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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 -
Journal of Clinical Anesthesia Jun 2024To identify whether adding ketamine to the local anesthetics (LA) in the regional anesthesia could prolong the duration of analgesia. (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVE
To identify whether adding ketamine to the local anesthetics (LA) in the regional anesthesia could prolong the duration of analgesia.
DESIGN
A Systematic review and meta-analysis of randomized controlled trials.
SETTING
The major dates were obtained in the operating room and the postoperative recovery ward.
PATIENTS
A total of 1011 patients at ASA physical status I and II were included in the analysis. Procedure performed including cesarean section, orthopedic, radical mastectomy, urological or lower abdominal surgery and intracavitary brachytherapy implants insertion.
INTERVENTIONS
After an extensive search of the electronic database, patients received regional anesthesia combined or not combined general anesthesia and with or without adding ketamine to LA were included in the analysis. The regional anesthesia includes spinal anesthesia, brachial plexus block, pectoral nerve block, transversus abdominis plane block and femoral and sciatic nerve block.
MEASUREMENT
The primary outcome was the duration of analgesia. Secondary outcomes were the duration and onset time of motor and sensory block as well as the ketamine-related adverse effect. Data are expressed in mean differences in continuous data and odds ratios (OR) for dichotomous data with 95% confidence intervals. The risk of bias of the included studies was evaluated using the revised Cochrane risk of bias tool for randomized trials. The quality of evidence for each outcome was rated according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Working Group system.
MAIN RESULT
Twenty randomized controlled trials were included in the analysis. When ketamine was used as an adjuvant to LA, the duration of analgesia could be prolonged(172.21 min, 95% CI, 118.20 to 226.22; P<0.00001, I = 98%), especially in the peripheral nerve block(366.96 min, 95% CI, 154.19 to 579.74; P = 0.0007, I = 98%). Secondary outcomes showed ketamine could prolong the duration of sensory block(29.12 min, 95% CI, 10.22 to 48.01; P = 0.003, I = 96%) but no effect on the motor block(6.94 min, 95% CI,-2.65 to 16.53;P = 0.16, I = 84%), the onset time of motor and sensory block (motor onset time, -1.17 min, 95% CI, -2.67 to 0.34; P = 0.13, I = 100%; sensory onset time, -0.33 min, 95% CI,-0.87 to 0.20; P = 0.23, I = 96%) as well as the ketamine-related adverse effect(OR, 1.97, 95% CI,0.93 to 4.17;P = 0.08, I = 57%).
CONCLUSION
This study indicates that ketamine could be an ideal adjuvant to local anesthetics regardless of the types of anesthesia. Overall, the quality of the evidence is low.
Topics: Female; Humans; Pregnancy; Anesthesia, Conduction; Anesthetics, Local; Brachial Plexus Block; Breast Neoplasms; Cesarean Section; Ketamine; Mastectomy; Pain, Postoperative; Randomized Controlled Trials as Topic
PubMed: 38394922
DOI: 10.1016/j.jclinane.2024.111415 -
Handchirurgie, Mikrochirurgie,... Aug 2021Liposuctions are among the most frequently performed operations in plastic surgery worldwide. They are offered as inpatient as well as outpatient procedures. In the...
BACKGROUND
Liposuctions are among the most frequently performed operations in plastic surgery worldwide. They are offered as inpatient as well as outpatient procedures. In the outpatient setting, tumescent anaesthesia is used in various forms. There is ambiguity about the amount of lipoaspirate that can be removed safely in an outpatient setting, and also about the monitoring of parameters and the duration of postoperative care.
MATERIAL AND METHODS
A systematic literature review was conducted with the help of the MEDLINE data base of the U. S. National Library of Medicine (NLM) and the bibliographic search engine Google Scholar (https://scholar.google.com) of Google LLC. The key words "Liposuction Anesthesia" and "Liposuction Guidelines" were used. All items resulting from the search were checked for thematic concordance and further analysed by their level of evidence, significance and availability.
