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BMC Anesthesiology Jul 2023The number of non-intubated general anesthesia outside the operating room is growing as the increasing demand for comfort treatment. Non-intubated general anesthesia... (Meta-Analysis)
Meta-Analysis
Analysis of the efficacy of subclinical doses of esketamine in combination with propofol in non-intubated general anesthesia procedures - a systematic review and meta-analysis.
BACKGROUND
The number of non-intubated general anesthesia outside the operating room is growing as the increasing demand for comfort treatment. Non-intubated general anesthesia outside the operating room requires rapid onset of anesthesia, smoothness, quick recovery, and few postoperative complications. Traditional anesthetic regimens (propofol alone or propofol and opioids/dezocine/midazolam, etc.) have severe respiratory and circulatory depression and many systemic adverse effects. In this paper, we compare the effectiveness and safety of propofol and subclinical doses of esketamine with other traditional regimens applied to non-intubated general anesthesia through a systematic review and meta-analysis.
METHODS
We searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and Sinomed databases for the period from January 2000 to October 2022. We rigorously screened the literature according to predefined inclusion and exclusion criteria, while risk assessment of the studies was performed using The Cochrane Collaboration's tool, and statistical analysis of the data was performed using RevMan 5.4 software. The main outcome indicators we evaluated were the various hemodynamic parameters and incidence of various adverse effects between the experimental and control groups after induction of anesthesia.
RESULTS
After a rigorous screening process, a total of 14 papers were included in the final meta-analysis. After risk bias assessment, three of the papers were judged as low risk and the others were judged as having moderate to high risk. Forest plots were drawn for a total of 16 indicators. Meta-analysis showed statistically significant differences in HR' WMD 3.27 (0.66, 5.87), MAP' WMD 9.68 (6.13, 13.24), SBP' WMD 5.42 (2.11, 8.73), DBP' WMD 4.02 (1.15, 6.88), propofol dose' SMD -1.39 (-2.45, -0.33), hypotension' RR 0.30 (0.20, 0.45), bradycardia' RR 0.33 (0.14, 0.77), hypoxemia or apnea' RR 0.45 (0.23, 0.89), injection pain' RR 0.28 (0.13, 0.60), intraoperative choking' RR 0.62 (0.50, 0.77), intraoperative body movements' RR 0.48 (0.29, 0.81) and overall incidence of adverse reactions' RR 0.52 (0.39, 0.70).The indicators that were not statistically different were time to wake up' WMD - 0.55 (-1.29, 0.19), nausea and vomiting 0.84' RR (0.43, 1.67), headache and dizziness' RR 1.57 (0.98, 2.50) and neuropsychiatric reaction' RR 1.05 (0.28, 3.93). The funnel plot showed that the vast majority of studies fell within the funnel interval, but the symmetry was relatively poor.
CONCLUSION
In non-intubated general anesthesia, the combination of subclinical doses of esketamine and propofol did reduce circulatory and respiratory depression, injection pain, and other adverse effects, while the incidence of esketamine's own side effects such as neuropsychiatric reactions did not increase, and the combination of the two did not cause the occurrence of new and more serious adverse reactions, and the combination of the two was safe and effective.
TRIAL REGISTRATION
PROSPREO registration number: CRD 42022368966.
Topics: Humans; Propofol; Ketamine; Anesthesia, General; Pain; Drug-Related Side Effects and Adverse Reactions
PubMed: 37479982
DOI: 10.1186/s12871-023-02135-8 -
Medicine Aug 2023Poststroke depression (PSD) is a common clinical poststroke complication that adversely affects cognitive and physical function rehabilitation. Scalp acupuncture (SA)... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Poststroke depression (PSD) is a common clinical poststroke complication that adversely affects cognitive and physical function rehabilitation. Scalp acupuncture (SA) can significantly improve somatic dysfunction and emotional disorder in stroke patients. This meta-analysis aims to evaluate the effectiveness and safety of SA in the treatment of PSD.
METHODS
We conducted a comprehensive search of multiple electronic databases, including PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Internet, China Science and Technology Journal Database, Wan Fang Data Knowledge Service Platform, and China Biology Medicine databases until December 20, 2022, to identify randomized controlled trials investigating the efficacy of SA in the treatment of PSD. Two independent researchers screened the literature, extracted data, and assessed the risk of bias in the included studies based on the inclusion and exclusion criteria. We performed a meta-analysis of the eligible literature using RevMan 5.4.1 and Stata 15.0 software.
