-
Medicine Jun 2023The analgesic sedation of dexmedetomidine compared with midazolam for third molar surgery remains controversial. We conduct a systematic review and meta-analysis to... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The analgesic sedation of dexmedetomidine compared with midazolam for third molar surgery remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexmedetomidine versus midazolam for third molar surgery.
METHODS
We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through December 2022 for randomized controlled trials assessing the effect of dexmedetomidine versus midazolam for third molar surgery. This meta-analysis was performed using the random-effect model.
RESULTS
Four randomized controlled trials were included in the meta-analysis. Overall, compared with midazolam for third molar surgery, dexmedetomidine administration leads to comparable oxygen saturation (standard mean difference [SMD] = 0.25; 95% confidence interval [CI] = -0.24 to 0.74; P = .31), heart rate (SMD = -0.37; 95% CI = -1.18 to 0.44; P = .37), SBP (SMD = -0.24; 95% CI = -0.57 to 0.09; P = .16), DBP (SMD = -0.26; 95% CI = -0.60 to 0.07; P = .12), as well as nausea and vomiting (OR = 0.58; 95% CI = 0.05-6.61; P = .66).
CONCLUSIONS
Dexmedetomidine may obtain the comparable sedation efficacy with midazolam for third molar surgery.
Topics: Humans; Midazolam; Hypnotics and Sedatives; Dexmedetomidine; Molar, Third; Randomized Controlled Trials as Topic
PubMed: 37352026
DOI: 10.1097/MD.0000000000033155 -
Cardiology 2023Space travel imposes significant gravitational and radiation stress on both cellular and systemic physiology, resulting in myriad cardiovascular changes that have not...
INTRODUCTION
Space travel imposes significant gravitational and radiation stress on both cellular and systemic physiology, resulting in myriad cardiovascular changes that have not been fully characterized.
METHODS
We conducted a systematic review of the cellular and clinical adaptations of the cardiovascular system after exposure to real or simulated space travel in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed and Cochrane databases were searched in June 2021 for all peer-reviewed articles published since 1950 related to the following search terms entered in separate pairs: "cardiology and space" and "cardiology and astronaut." Only cellular and clinical studies in English concerning the investigation of cardiology and space were included.
RESULTS
Eighteen studies were identified, comprising 14 clinical and 4 cellular investigations. On the genetic level, pluripotent stem cells in humans and cardiomyocytes in mice displayed increased beat irregularity, with clinical studies revealing a persistent increase in heart rate after space travel. Further cardiovascular adaptations included a higher frequency of orthostatic tachycardia but no evidence of orthostatic hypotension, after return to sea level. Hemoglobin concentration was also consistently decreased after return to Earth. No consistent change in systolic or diastolic blood pressure or any clinically significant arrhythmias were observed during or after space travel.
CONCLUSION
Changes in oxygen carrying capacity, blood pressure, and post-flight orthostatic tachycardia may serve as reasons to further screen for pre-existing anemic and hypotensive conditions among astronauts.
Topics: Humans; Animals; Mice; Space Flight; Astronauts; Heart; Blood Pressure; Tachycardia
PubMed: 37302388
DOI: 10.1159/000531466 -
Cureus Apr 2023Optimal perioperative fluid management is crucial, with over- or under-replacement associated with complications. There are many strategies for fluid therapy,... (Review)
Review
Optimal perioperative fluid management is crucial, with over- or under-replacement associated with complications. There are many strategies for fluid therapy, including liberal fluid therapy (LFT), restrictive fluid therapy (RFT) and goal-directed fluid therapy (GDT), without a clear consensus as to which is better. We aimed to find out which is the more effective fluid therapy option in adult surgical patients undergoing non-vascular abdominal surgery in the perioperative period. This study is a systematic review and network meta-analysis (NMA) with node-splitting analysis of inconsistency, sensitivity analysis and meta-regression. We conducted a literature search of Pubmed, Cochrane Library, EMBASE, Google Scholar and Web of Science. Only studies comparing restrictive, liberal and goal-directed fluid therapy during the perioperative phase in major non-cardiac surgery in adult patients will be included. Trials on paediatric patients, obstetric patients and cardiac surgery were excluded. Trials that focused on goal-directed therapy monitoring with pulmonary artery catheters and venous oxygen saturation (SvO2), as well as those examining purely biochemical and laboratory end points, were excluded. A total of 102 randomised controlled trials (RCTs) and 78 studies (12,100 patients) were included. NMA concluded that goal-directed fluid therapy utilising FloTrac was the most effective intervention in reducing the length of stay (LOS) (surface under cumulative ranking curve (SUCRA) = 91%, odds ratio (OR) = -2.4, 95% credible intervals (CrI) = -3.9 to -0.85) and wound complications (SUCRA = 86%, OR = 0.41, 95% CrI = 0.24 to 0.69). Goal-directed fluid therapy utilising pulse pressure variation was the most effective in reducing the complication rate (SUCRA = 80%, OR = 0.25, 95% CrI = 0.047 to 1.2), renal complications (SUCRA = 93%, OR = 0.23, 95% CrI = 0.045 to 1.0), respiratory complications (SUCRA = 74%, OR = 0.42, 95% CrI = 0.053 to 3.6) and cardiac complications (SUCRA = 97%, OR = 0.067, 95% CrI = 0.0058 to 0.57). Liberal fluid therapy was the most effective in reducing the mortality rate (SUCRA = 81%, OR = 0.40, 95% CrI = 0.12 to 1.5). Goal-directed therapy utilising oesophageal Doppler was the most effective in reducing anastomotic leak (SUCRA = 79%, OR = 0.45, 95% CrI = 0.12 to 1.5). There was no publication bias, but moderate to substantial heterogeneity was found in all networks. In preventing different complications, except mortality, goal-directed fluid therapy was consistently more highly ranked and effective than standard (SFT), liberal or restricted fluid therapy. The evidence grade was low quality to very low quality for all the results, except those for wound complications and anastomotic leak.
