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Zhongguo Zhen Jiu = Chinese Acupuncture... Jan 2023To evaluate the clinical value and safety of combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the clinical value and safety of combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery.
METHODS
The randomized controlled trials (RCTs) related to combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery were searched in PubMed, EMbase, Cochrane Library, Web of Science, SinoMed, CNKI, VIP database, Wanfang database, ClinicalTrials.gov, and the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) from the inception of each database up to July 12, 2022. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool, and Meta-analysis was conducted using RevMan5.4.
RESULTS
A total of 33 RCTs were included, involving 2 526 participants. The Meta-analysis results showed that compared to conventional anesthesia, the patients receiving combined anesthesia of acupuncture-pharmacotherapy had more stable vital signs during surgery, reduced intraoperative fentanyl usage [=-3.73, 95%(-5.28, -2.18), =4.72, <0.000 01], decreased postoperative sufentanil consumption [=-20.85, 95%(-24.84, -16.86), =10.24, <0.000 01], reduced total/effective presses of the postoperative patient-controlled analgesia pump [=-5.70, 95% (-9.04, -2.36), =3.35, =0.000 8], lowered postoperative pain visual analogue scale (VAS) [=-1.63, 95%(-2.02, -1.23), =7.97, <0.000 01], shorter length of postoperative hospital stay [=-1.14, 95%(-1.85, -0.43), =3.15, =0.002], and higher levels of CD 4+ T lymphocytes, CD 8+ T lymphocytes, natural killer (NK) cell activity, and superoxide dismutase (SOD). Additionally, tumor necrosis factor-alpha (TNF-α), adrenaline and cortisol levels were decreased (<0.05). No adverse events related to acupuncture or electrical stimulation were reported, and the incidence of postoperative complications was lower than that of conventional anesthesia [=0.47, 95%(0.36, 0.62), =5.36, <0.000 01].
CONCLUSIONS
The combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery could improve anesthesia and analgesia effectiveness, reduce anesthesia drug usage, regulate immune responses, suppress stress reactions, and the safety is satisfactory. However, there is substantial heterogeneity among the included studies, and outcome measures vary widely. Further large-sample, high-quality, internationally standardized clinical trials are needed to clarify its clinical value and safety, providing reliable evidence for clinical practice.
Topics: Humans; Anesthesia; Acupuncture Therapy; Postoperative Complications; Pain Management; Analgesia, Patient-Controlled
PubMed: 38191169
DOI: 10.13703/j.0255-2930.20221008-0005 -
Journal of Clinical Anesthesia Sep 2021Moderate to severe postoperative pain occurs in up to 60% of women following breast operations. Our aim was to perform a network meta-analysis and systematic review to... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
Moderate to severe postoperative pain occurs in up to 60% of women following breast operations. Our aim was to perform a network meta-analysis and systematic review to compare the efficacy and side effects of different analgesic strategies in breast surgery.
DESIGN
Systematic review and network meta-analysis.
SETTING
Operating room, postoperative recovery room and ward.
PATIENTS
Patients scheduled for breast surgery under general anesthesia.
INTERVENTIONS
Following an extensive search of electronic databases, those who received any of the following interventions, control, local anesthetic (LA) infiltration, erector spinae plane (ESP) block, pectoralis nerve (PECS) block, paravertebral block (PVB) or serratus plane block (SPB), were included. Exclusion criteria were met if the regional anesthesia modality was not ultrasound-guided. Network plots were constructed and network league tables were produced.
MEASUREMENTS
Co-primary outcomes were the pain at rest at 0-2 h and 8-12 h. Secondary outcomes were those related to analgesia, side effects and functional status.
MAIN RESULTS
In all, 66 trials met our inclusion criteria. No differences were demonstrated between control and LA infiltration in regard to the co-primary outcomes, pain at rest at 0-2 and 8-12 h. The quality of evidence was moderate in view of the serious imprecision. With respect to pain at rest at 8-12 h, ESP block, PECS block and PVB were found to be superior to control or LA infiltration. No differences were revealed between control and LA infiltration for outcomes related to analgesia and side effects, and few differences were shown between the various regional anesthesia techniques.
CONCLUSIONS
In breast surgery, regional anesthesia modalities were preferable from an analgesic perspective to control or LA infiltration, with a clinically significant decrease in pain score and cumulative opioid consumption, and limited differences were present between regional anesthetic techniques themselves.