RESULTS
After the literature review, a total of 197 items were identified for further analysis. The analysis of the international and German literature yielded a systematic overview of recommendations.
CONCLUSIONS
Tumescence anaesthesia in an outpatient setting has various advantages, e. g. cost reduction for provider and patient as well as avoidance of the risk profile of general anaesthesia. Also patients can change their position autonomously, which can be beneficial for surgery. However, there are limitations in terms of the lipoaspirate volume that can be removed safely. With increasing lipoaspirate volumes, more local anaesthetic is needed, which also increases the postoperative monitoring time. In the authors view, tumescent anaesthesia should only be used for small-volume and localised liposuctions. Liposuction in general anaesthesia offers more advantages, especially with increasing lipoaspirate volumes.
Topics: Anesthesia, General; Anesthesia, Local; Anesthetics, Local; Humans; Lipectomy; United States
PubMed: 33525036
DOI: 10.1055/a-1333-2696 -
BMC Anesthesiology May 2023Previous studies of the perioperative effects of general and regional anesthesia in adult patients undergoing effects of different anesthesia techniques on patients... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous studies of the perioperative effects of general and regional anesthesia in adult patients undergoing effects of different anesthesia techniques on patients undergoing hip fracture surgery have not produced consistent results. The aim of this systematic review and meta-analysis was to compare the hip fracture surgery.
METHODS
We performed a systematic review and meta-analysis to compare the effects of general anesthesia with regional anesthesia on in-hospital mortality, 30-day mortality, postoperative pneumonia, and delirium in adult hip fracture patients (≥ 18 years). Between January 1, 2022, and March 31, 2023, a systematic search was performed for retrospective observational and prospective randomized controlled studies in PubMed, Ovid Medline, Cochrane Library, and Scopus.
RESULTS
Twenty-one studies including 363,470 patients showed higher in-hospital mortality in the general anesthesia group compared with regional anesthesia (OR = 1.21; 95% CI 1.13-1.29; P < 0.001, n = 191,511). The 30-day mortality (OR = 1.00; 95% CI 0.96-1.05; P = 0.95, n = 163,811), the incidence of postoperative pneumonia (OR = 0.93; 95% CI 0.82-1.06; P = 0.28, n = 36,743) and the occurrence of postoperative delirium in the two groups (OR = 0.94; 95% CI 0.74-1.20; P = 0.61, n = 2861) had no significant difference.
CONCLUSION
Regional anesthesia is associated with reduced in-hospital mortality. However, the type of anesthesia did not affect the occurrence of 30-day mortality, postoperative pneumonia, and delirium. A large number of randomized studies are needed in the future to examine the relationship between type of anesthesia, postoperative complications, and mortality.
Topics: Humans; Prospective Studies; Retrospective Studies; Hip Fractures; Anesthesia, Conduction; Anesthesia, General; Postoperative Complications; Emergence Delirium
PubMed: 37237276
DOI: 10.1186/s12871-023-02150-9 -
The Journal of Evidence-based Dental... Sep 2023The aim of the present paper is to summarize the effectiveness of Phentolamine mesylate on the reversal of local anesthesia (LA). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of the present paper is to summarize the effectiveness of Phentolamine mesylate on the reversal of local anesthesia (LA).
METHODOLOGY
Seven electronic databases were searched for randomized clinical trials in patients who received LA (population) and either received a Phentolamine injection (intervention) after LA compared to placebo or sham (control) to cause a return of normal sensation (outcome). Risk of bias assessment was performed using Cochrane risk of bias assessment tool 2.0. The hazard ratio (HR) was calculated as the event (time to return to the normal sensation) was a time-dependent event, as well as the weighted mean difference (WMD), was computed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of the evidence.