RESULTS
This study comprised a total of 14 randomized controlled trials, 10 of which used SA and 4 of which used SA in combination with electroacupuncture therapy. The results of the meta-analysis revealed that the effective rate of the SA group was significantly higher than that of the Western medicine group (relative risk = 1.09, 95% confidence interval (CI) [1.02, 1.16], P = .008). Moreover, compared to the Western medicine group, the SA group demonstrated significant improvements in Hamilton depression scale scores (mean difference = -2.29, 95% CI [-3.88, -0.70], P = .005) and neurological function deficit scores (mean difference = -3.06, 95% CI [-5.91, -0.21], P = .04). Additionally, the SA group has a lower incidence of adverse events than the western medicine group (relative risk = 0.12, 95% CI [0.05, 0.29], P < .00001).
CONCLUSION
SA has superior efficacy and safety compared to Western medicine for PSD. These findings suggest that SA could be a promising alternative treatment for the assessed condition. Due to the limited number and quality of the included literature, the above conclusions must be confirmed by additional high-quality research.
Topics: Humans; Depression; Scalp; Acupuncture Therapy; Electroacupuncture; Stroke; Randomized Controlled Trials as Topic
PubMed: 37543780
DOI: 10.1097/MD.0000000000034561 -
Medicine Jun 2023To explore the efficacy and safety of electroacupuncture (EA) for secondary insomnia through a meta-analysis and a systematic review. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To explore the efficacy and safety of electroacupuncture (EA) for secondary insomnia through a meta-analysis and a systematic review.
METHODS
The CNKI, Wanfang, VIP database, Web of Science, EMBASE, PubMed, and Cochrane Library were retrieved. The retrieval date was February 28, 2023. Two independent reviewers conducted literature screening, data extraction, and risk of bias (ROB) assessment. The revised Cochrane ROB tool was used to assess the ROB in included studies. Data analysis was performed using RevMan 5.4 software and Stata 15.0.
RESULTS
Thirteen randomized controlled studies were included, involving 820 patients, including 414 patients in EA group and 406 patients in the control group. Compared with the control group, EA could improve secondary insomnia overall responses (relative risk = 3.90, 95% confidence interval [CI] [1.87, 8.13], P < .001), reduce Pittsburgh Sleep Quality Index score (mean difference [MD] = -2.26, 95% CI [-4.14, -0.37], P = .02), reduce Athens Insomnia Scale score (MD = -0.57, 95% CI [-2.70, 1.56], P = .60), prolonged total sleep time (MD = 2.63, 95% CI [-0.59, 5.86], P = .11), and not increase adverse events (relative risk = 0.50, 95% CI [0.18, 1.44], P = .20).
CONCLUSION
EA may be a promising treatment for secondary sleep disorders; however, more high-quality studies are needed to confirm our findings.
Topics: Humans; Electroacupuncture; Sleep Initiation and Maintenance Disorders; Control Groups; Data Analysis; Databases, Factual
PubMed: 37390293
DOI: 10.1097/MD.0000000000034150 -
Chinese Medical Journal Sep 2021Whether regional anesthesia may help to prevent disease recurrence in cancer patients is still controversial. The stage of cancer at the time of diagnosis is a key... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Whether regional anesthesia may help to prevent disease recurrence in cancer patients is still controversial. The stage of cancer at the time of diagnosis is a key factor that defines prognosis and is one of the most important sources of heterogeneity for the treatment effect. We sought to update existing systematic reviews and clarify the effect of regional anesthesia on cancer recurrence in late-stage cancer patients.
METHODS
Medline, Embase, and Cochrane Library were searched from inception to September 2020 to identify randomized controlled trials (RCTs) and cohort studies that assessed the effect of regional anesthesia on cancer recurrence and overall survival (OS) compared with general anesthesia. Late-stage cancer patients were primarily assessed according to the American Joint Committee on Cancer Cancer Staging Manual (eighth edition), and the combined hazard ratio (HR) from random-effects models was used to evaluate the effect of regional anesthesia.