Topics: Anesthesia, Conduction; Breast Neoplasms; Female; Humans; Nerve Block; Network Meta-Analysis; Pain, Postoperative
PubMed: 33873002
DOI: 10.1016/j.jclinane.2021.110274 -
The Cochrane Database of Systematic... Oct 2021Carotid endarterectomy may significantly reduce the risk of stroke in people with recently symptomatic, severe carotid artery stenosis. However, there are significant... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Carotid endarterectomy may significantly reduce the risk of stroke in people with recently symptomatic, severe carotid artery stenosis. However, there are significant perioperative risks that may be minimised by performing the operation under local rather than general anaesthetics. This is an update of a Cochrane Review first published in 1996, and previously updated in 2004, 2008, and 2013.
OBJECTIVES
To determine whether carotid endarterectomy under local anaesthetic: 1) reduces the risk of perioperative stroke and death compared with general anaesthetic; 2) reduces the complication rate (other than stroke) following carotid endarterectomy; and 3) is acceptable to individuals and surgeons.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, and two trials registers (to February 2021). We also reviewed reference lists of articles identified.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing the use of local anaesthetics to general anaesthetics for people having carotid endarterectomy were eligible.
DATA COLLECTION AND ANALYSIS
Three review authors independently extracted data, assessed risk of bias, and evaluated quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool. We calculated a pooled Peto odds ratio (OR) and corresponding 95% confidence interval (CI) for the following outcomes that occurred within 30 days of surgery: stroke, death, ipsilateral stroke, stroke or death, myocardial infarction, local haemorrhage, and arteries shunted.
MAIN RESULTS
We included 16 RCTs involving 4839 participants, of which 3526 were obtained from the single largest trial (GALA). The main findings from our meta-analysis showed that, within 30 days of operation, neither incidence of stroke nor death were significantly different between local and general anaesthesia. Of these, the incidence of stroke in the local and general anaesthesia groups was 3.2% and 3.5%, respectively (Peto odds ratio (OR) 0.91, 95% confidence interval (CI) 0.66 to 1.26; P = 0.58; 13 studies, 4663 participants; low-quality evidence). The rate of ipsilateral stroke under both types of anaesthesia was 3.1% (Peto OR 1.03, 95% CI 0.71 to 1.48; P = 0.89; 2 studies, 3733 participants; low-quality evidence). The incidence of stroke or death in the local anaesthesia group was 3.5%, while stroke or death incidence was 4.1% in the general anaesthesia group (Peto OR 0.85, 95% CI 0.62 to 1.16; P = 0.31; 11 studies, 4391 participants; low-quality evidence). A lower rate of death was observed in the local anaesthetic group but evidence was of low quality (Peto OR 0.61, 95% CI 0.35 to 1.06; P = 0.08; 12 studies, 4421 participants).
AUTHORS' CONCLUSIONS
The incidence of stroke and death were not convincingly different between local and general anaesthesia for people undergoing carotid endarterectomy. The current evidence supports the choice of either approach. Further high-quality studies are still needed as the evidence is of limited reliability.
Topics: Anesthesia, General; Anesthesia, Local; Carotid Stenosis; Endarterectomy, Carotid; Humans; Stroke
PubMed: 34642940
DOI: 10.1002/14651858.CD000126.pub5 -
Annals of Palliative Medicine Nov 2021Several studies have evaluated the association between thermal insulation (TI) and control after surgery, with various research designs, recruitment and exclusion... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several studies have evaluated the association between thermal insulation (TI) and control after surgery, with various research designs, recruitment and exclusion criteria, and measurements. The current meta-analysis aimed to assess the correlation between TI and stroke during recovery from anesthesia.
METHODS
We searched for full-text articles of us of TI during anesthesia recovery in multiple databases including PubMed, Springer, EMBASE and Chinese journal full-text databases. Two reviewers read each article and extracted the relevant data of into a Microsoft Excel table: name of the first author, publication year, year of onset, sample size (TI/control group), patient age range, and other information related to TI patients and control group. The meta-analysis, sensitivity analysis and bias analysis were performed using Review Manager 5.0.
RESULTS
A total of 723 patients from 7 studies met the eligibility criteria and were included in the final analysis. The meta-analysis showed that the recovery time after anesthesia in the TI group was significantly different from that in the control group [mean difference (MD) =-7.02, 95% confidence interval (CI): -10.10 to -3.95, P<0.00001; P for heterogeneity <0.00001, I2=99%], length of stay in Postanesthesia Care Unit (PACU) score [MD =-20.78, 95% CI: -31.32 to -10.24, P=0.0001; P for heterogeneity <0.00001, I2=92%] and shivering rate [relative risk (RR) =0.25, 95% CI: 0.08 to 0.77, P=0.02; P for heterogeneity =0.07, I2=71%].