RESULTS
Ten studies met our inclusion criteria and were included in this review. After pooling the results quantitatively, the value of the HR in the tongue was 0.56 (95% CI: 0.41-0.75, P<.001); in lower lip, the value was 0.56 (95% CI: 0.38-0.83, P = .004) and for upper lip, the value was 0.50 (95% CI: 0.31-0.80, P = .004). The WMD for the time to return for normal sensation was -47.71 min for the tongue (95% CI: -73.63 to -21.80 min, P<.001), -73.29 min for lower lip (95% CI: -88.41 to -58.16 min, P<.001) and -86.86 min for upper lip (95% CI: -101.16 to -72.57 min, P<.001). There is a high certainty of evidence that patients who have been administered local anesthesia may achieve faster recovery of normal sensation in tongue, and moderate certainty of evidence for return of normal sensation in lower lip and upper lip, if Phentolamine was administered after the local anesthesia. The adverse effects were reported in a few studies and were minor, not necessitating any medical intervention.
CONCLUSIONS
Phentolamine might be a useful adjunct in patients who desire an earlier return of normal sensation and function after local anesthesia. Future research should be directed to study the cost-effectiveness or dental patient-reported outcomes of Phentolamine after local anesthetic injections.
Topics: Humans; Anesthesia, Local; Phentolamine; Anesthetics, Local; Patient Reported Outcome Measures
PubMed: 37689448
DOI: 10.1016/j.jebdp.2023.101861 -
American Journal of Ophthalmology Aug 2023This network meta-analysis aims to determine the differences between adjuvants that are used in combination with local anesthetics for ophthalmic regional anesthesia. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This network meta-analysis aims to determine the differences between adjuvants that are used in combination with local anesthetics for ophthalmic regional anesthesia.
DESIGN
Systematic review and network meta-analysis.
METHODS
A systematic literature search for randomized controlled trials, comparing the impact of adjuvants in ophthalmic regional anesthesia, in Embase, CENTRAL, MEDLINE and Web of Science was performed. Risk of bias was evaluated using the Cochrane risk of bias tool. Frequentist network meta-analysis was performed using a random effects model with saline as the comparator. Primary endpoints were the onset and the duration of sensory block and globe akinesia, as well as the duration of analgesia. Summary measure was the ratio of means (ROM). Secondary endpoints were the rates of side effects and adverse events.
RESULTS
A total of 39 trials were identified as eligible for network meta-analysis, including 3046 patients. In all, 17 adjuvants were compared in the most extensive network (onset of globe akinesia). The addition of fentanyl (F), clonidine (C), or dexmedetomidine (D) showed the best overall results. Onset of sensory block was as follows: F 0.58 (CI = 0.47-0.72), C 0.75 (0.63-0.88), D 0.71 (0.61-0.84); onset of globe akinesia: F 0.71 (0.61-0.82), C 0.70 (0.61-0.82), D 0.81 (0.71-0.92); duration of sensory block: F 1.20 (1.14-1.26), C 1.22 (1.18-1.27), D 1.44 (1.34-1.55); duration of globe akinesia: F 1.38 (1.22-1.57), C 1.45 (1.26-1.67), D 1.41 (1.24-1.59); and duration of analgesia: F 1.46 (1.33-1.60), C 1.78 (1.63-1.96), D 1.41 (1.28-1.56).
CONCLUSIONS
The addition of fentanyl, clonidine, or dexmedetomidine showed beneficial effects regarding onset and duration of sensory block and globe akinesia.
Topics: Humans; Anesthesia, Conduction; Anesthetics, Local; Clonidine; Dexmedetomidine; Fentanyl; Network Meta-Analysis
PubMed: 36906095
DOI: 10.1016/j.ajo.2023.02.023 -
Journal of Gastrointestinal Surgery :... Aug 2021Surgery is required for cure of most solid tumors, and general anesthesia is required for most cancer surgery. The vast majority of cancer surgery is facilitated by... (Review)
Review
BACKGROUND
Surgery is required for cure of most solid tumors, and general anesthesia is required for most cancer surgery. The vast majority of cancer surgery is facilitated by general anesthesia using volatile inhalational agents such as isoflurane and sevoflurane. Only recently have the immunologic and oncologic effect of inhalational agents, and their alternative, propofol-based total intravenous anesthesia (TIVA), come under investigation.