RESULTS
A total of three RCTs and 34 cohort studies (including 64,691 patients) were identified through the literature search for inclusion in the analysis. The risk of bias was low in the RCTs and was moderate in the observational studies. The pooled HR for recurrence-free survival (RFS) or OS did not favor regional anesthesia when data from RCTs in patients with late-stage cancer were combined (RFS, HR = 1.12, 95% confidence interval [CI]: 0.58-2.18, P = 0.729, I2 = 76%; OS, HR = 0.86, 95% CI: 0.63-1.18, P = 0.345, I2 = 48%). Findings from observational studies showed that regional anesthesia may help to prevent disease recurrence (HR = 0.87, 95% CI: 0.78-0.96, P = 0.008, I2 = 71%) and improve OS (HR = 0.88, 95% CI: 0.79-0.98, P = 0.022, I2 = 79%).
CONCLUSIONS
RCTs reveal that OS and RFS were similar between regional and general anesthesia in late-stage cancers. The selection of anesthetic methods should still be based on clinical evaluation, and changes to current practice need more support from large, well-powered, and well-designed studies.
Topics: Anesthesia, Conduction; Humans; Neoplasms; Recurrence
PubMed: 34608071
DOI: 10.1097/CM9.0000000000001676 -
Acta Anaesthesiologica Scandinavica Sep 2022Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO ) in adults undergoing general anesthesia. This... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO ) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO on postoperative outcomes.
METHODS
PubMed and Embase were searched on March 22, 2022 for randomized clinical trials investigating the effect of different FiO levels in adults undergoing general anesthesia for non-cardiac surgery. Two investigators independently reviewed studies for relevance, extracted data, and assessed risk of bias. Meta-analyses were performed for relevant outcomes, and potential effect measure modification was assessed in subgroup analyses and meta-regression. The evidence certainty was evaluated using GRADE.
RESULTS
This review included 25 original trials investigating the effect of a high (mostly 80%) versus a low (mostly 30%) FiO . Risk of bias was intermediate for all trials. A high FiO did not result in a significant reduction in surgical site infections (OR: 0.91, 95% CI 0.81-1.02 [p = .10]). No effect was found for all other included outcomes, including mortality (OR = 1.27, 95% CI: 0.90-1.79 [p = .18]) and hospital length of stay (mean difference = 0.03 days, 95% CI -0.25 to 0.30 [p = .84). Results from subgroup analyses and meta-regression did not identify any clear effect modifiers across outcomes. The certainty of evidence (GRADE) was rated as low for most outcomes.
CONCLUSIONS
In adults undergoing general anesthesia for non-cardiac surgery, a high FiO did not improve outcomes including surgical site infections, length of stay, or mortality. However, the certainty of the evidence was assessed as low.
Topics: Adult; Anesthesia, General; Humans; Oxygen; Surgical Wound Infection
PubMed: 35675085
DOI: 10.1111/aas.14102 -
PloS One 2023This systematic review and meta-analysis aimed to assessment effects of electroacupuncture (EA) therapy on intractable facial paralysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis aimed to assessment effects of electroacupuncture (EA) therapy on intractable facial paralysis.
METHODS
The articles of EA treatment for intractable facial paralysis were retrieved from seven databases, the publication period was from its inception to November 30, 2022. Primary measure was the total effective rate, and other measures included the cure rate, Portmann scores, House-Brackmann scores, Sunnybrook scores and adverse events. The effect size of meta-analysis was expressed using relative risk (RR) or standardized mean difference (SMD) with 95% confidence interval (CI).
RESULTS
A total of 18 studies with 1,119 participants were included, all of them had various aspects of bias risk. Meta-analysis results revealed that EA ways improved total effective rate more effectively compared with non-EA counterparts (RR 1.23, 95% CI 1.17-1.31, I2 = 0%, 18 studies, 1119 participants), and improved cure rate more significantly than non-EA groups (RR 2.04, 95% CI 1.70-2.44, I2 = 0%, 18 studies, 1119 participants). None of studies reported adverse events.
CONCLUSION
EA therapy is more beneficial for patients with intractable facial paralysis than non-EA, but we lack sufficient evidence to evaluate its safety and follow-up effect. Therefore, more clinical trials with high quality methodologies are needed to further verify long-term effects of EA for IFP and improve the level of evidence.
