2022Postoperative delirium (POD) is one of the serious postoperative complications in elderly patients, which is always related to long-term mortality. Anesthesia is often...
STUDY OBJECTIVE
Postoperative delirium (POD) is one of the serious postoperative complications in elderly patients, which is always related to long-term mortality. Anesthesia is often considered a risk factor for POD. This systematic review and network meta-analysis (NMA) aimed to assess the impact of different anesthesia methods and anesthetics on POD.
MEASUREMENTS
We searched for studies published in PubMed, Embase, Web of Science, Scopus, and Cochrane Library (CENTRAL) from inception to 18 March 2022. RevMan 5.3 and CINeMA 2.0.0 were used to assess the risk of bias and confidence. Data analysis using STATA 17.0 and R 4.1.2. STATA 17.0 was used to calculate the surface under the cumulative ranking curve (SUCRA) and provide network plots with CINeMA 2.0.0. NMA was performed with R 4.1.2 software gemtc packages in RStudio.
MAIN RESULTS
This NMA included 19 RCTs with 5,406 patients. In the pairwise meta-analysis results, only regional anesthesia (RA) with general anesthesia (GA) vs. GA (Log OR: -1.08; 95% CI: -1.54, -0.63) were statistically different in POD incidence. In the NMA results, there was no statistical difference between anesthesia methods, and psoas compartment block (PCB) with bupivacaine was superior to the desflurane, propofol, sevoflurane, and spinal anesthesia with bupivacaine of POD occurrence.
CONCLUSION
Our study indicated that RA and GA had no significant effect on POD, and there was no difference between anesthesia methods. Pairwise meta-analysis showed that, except for RA with GA vs. GA, the rest of the results were not statistically different. Besides, PCB with bupivacaine may benefit to reduce POD incidence.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/dis play_record.php?ID=CRD42022319499, identifier PROSPERO 2022 CRD42022319499.
PubMed: 36408115
DOI: 10.3389/fnagi.2022.935716 -
Academic Emergency Medicine : Official... Feb 2020Propofol has not been extensively studied as an acute migraine therapy; however, based on the limited evidence from outpatient and inpatient settings, propofol has been... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Propofol has not been extensively studied as an acute migraine therapy; however, based on the limited evidence from outpatient and inpatient settings, propofol has been proposed as an option for patients who present to the emergency department (ED). The purpose of this review was to evaluate the existing literature regarding the safety and efficacy of propofol for acute migraine treatment in the ED.
METHODS
A systematic review of clinical studies of propofol treatment for acute migraine in the ED was performed using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Trials were identified through PubMed, Google Scholar, clinical trial registries, research registries, and key journals through May 2019. A modified Jadad scoring system was used to assess the methodologic quality of the included randomized controlled trials, and the Newcastle-Ottawa Scale was used for the retrospective cohort study.
RESULTS
Nine studies, including five case reports or series, one retrospective cohort study, and three randomized controlled trials, consisting of 290 patients, were reviewed. All studies in adults reported propofol to be an effective therapy for migraine, but the strength of these results was limited by dosing variations, small sample sizes, and limited generalizability. Pediatric studies produced mixed results.
CONCLUSIONS
Propofol may be an effective rescue therapy for patients presenting to the ED for acute migraine, but its place in therapy based on the limited available evidence is unknown. The safety of propofol for migraine management in the ED has not been adequately examined.
Topics: Acute Disease; Adolescent; Adult; Child; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Migraine Disorders; Propofol; Randomized Controlled Trials as Topic; Retrospective Studies; Young Adult
PubMed: 31621134
DOI: 10.1111/acem.13870 -
Annals of Palliative Medicine Oct 2021Optic nerve sheath diameter (ONSD) is recognized as a surrogate indicator of intracranial pressure (ICP) during surgery. Due to the requirements of surgery, the... (Meta-Analysis)
Meta-Analysis
Effects of propofol and inhalational anesthetics on the optic nerve sheath diameter in patients undergoing surgery in the steep Trendelenburg position: a systematic review and meta-analysis.