DISCUSSION
TI is an important measure during recovery from anesthesia.
Topics: Anesthesia; Body Temperature; Humans; Postoperative Care
PubMed: 34872265
DOI: 10.21037/apm-21-2716 -
Neurourology and Urodynamics Aug 2021The decision on the appropriate type of anesthesia for pelvic floor repair depends on a variety of factors including patients' age, performance status, comorbidities,... (Meta-Analysis)
Meta-Analysis Review
AIMS
The decision on the appropriate type of anesthesia for pelvic floor repair depends on a variety of factors including patients' age, performance status, comorbidities, cost-effectiveness and personal preferences. We aim to review the literature on urogynecological procedures performed under local anesthesia (LA).
METHODS
A systematic search of four electronic databases was conducted for articles published up to May 2020. Studies reporting outcomes of women who underwent pelvic floor reconstructive surgery under LA with or without sedation, were considered eligible.
RESULTS
Nineteen studies (14 noncomparative and 5 comparative), including 1626 cases of urogynecological procedures under LA were recruited. Meta-analysis revealed significantly lower mean pain scores in LA group compared to general-regional anesthesia one (GA/RA) at both 4-6 h and 8-18 h postoperatively (160 patients; mean difference [MD], -1.70; 95% confidence interval [CI]: -3.12, -0.28; p = 0.02 and 160 patients; MD, -0.72; 95% CI: -1.17, 0.27; p = 0.002, respectively). Pain scores at >24 h did not differ among the two groups (160 patients; MD, -0.28; 95% CI: -0.60-0.05; p = 0.10). Intra- and postoperatively morphine use was not different among patients who received LA and GA during prolapse surgery while nausea rates were significantly lower in LA group compared to RA group 8 h postoperatively.
CONCLUSIONS
LA with or without sedation represents a safe and efficient alternative anesthetic technique for urogynecological procedures with improved pain scores in up to 18 h postoperatively especially in patients who underwent surgery for SUI. LA is feasible and could be offered to patients undergoing pelvic floor surgery allowing a prompt postoperative recovery.
Topics: Anesthesia, Local; Female; Humans; Orthopedic Procedures; Pelvic Floor; Pelvic Organ Prolapse; Plastic Surgery Procedures
PubMed: 34146436
DOI: 10.1002/nau.24691 -
Journal of Cardiothoracic and Vascular... Jan 2020The choice of anesthetic technique in carotid endarterectomy (CEA) has been controversial. This study compared the outcomes of general anesthesia (GA) and local... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
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.
DESIGN
Systematic review and meta-analysis of comparative studies.
SETTING
Hospitals.
PARTICIPANTS
Adult patients undergoing CEA with either LA or GA.
INTERVENTIONS
The effects of GA and LA on CEA outcomes were compared.
MEASUREMENTS AND MAIN RESULTS
PubMed, OVID, Scopus, and Embase were searched to June 2018. Thirty-one studies with 152,376 patients were analyzed. A random effect model was used, and heterogeneity was assessed with the I and chi-square tests. LA was associated with shorter surgical time (weighted mean difference -9.15 min [-15.55 to -2.75]; p = 0.005) and less stroke (odds ratio [OR] 0.76 [0.62-0.92]; p = 0.006), cardiac complications (OR 0.59 [0.47-0.73]; p < 0.00001), and in-hospital mortality (OR 0.72 [0.59-0.90]; p = 0.003). Transient neurologic deficit rates were similar (OR 0.69 [0.46-1.04]; p = 0.07). Heterogeneity was significant for surgical time (I = 0.99, chi-square = 1,336.04; p < 0.00001), transient neurologic deficit (I = 0.41, chi-square = 28.81; p = 0.04), and cardiac complications (I = 0.42, chi-square = 43.32; p = 0.01) but not for stroke (I = 0.22, chi-square = 30.72; p = 0.16) and mortality (I = 0.00, chi-square = 21.69; p = 0.65). Randomized controlled trial subgroup analysis was performed, and all the aforementioned variables were not significantly different or heterogenous.
CONCLUSION
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.