TRIAL REGISTRATION
Registration number: CRD42021278541.
Topics: Humans; Electroacupuncture; Facial Paralysis
PubMed: 37440529
DOI: 10.1371/journal.pone.0288606 -
BMC Anesthesiology Dec 2022The objective of this systematic review and network meta-analysis was to compare the effects of single-shot ultrasound-guided regional anesthesia techniques on... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The objective of this systematic review and network meta-analysis was to compare the effects of single-shot ultrasound-guided regional anesthesia techniques on postoperative opioid consumption in patients undergoing open cardiac surgery.
METHODS
This systematic review and network meta-analysis involved cardiac surgical patients (age > 18 y) requiring median sternotomy. We searched PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science. The effects of the single-shot ultrasound-guided regional anesthesia technique were compared with those of placebo and no intervention. We conducted a risk assessment of bias for eligible studies and assessed the overall quality of evidence for each outcome.
RESULTS
The primary outcome was opioid consumption during the first 24 h after surgery. The secondary outcomes were pain after extubation at 12 and 24 h, postoperative nausea and vomiting, extubation time, intensive care unit discharge time, and length of hospital stay. Fifteen studies with 849 patients were included. The regional anesthesia techniques included pecto-intercostal fascial block, transversus thoracis muscle plane block, erector spinae plane (ESP) block, and pectoralis nerve block I. All the regional anesthesia techniques included significantly reduced postoperative opioid consumption at 24 h, expressed as morphine milligram equivalents (MME). The ESP block was the most effective treatment (-22.93 MME [-34.29;-11.56]).
CONCLUSIONS
In this meta-analysis, we concluded that fascial plane blocks were better than placebo when evaluating 24 h MMEs. However, it is still challenging to determine which is better, given the paucity of studies available in the literature. More randomized controlled trials are required to determine which regional anesthesia technique is better.
TRIAL REGISTRATION
PROSPERO; CRD42022315497.
Topics: Humans; Adult; Middle Aged; Analgesics, Opioid; Network Meta-Analysis; Pain, Postoperative; Anesthesia, Conduction; Cardiac Surgical Procedures; Ultrasonography, Interventional
PubMed: 36581838
DOI: 10.1186/s12871-022-01952-7 -
PloS One 2020Studies have shown that both perioperative and anesthesia-related cardiac arrest (CA) and mortality rates are much higher in developing countries than in developed... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Studies have shown that both perioperative and anesthesia-related cardiac arrest (CA) and mortality rates are much higher in developing countries than in developed countries. This review aimed to compare the rates of perioperative and anesthesia-related CA and mortality during 2 time periods in Brazil.
METHODS
A systematic review with meta-analysis of full-text Brazilian observational studies was conducted by searching the Medline, EMBASE, LILACS and SciELO databases up to January 29, 2020. The primary outcomes were perioperative CA and mortality rates and the secondary outcomes included anesthesia-related CA and mortality events rates up to 48 postoperative hours.
RESULTS
Eleven studies including 719,273 anesthetic procedures, 962 perioperative CAs, 134 anesthesia-related CAs, 1,239 perioperative deaths and 29 anesthesia-related deaths were included. The event rates were evaluated in 2 time periods: pre-1990 and 1990-2020. Perioperative CA rates (per 10,000 anesthetics) decreased from 39.87 (95% confidence interval [CI]: 34.60-45.50) before 1990 to 17.61 (95% CI: 9.21-28.68) in 1990-2020 (P < 0.0001), while the perioperative mortality rate did not alter (from 19.25 [95% CI: 15.64-23.24] pre-1990 to 25.40 [95% CI: 13.01-41.86] in 1990-2020; P = 0.1984). Simultaneously, the anesthesia-related CA rate decreased from 14.39 (95% CI: 11.29-17.86) to 3.90 (95% CI: 2.93-5.01; P < 0.0001), while there was no significant difference in the anesthesia-related mortality rate (from 1.75 [95% CI: 0.76-3.11] to 0.67 [95% CI: 0.09-1.66; P = 0.5404).
CONCLUSIONS
This review demonstrates an important reduction in the perioperative CA rate over time in Brazil, with a large and consistent decrease in the anesthesia-related CA rate; however, there were no significant differences in perioperative and anesthesia-related mortality rates between the assessed time periods.