BACKGROUND
Optic nerve sheath diameter (ONSD) is recognized as a surrogate indicator of intracranial pressure (ICP) during surgery. Due to the requirements of surgery, the adjustment to the steep Trendelenburg position and the establishment of CO2 pneumoperitoneum can lead to an increase in ICP, resulting in an increase in the ONSD. Anesthetic agents have different impacts on cerebral blood volume and ICP. The aim of this study was to evaluate the effects of propofol and inhalational anesthetics on the ONSD based on data from randomized controlled trials (RCTs).
METHODS
The electronic databases of PubMed, EMBASE, Ovid MEDLINE, the Cochrane Library, and other databases were searched systematically using specified keywords from their inception to June 2021. The Chi-square test and I2 test were used to evaluate the heterogeneity across the studies. The weighted mean difference (WMD) with 95% confidence interval (CI) were adopted to analyze continuous data.
RESULTS
A total of 379 patients from 7 studies were involved in this meta-analysis. There were borderline significant differences in the ONSD atT2 between propofol and the control group: T2 (WMD =-0.15, 95% CI: -0.31, -0.00, P=0.005). There were significant differences at T3 (WMD =-0.23,95% CI: -0.42, -0.05, P =0.013) and T4 (WMD =-0.18, 95% CI: -0.29, -0.07, P =0 .001). After statistical verification, there was no significant difference in the ONSD at T1 between the 2 groups: T1 (WMD =-0.08, 95% CI: -0.26, 0.10, P =0 .368). There were also no significant differences in mean arterial pressure (MAP) (P=0.654, 0.445, 0.698, and 0.562, respectively) and end tidal CO2 (ETCO2) (P=0.081, 0.506, 0.126, and 0.983, respectively) at T1, T2, T3 and T4 between propofol and inhalational anesthetics.
DISCUSSION
The findings in the present study indicated that the ONSD during propofol anesthesia was significantly lower than that during inhalational anesthesia after adopting the Trendelenburg position and CO2 pneumoperitoneum. These analysis results suggest that propofol anesthesia may help to minimize changes in ICP compared to inhalational anesthetics.
Topics: Anesthetics, Inhalation; Head-Down Tilt; Humans; Laparoscopy; Male; Optic Nerve; Propofol; Prostatectomy; Randomized Controlled Trials as Topic; Robotic Surgical Procedures
PubMed: 34763494
DOI: 10.21037/apm-21-2363 -
Journal of Pain Research 2024To systematically evaluate the effectiveness and safety of ketamine in preventing propofol injection pain (PIP). (Review)
Review
PURPOSE
To systematically evaluate the effectiveness and safety of ketamine in preventing propofol injection pain (PIP).
PATIENTS AND METHODS
The electronic databases including PubMed, Embase, Web of Science, and Cochrane Library were searched from their inception until 2 August 2023. Randomized controlled trials (RCT) comparing ketamine with placebo or other interventions to alleviate PIP in adults were included. Fixed-effects or random-effects models were used to calculate pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) based on the heterogeneity of the studies included.
RESULTS
Thirteen RCTs involving 2105 patients were included. In terms of reducing the incidence of PIP, ketamine is more effective than placebo (RR = 0.43, 95% CI = [0.34, 0.55], < 0.00001), lidocaine (RR = 0.70, 95% CI = [0.55, 0.90], = 0.005), dexmedetomidine (RR = 0.52, 95% CI = [0.40, 0.66], < 0.00001), and thiopental (RR = 0.25, 95% CI = [0.08, 0.83], = 0.02). In reducing the incidence of severe PIP, ketamine is superior to placebo (RR = 0.12, 95% CI = [0.08, 0.19], < 0.00001), and lidocaine (RR = 0.34, 95% CI = [0.21, 0.56], < 0.0001), except dexmedetomidine (RR = 0.20, 95% CI = [0.04, 1.13], = 0.07), and thiopental (RR = 0.33, 95% CI = [0.04, 3.10], = 0.33). Compared with mixed injection, separate injection of ketamine and propofol showed no significant difference in the incidence of PIP (RR = 0.96, 95% CI = [0.31, 3.00], = 0.95) and severe PIP (RR = 1.19, 95% CI = [0.07, 21.29], = 0.90). Based solely on the reports from the studies included, subanesthetic doses of ketamine are generally safe in preventing PIP.