Topics: Adult; Anesthesia, General; Anesthesia, Local; Carotid Stenosis; Endarterectomy, Carotid; Humans; Risk Factors; Stroke; Treatment Outcome
PubMed: 31072705
DOI: 10.1053/j.jvca.2019.03.029 -
Medicine Jan 2023Combined acupuncture-medicine anesthesia (CAMA) is extensively used in thyroid surgery in China. We conducted a systematic review and meta-analysis to assess the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Combined acupuncture-medicine anesthesia (CAMA) is extensively used in thyroid surgery in China. We conducted a systematic review and meta-analysis to assess the efficacy and safety of CAMA.
METHODS
We searched the China National Knowledge Infrastructure (CNKI), VIP database, WanFang database, PubMed, EMBASE, and the Cochrane Library for relevant literature. The term of literature was published before April 18, 2020, and there were no restrictions on publication language, region, or publication year. The inclusion criteria included a randomized controlled trial (RCT) of acupuncture combined with cervical plexus anesthesia. We used RevMan5.3 software for data analysis. If the chi-square test showed no significant heterogeneity (P > .10, I2 < 50%), we used the fixed-effect model to calculate risk ratio (RR) and mean difference. Otherwise, the random-effects model was used.
RESULTS
Overall, 18 RCTs involving 1211 patients were included in the study. The anesthesia significant rate (ASR) in the transcutaneous electrical acupoint stimulation (TEAS) plus cervical plexus block anesthesia (CPBA) and electroacupuncture (EA) plus CPBA groups was significantly higher compared with the CPBA group (TEAS + CPBA: P < .001; EA + CPBA: P < .001). The pooled effect values of the intraoperative heart rate (HR) and mean arterial pressure (MAP) were significantly lower in both the TEAS + CPBA and EA + CPBA groups relative to the control group (HR: P = .05, P < .001; the MAP: P = .002, P < .001; respectively). Moreover, the postoperative adverse reaction was markedly lower in the experimental group than in the control group (RR = 0.30, P < .001), and there was no heterogeneity between the two groups (P = .71, I2 = 0%).
CONCLUSION
Combined acupuncture-medicine anesthesia significantly increases the anesthesia significance rate, reduces the intraoperative heart rate, and blood pressure, and reduces the incidence of postoperative adverse reactions. However, more high-quality future studies should be conducted to validate the efficacy and safety of acupuncture combined anesthesia further.
Topics: Humans; Thyroid Gland; Electroacupuncture; Acupuncture Therapy; Acupuncture Analgesia; Anesthesia; Randomized Controlled Trials as Topic
PubMed: 36607887
DOI: 10.1097/MD.0000000000032582 -
BMJ Open Nov 2023The optimal puncture technique for neuraxial anaesthesia in different populations is unclear. We sought to obtain data from randomised controlled trials comparing the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The optimal puncture technique for neuraxial anaesthesia in different populations is unclear. We sought to obtain data from randomised controlled trials comparing the impact of ultrasound-guided technology and traditional positioning technology on the success rate of neuraxial anaesthesia.
DESIGN
Systematic review and network meta-analysis using study populations, interventions, intervention comparisons, outcome measures and study types.
DATA SOURCES
PubMed, Embase, Cochrane Library and Web of science were searched until 31 September 2022.
ELIGIBILITY CRITERIA
We included randomised controlled trials comparing three types of neuraxial anaesthesia: ultrasound-assisted, ultrasound real-time guidance and conventional positioning to describe which neuraxial anaesthesia modality is best for patients and to recommend the appropriate one for different populations.
DATA EXTRACTION AND SYNTHESIS
Five independent reviewers retrieved, screened and edited included studies using standardised methods. Assess risk of bias using the Cochrane Collaboration and Evidence Project tools. Network meta-analysis was performed using STATA V.15 statistical software.
RESULTS
Twenty-two studies containing three different interventions were included. The SUCRA values of first-pass success rates for the three neuraxial anaesthesia methods were real-time guidance (82.8%), ultrasound-assisted (67.1%) and traditional positioning (0.1%). Both ultrasound techniques improved first-pass success rates compared with traditional localization, but there was no significant difference between the two. Subgroup analysis showed that the use of real-time ultrasound guidance for neuraxial anaesthesia in pregnant and patients with obesity improved first-pass success rates. Ultrasound-assisted technology can improve first-attempt success rates in older patients with abnormal lumbar spine anatomy.