METHODS
Between January 2019 and June 2020, English language articles on PubMed were searched for the keywords "Propofol" "TIVA" or "IV anesthesia" and either "cancer surgery" or "surgical oncology." Duplicates were removes, manuscripts classified as either in vitro, animal, translational, or clinical studies, and their results summarized within these categories.
RESULTS
In-vitro and translational data suggest that inhalational anesthetics are potent immunosuppressive and tumorigenic agents that promote metastasis, while propofol is anti-inflammatory, anti-tumorigenic, and prevents metastasis development. Clinically there is a recurring association, based largely on retrospective, single institution series, that TIVA is associated with significant improvements in disease-free interval and overall survival in a number of, but not all, solid tumors. The longer the surgery is, the more intense the surgical trauma is, the more aggressive the malignancy is, and the higher likelihood of an association is.
DISCUSSION
Prospective randomized trials, coupled with basic science and translational studies, are needed to further define this association.
Topics: Anesthesia; Anesthesia, Intravenous; Anesthetics, Inhalation; Anesthetics, Intravenous; Humans; Neoplasms; Propofol; Prospective Studies; Retrospective Studies
PubMed: 34100251
DOI: 10.1007/s11605-021-05037-7 -
Asian Journal of Surgery Dec 2023
Meta-Analysis
Topics: Child; Humans; Pediatric Anesthesia; Ketamine; Treatment Outcome
PubMed: 37684126
DOI: 10.1016/j.asjsur.2023.08.073 -
Seminars in Cardiothoracic and Vascular... Sep 2023Despite their extensive clinical use, opioids are characterized by several side effects. These complications, coupled with the ongoing opioid epidemic, have favored the... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Despite their extensive clinical use, opioids are characterized by several side effects. These complications, coupled with the ongoing opioid epidemic, have favored the rise of opioid-free-anesthesia (OFA). Herein, we perform the first pairwise meta-analysis of clinical outcomes for OFA vs opioid-based anesthesia (OBA) in patients undergoing cardiovascular and thoracic surgery.
METHODS
We comprehensively searched medical databases to identify studies comparing OFA and OBA in patients undergoing cardiovascular or thoracic surgery. Pairwise meta-analysis was performed using the Mantel-Haenszel method. Outcomes were pooled as risk ratios (RR) or standard mean differences (SMD) and their 95% confidence intervals (95% CI).
RESULTS
Our pooled analysis included 919 patients (8 studies), of whom 488 underwent surgery with OBA and 431 with OFA. Among cardiovascular surgery patients, compared to OBA, OFA was associated with significantly reduced post-operative nausea and vomiting (RR, 0.57; = .042), inotrope need (RR .84, = .045), and non-invasive ventilation (RR, .54; = .028). However, no differences were observed for 24hr pain score (SMD, -.35; = .510) or 48hr morphine equivalent consumption (SMD, -1.09; = .139). Among thoracic surgery patients, there was no difference between OFA and OBA for any of the explored outcomes, including post-operative nausea and vomiting (RR, 0.41; = .025).
CONCLUSION
Through the first pooled analysis of OBA vs OFA in a cardiothoracic-exclusive cohort, we found no significant difference in any of the pooled outcomes for thoracic surgery patients. Although limited to 2 cardiovascular surgery studies, OFA was associated with significantly reduced postoperative nausea and vomiting, inotrope need, and non-invasive ventilation in these patients. With growing use of OFA in invasive operations, further studies are needed to assess their efficacy and safety in cardiothoracic patients.
Topics: Humans; Analgesics, Opioid; Anesthesia; Nausea; Pain, Postoperative; Cardiovascular Surgical Procedures; Thoracic Surgical Procedures; Postoperative Nausea and Vomiting
PubMed: 37300532
DOI: 10.1177/10892532231180227