Topics: Anesthesia; Brazil; Heart Arrest; Humans; Perioperative Period; Survival Rate
PubMed: 33137159
DOI: 10.1371/journal.pone.0241751 -
Canadian Journal of Anaesthesia =... Aug 2021Interest in implicit memory formation and unconscious auditory stimulus perception during general anesthesia has resurfaced as perioperative music has been reported to... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Interest in implicit memory formation and unconscious auditory stimulus perception during general anesthesia has resurfaced as perioperative music has been reported to produce beneficial effects. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating explicit and implicit memory formation during general anesthesia and its effects on postoperative patient outcomes and recovery.
SOURCE
We performed a systematic literature search of Embase, Ovid Medline, and Cochrane Central from inception date until 15 October 2020. Eligible for inclusion were RCTs investigating intraoperative auditory stimulation in adult surgical patients under general anesthesia in which patients, healthcare staff, and outcome assessors were all blinded. We used random effects models for meta-analyses. This study adhered to the PRISMA guidelines and was registered in PROSPERO (CRD42020178087).
PRINCIPAL FINDINGS
Fifty-three (4,200 patients) of 5,859 identified articles were included. There was evidence of implicit memory formation in seven out of 17 studies (41%) when assessed using perceptual priming tasks. Mixed results were observed on postoperative behavioural and motor response after intraoperative suggestions. Intraoperative music significantly reduced postoperative pain (standardized mean difference [SMD], -0.84; 95% confidence interval [CI], -1.1 to -0.57; P < 0.001; I = 0; n = 226) and opioid requirements (SMD, -0.29; 95% CI, -0.57 to -0.015; P = 0.039; I = 36; n = 336), while positive therapeutic suggestions did not.
CONCLUSION
The results of this systematic review and meta-analysis show that intraoperative auditory stimuli can be perceived and processed during clinically adequate, general anesthesia irrespective of surgical procedure severity, leading to implicit memory formation without explicit awareness. Intraoperative music can exert significant beneficial effects on postoperative pain and opioid requirements. Whether the employed intraoperative anesthesia regimen is of influence is not yet clear.
Topics: Adult; Analgesics, Opioid; Anesthesia, General; Humans; Pain, Postoperative; Perception
PubMed: 34013463
DOI: 10.1007/s12630-021-02015-0 -
Korean Journal of Anesthesiology Feb 2023Different regional anesthesia (RA) techniques have been used for laparoscopic cholecystectomy (LC), but there is no consensus on their comparative effectiveness. Our... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Different regional anesthesia (RA) techniques have been used for laparoscopic cholecystectomy (LC), but there is no consensus on their comparative effectiveness. Our objective was to evaluate the effect of RA techniques on patients undergoing LC using a network meta-analysis approach.
METHODS
We conducted a systematic review and network meta-analysis. We searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (Science and Social Science Citation Index) using the following PICOS criteria: (P) adult patients undergoing LC; (I) any RA single-shot technique with injection of local anesthetics; (C) placebo or no intervention; (O) postoperative opioid consumption expressed as morphine milligram equivalents (MME), rest pain at 12 h and 24 h post-operation, postoperative nausea and vomiting (PONV), length of stay; and (S) randomized controlled trials.
RESULTS
A total of 84 studies were included. With the exception of the rectus sheath block (P = 0.301), the RA techniques were superior to placebo at reducing opioid consumption. Regarding postoperative pain, the transversus abdominis plane (TAP) block (-1.80 on an 11-point pain scale) and erector spinae plane (ESP) block (-1.33 on an 11-point pain scale) were the most effective at 12 and 24 h. The TAP block was also associated with the greatest reduction in PONV.
CONCLUSIONS
RA techniques are effective at reducing intraoperative opioid use, postoperative pain, and PONV in patients undergoing LC. Patients benefit the most from the bilateral paravertebral, ESP, quadratus lumborum, and TAP blocks.
Topics: Adult; Humans; Cholecystectomy, Laparoscopic; Analgesics, Opioid; Postoperative Nausea and Vomiting; Network Meta-Analysis; Anesthesia, Conduction; Pain, Postoperative
PubMed: 36345156
DOI: 10.4097/kja.22366