CONCLUSION
A subanesthetic dose of ketamine can effectively and safely reduce the incidence of PIP and severe PIP in adults, and is more effective than lidocaine, dexmedetomidine, and thiopental.
REGISTRATION
PROSPERO CRD42023455093.
PubMed: 38318331
DOI: 10.2147/JPR.S440250 -
Medicine Oct 2021Postoperative cognitive dysfunction (POCD) is a very common event in elderly noncardiac surgical patients. The effects of inhalational anaesthetics and propofol on the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postoperative cognitive dysfunction (POCD) is a very common event in elderly noncardiac surgical patients. The effects of inhalational anaesthetics and propofol on the incidence of POCD and postoperative cognitive status at different time points after surgery are currently unclear.
METHODS
We searched the Embase, Medline, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs), in which inhalation anaesthesia and propofol anaesthesia were compared. The incidence of POCD or postoperative cognitive status was assessed in elderly patients undergoing noncardiac surgery.
RESULTS
Fifteen RCTs with 1854 patients were included in this meta-analysis. The incidence of POCD on postoperative Days 2-6 after propofol anaesthesia was markedly lower than that after inhalation anaesthesia (risk ratio (RR): 0.37, 95% confidence interval (CI): 0.15-0.88, P = .025), and Mini-Mental State Examination (MMSE) scores after propofol anaesthesia were substantially higher than those after inhalation anaesthesia (standard mean difference (SMD): 0.59, 95% CI: 0.07-1.11, P = .026). The levels of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were much lower after propofol anaesthesia than after inhalation anaesthesia (SMD: -2.027, 95% CI: -3.748- -0.307, P = .021; SMD: -0.68, 95% CI: -0.93- -0.43, P < .001).
CONCLUSIONS
The moderate evidence from this meta-analysis shows that, in elderly noncardiac surgical patients, propofol anaesthesia is superior to inhalation anaesthesia for attenuating of early POCD incidence, and low-level evidence shows that cognitive status is higher and systemic inflammation is less severe after propofol anaesthesia in the early days after surgery.
LIMITATIONS
The sample size was not sufficiently large for systemic inflammation, and the tools to identify POCD were not uniform in the included studies.
Topics: Anesthesia, Inhalation; Anesthetics, Inhalation; Anesthetics, Intravenous; Humans; Mental Status and Dementia Tests; Postoperative Cognitive Complications; Propofol; Randomized Controlled Trials as Topic; Surgical Procedures, Operative
PubMed: 34713863
DOI: 10.1097/MD.0000000000027668 -
Heliyon Dec 2023Ciprofol (HSK3486) is a novel gamma-aminobutyric acid type A (GABAA) receptor agonist that has attracted wide attention because of its lower injection pain and fewer...
BACKGROUND
Ciprofol (HSK3486) is a novel gamma-aminobutyric acid type A (GABAA) receptor agonist that has attracted wide attention because of its lower injection pain and fewer adverse events. We summarized all available evidence and analyzed the efficacy and safety of ciprofol during procedural sedation and anesthesia induction.
METHODS
An electronic search of PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, Science Direct, the Chinese National Knowledge Infrastructure, Wan Fang Data, and the VIP Chinese Journal Service platform was conducted from inception of databases to March 1, 2023. Risk ratio (RR) and mean difference (MD) with 95 % confidence interval (CI) were used separately for binary categorical and continuous variables. We performed trial sequential analysis and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to judge the certainty of evidence.
RESULTS
Fifteen randomized controlled trials with 2441 patients were included in this study. Ciprofol showed similar advantages to propofol in terms of induction success rate (RR = 1, 95 % CI = 0.99, 1.01, moderate certainty) and induction time (MD = 3.31, 95 % CI = -0.34, 6.95, low certainty), but did not increase the incidence of adverse events (RR = 0.88, 95 % CI = 0.78, 1.00, very low certainty), such as bradycardia (RR = 0.96, 95 % CI = 0.77, 1.21, high certainty), hypoxia (RR = 0.79, 95 % CI = 0.46, 1.37, p = 0.40, moderate certainty) and other adverse events. Although it may be associated with a longer time to be fully alert (MD = 1.22, 95 % CI = 0.32, 2.12, very low certainty), ciprofol significantly reduced injection pain (RR = 0.15, 95 % CI 0.09, 0.24, low certainty) and may have reduced the incidence of hypotension (RR = 0.77, 95 % CI = 0.63, 0.94, low certainty) and respiratory depression (RR = 0.29, 95 % CI = 0.15, 0.56, moderate certainty).