CONCLUSION
Compared with conventional positioning, ultrasound guidance technology can improve the first-pass success rate of neuraxial anaesthesia, but there is no significant difference between ultrasound-assisted and real-time guidance technology. The results of subgroup analysis tell us that the most suitable neuraxial anaesthesia method is different for different groups of people.
PROSPERO REGISTRATION NUMBER
PROSPERO number: CRD42022376041.
Topics: Humans; Aged; Network Meta-Analysis; Spinal Puncture; Anesthesia, Epidural; Lumbar Vertebrae; Ultrasonography, Interventional
PubMed: 37918920
DOI: 10.1136/bmjopen-2022-071253 -
AANA Journal Feb 2023Video laryngoscopy is useful when direct laryngoscopy fails. However, should video laryngoscopy replace conventional laryngoscopy? We sought evidence updating previous...
Video laryngoscopy is useful when direct laryngoscopy fails. However, should video laryngoscopy replace conventional laryngoscopy? We sought evidence updating previous systematic reviews examining whether video laryngoscopy should replace direct laryngoscopy for routine adult intubations performed by experienced anesthesia providers in the operating room. Six randomized controlled trials met the inclusion criteria. All trials compared the success of various video laryngoscopes to Macintosh laryngoscopes. The primary outcome was the first-pass success rate. The secondary outcomes were time to successful intubation and oropharyngeal trauma occurrence. Overall, the evidence suggests there is no difference between video laryngoscopy versus direct laryngoscopy in first-pass endotracheal success rate, time to tracheal intubation, and occurrence of oropharyngeal trauma for adult intubations performed in the operating room. However, an important consideration in interpreting the evidence is that the studies were not uniformly powered to measure the outcomes of interest. Anesthesia providers should consider continuing the use of conventional laryngoscopy for adults not suspected of being difficult to intubate however, a video laryngoscope should be readily available. Future large-scale studies examining the use of the video laryngoscope for all adult intubations are needed.
Topics: Adult; Humans; Anesthesia; Anesthesiology; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy
PubMed: 36722782
DOI: No ID Found -
Oral and Maxillofacial Surgery Dec 2023Pediatric dental surgeries are associated with the emotions of fear, anxiety, and other behavioral disturbances of children that need to be managed. Sedation using drugs... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis comparing the efficacy of dexmedetomidine to midazolam as premedication and a sedative agent in pediatric patients undergoing dental procedures.
INTRODUCTION
Pediatric dental surgeries are associated with the emotions of fear, anxiety, and other behavioral disturbances of children that need to be managed. Sedation using drugs like dexmedetomidine (DEX) and midazolam (MID) is a common pharmacological behavior managing technique. We conducted this meta-analysis to evaluate the efficacy of both these drugs in current literature.
METHODOLOGY
A thorough literature search was conducted on PubMed, MEDLINE, Google Scholar, and Cochrane's database for randomized studies that compared sedative efficacy of dexmedetomidine with midazolam in children of 0-15 years of age undergoing dental surgeries. Sedation in children during dental procedure, when used as a premedication, at the time of separation from parents and at the time of mask induction, onset time, duration of anesthesia, and surgery were evaluated. The mean differences (MDs), odds ratio (OR), and their 95% confidence intervals (CIs) were calculated both for continuous and dichotomous outcome data using random-effects model.
RESULTS
Seven studies met out inclusion criteria and were analyzed. Results of premedication with DEX was associated with more anxiolysis (OR=0.29, 95% CI: 0.17-0.52, p=0.0001; I=0%) and at the time of separation from parents (OR=0.36, 95% CI: 0.19-0.69, p=0.002; I=52%) in comparison to MID. No significant differences in results were seen at mask induction (OR=0.63, 95% CI: 0.34-1.18, p=0.15; I=47%) and for sedation in children during dental procedures (OR=0.52, 95% CI: 0.07-3.70, p=0.51; I=72%). Also, there were no significant differences in onset time, duration of anesthesia, and surgery between the two agents.
CONCLUSION
DEX proved to be a better premedicant than MID for pediatric patients. No significant difference in efficacy of both sedative agents was observed in children undergoing dental treatment. More clinical trials need to be conducted to see its efficacy in dental surgeries in children of standardized ages and with standard doses.
Topics: Child; Humans; Midazolam; Dexmedetomidine; Hypnotics and Sedatives; Premedication; Anesthesia, Dental
PubMed: 35759132
DOI: 10.1007/s10006-022-01087-6