CONCLUSION
Ciprofol and propofol had similar effects on most outcomes. While the time to full alertness may be prolonged, injection pain was significantly reduced, and hypotension and respiratory depression may be reduced compared with propofol. We believe that ciprofol is an effective alternative to intravenous anesthetic agents.
PubMed: 38125496
DOI: 10.1016/j.heliyon.2023.e22634 -
International Journal of Surgery... Dec 2023
Meta-Analysis
Topics: Humans; Propofol; Anesthesia, Intravenous; Benzodiazepines
PubMed: 37816162
DOI: 10.1097/JS9.0000000000000710 -
BMJ Open Jul 2016Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological... (Review)
Review
OBJECTIVES
Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients.
SETTING/PARTICIPANTS
We searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention.
PRIMARY AND SECONDARY OUTCOME MEASURES
Two reviewers assessed studies for inclusion and extracted data for efficacy outcomes, including sleep efficiency, sleep latency, sleep fragmentation and objectively measured sleep stage distribution. Risk of bias was assessed and meta-analyses were planned contingent upon homogeneity of the included studies.
RESULTS
After screening 1920 citations, 15 studies involving 861 patients were included. Medications studied included benzodiazepines, nonbenzodiazepine sedatives, melatonin, propofol and dexmedetomidine. Five studies were deemed to be of high quality. Heterogeneity and variable outcome reporting precluded meta-analysis in most cases. No consistent trends with respect to sleep efficiency, quality or interruptions were observed identifying a drug or drug class as superior to another or no treatment. Benzodiazepines appeared to be better than no treatment with respect to sleep latency, but this was not consistently demonstrated across all studies. Sleep stage distribution shows that sleep in hospital is dominated by stages N1 and N2.
CONCLUSIONS
There is insufficient evidence to suggest that pharmacotherapy improves the quality or quantity of sleep in hospitalised patients suffering from poor sleep. No drug class or specific drug was identified as superior even when compared to placebo or no treatment. Although 15 studies were included, the quality of evidence was limited by their quality and size. Larger, better-designed trials in hospitalised adults are needed.
Topics: Evidence-Based Medicine; Humans; Hypnotics and Sedatives; Inpatients; Melatonin; Sleep Initiation and Maintenance Disorders
PubMed: 27473952
DOI: 10.1136/bmjopen-2016-012108 -
The Cochrane Database of Systematic... Oct 2016Functional endoscopic sinus surgery (FESS) is a minimally invasive technique that is used to treat chronic sinusitis. Small bleeding areas can reduce operative... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Functional endoscopic sinus surgery (FESS) is a minimally invasive technique that is used to treat chronic sinusitis. Small bleeding areas can reduce operative visibility and result in destruction of surrounding structures. Deliberate hypotension (lowering the mean arterial blood pressure to between 50 and 65 mm Hg in normotensive patients) using a range of pharmacological agents during general anaesthesia reduces blood loss in many operations. This review was originally published in 2013 and updated in February 2016.
OBJECTIVES
We aimed to compare the use of propofol versus other techniques for achieving deliberate intraoperative hypotension during FESS procedures with regard to blood loss and operative conditions.
SEARCH METHODS
We searched the following databases in the updated review: the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE (1950 to February 2016), Embase (1980 to February 2016), LILACS (1982 to February 2016), and ISI Web of Science (1946 to February 2016). We also searched the reference lists of relevant articles and conference proceedings and contacted the authors of included trials.
SELECTION CRITERIA
We sought all randomized controlled trials comparing propofol with other techniques for deliberate hypotension during FESS with regard to blood loss and operative conditions in both adults and children. Our primary outcome was total blood loss (TBL). Other outcomes included surgical field quality, operation time, mortality within 24 hours, complications, and failure to reach target blood pressure.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Two review authors independently extracted details of trial methodology and outcome data from the reports of all trials considered eligible for inclusion. We made all analyses on an intention-to-treat basis where possible. When I was less than 40% and the P value from the Chi test was higher than 0.10, we pooled data using the fixed-effect model. Otherwise, we pooled data using the random-effects model.
MAIN RESULTS
We found no new studies. This updated review therefore includes four studies with 278 participants. Most analyses were based on data from few participants and low-quality evidence, so our results should be interpreted with caution. Deliberate hypotension with propofol did not decrease TBL (millilitres) when compared with inhalation anaesthetics in either children (1 study; 70 participants; very low-quality evidence), or adults (1 study; 88 participants; moderate-quality evidence). Propofol improved the quality of the surgical field by less than one category on a scale from 0 (no bleeding) to 5 (severe bleeding) (mean difference -0.64, 95% CI -0.91 to -0.37; 4 studies; 277 participants; low-quality evidence), but no difference in operation time was reported (3 studies; 214 participants; low-quality evidence). Failure to lower blood pressure to target was less common in the propofol group (risk ratio of failure with propofol 0.24, 95% CI 0.09 to 0.66; 1 study; 88 participants; moderate-quality evidence).
AUTHORS' CONCLUSIONS
Using propofol to achieve deliberate hypotension probably improves the surgical field, but the effect is small. Deliberate hypotension with propofol did not decrease TBL and the operation time. However, due to the very low quality of the evidence, this conclusion is not definitive. Randomized controlled trials with good-quality methodology and large sample size are required to investigate the effectiveness of deliberate hypotension with propofol for FESS.
Topics: Adult; Anesthetics, Intravenous; Blood Loss, Surgical; Child; Endoscopy; Humans; Hypotension, Controlled; Operative Time; Paranasal Sinuses; Propofol; Randomized Controlled Trials as Topic
PubMed: 27731501
DOI: 10.1002/14651858.CD006623.pub3 -
Medicine Feb 2023Propofol is increasingly being used for sedation in gastrointestinal endoscopy; however, owing to its side effects, an alternative drug is needed. We aimed to compare... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Propofol is increasingly being used for sedation in gastrointestinal endoscopy; however, owing to its side effects, an alternative drug is needed. We aimed to compare the safety, satisfaction, and efficacy outcomes of etomidate versus propofol in patients undergoing gastrointestinal endoscopy, including advanced endoscopic procedures.
METHODS
We systematically searched Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL (via EBSCO), China National Knowledge Infrastructure, and Web of Science (1946-April 2020) databases for randomized controlled trials of gastrointestinal endoscopy (upper gastrointestinal endoscopy, colonoscopy, and advanced endoscopy) using etomidate or propofol as sedatives. We pooled odds ratios (ORs) for the safety profile and patient and anesthesiologist satisfaction using mixed-effects conditional logistic models and standardized mean differences for efficiency outcomes using random-effects models.
RESULTS
Twenty-four studies involving 3875 patients were included. Compared with propofol, etomidate resulted in significantly reduced apnea (OR: 0.22; 95% confidence interval [CI]: 0.13-0.37; P < .001), hypoxemia (OR: 0.43; 95% CI: 0.35-0.54; P < .001), hypotension (OR: 0.20; 95% CI: 0.11-0.36; P < .001), and bradycardia (OR: 0.52; 95% CI: 0.30-0.91; P = .02) but led to increased myoclonus (OR: 8.54; 95% CI: 5.20-14.01; P < .001) and lowered anesthesiologist satisfaction (OR: 0.60; 95% CI: 0.39-0.91; P = .02).
CONCLUSION
Etomidate may be a good alternative to propofol for gastrointestinal endoscopy, especially advanced endoscopy. Etomidate appears to be safe as an inducer for hemodynamically unstable patients or older adult patients undergoing gastrointestinal endoscopy.
Topics: Humans; Aged; Propofol; Etomidate; Endoscopy, Gastrointestinal; Hypnotics and Sedatives; Colonoscopy
PubMed: 36820568
DOI: 10.1097/MD.0000000000032876