PubMed: 37261162
DOI: 10.7759/cureus.38238 -
Frontiers in Medicine 2023This review aimed to summarize the recent literature on positive-pressure extubation.
OBJECTIVES
This review aimed to summarize the recent literature on positive-pressure extubation.
DESIGN
A scoping review was conducted under the framework of the Joanna Briggs Institute.
DATA SOURCES
Web of Science, PubMed, Ovid, Cumulative Index to Nursing & Allied Health, EBSCO, Cochrane Library, Wan Fang Data, China National Knowledge Infrastructure, and China Biology Medicine databases were searched for studies on adults and children.
STUDY SELECTION
All articles describing the use of positive-pressure extubation were considered eligible for inclusion. The exclusion criteria were articles not available in English or Chinese, and those without full text available.
DATA EXTRACTION AND SYNTHESIS
The database searches identified 8,381 articles, 15 of which could be included in this review, with an aggregated patient number of 1,544. Vital signs, including mean arterial pressure, heart rate, R-R interval, and SpO before and after extubation; blood gas analysis indexes, including pH, oxygen saturation, PaO, and PaCO before and after extubation; and incidence of respiratory complications, including bronchospasm, laryngeal edema, aspiration atelectasis, hypoxemia, and hypercapnia, were reported in the included studies.
RESULTS
The majority of these studies reported that the positive-pressure extubation technique can maintain stable vital signs and blood gas analysis indices as well as prevent complications during the peri-extubation period.
CONCLUSIONS
The positive-pressure extubation technique has a safety performance similar to that of the traditional negative-pressure extubation technique and may lead to better clinical outcomes, including stable vital signs, arterial blood gas analysis, and a lower incidence of respiratory complications.
PubMed: 37250624
DOI: 10.3389/fmed.2023.1169879 -
Cureus Apr 2023The main risk factor for atherosclerotic cardiovascular disease is smoking. Nicotine and carbon monoxide are two dangerous substances that are found in cigarette smoke.... (Review)
Review
The main risk factor for atherosclerotic cardiovascular disease is smoking. Nicotine and carbon monoxide are two dangerous substances that are found in cigarette smoke. The increased heart rate can have an almost instantaneous impact on the heart and blood vessels. Smoking is well known to cause oxidative stress, endanger the lining of the arteries, and accelerate the accumulation of fatty plaque in the blood vessels. It raises the danger of sudden thrombotic events, inflammatory alterations, and low-density lipoprotein oxidation. The smoke's carbon monoxide decreases the blood's capacity to deliver oxygen, adding to the heart's stress. Notably, these risks increase when diabetes, hypertension, high cholesterol, and glucose intolerance are present. It has a detrimental effect on peripheral blood vessels, raising the possibility of thromboangiitis obliterans. Stroke risk is known to be increased by smoking. As compared to those who continue to smoke, those who give up smoking have a much longer life expectancy. Chronic cigarette smoking has been shown to affect the macrophages' ability to remove cholesterol. Abstinence from smoking enhances the function of high-density lipoproteins and cholesterol efflux, lowering the risk of plaque buildup. In this review, we present the most recent information regarding the causal relationship between smoking and cardiovascular health as well as the long-term advantages of quitting.
PubMed: 37234135
DOI: 10.7759/cureus.38073 -
Sports Medicine (Auckland, N.Z.) Aug 2023Repeated-sprint training (RST) involves maximal-effort, short-duration sprints (≤ 10 s) interspersed with brief recovery periods (≤ 60 s). Knowledge about the... (Meta-Analysis)
Meta-Analysis
The Acute Demands of Repeated-Sprint Training on Physiological, Neuromuscular, Perceptual and Performance Outcomes in Team Sport Athletes: A Systematic Review and Meta-analysis.
BACKGROUND
Repeated-sprint training (RST) involves maximal-effort, short-duration sprints (≤ 10 s) interspersed with brief recovery periods (≤ 60 s). Knowledge about the acute demands of RST and the influence of programming variables has implications for training prescription.
OBJECTIVES
To investigate the physiological, neuromuscular, perceptual and performance demands of RST, while also examining the moderating effects of programming variables (sprint modality, number of repetitions per set, sprint repetition distance, inter-repetition rest modality and inter-repetition rest duration) on these outcomes.
METHODS
The databases Pubmed, SPORTDiscus, MEDLINE and Scopus were searched for original research articles investigating overground running RST in team sport athletes ≥ 16 years. Eligible data were analysed using multi-level mixed effects meta-analysis, with meta-regression performed on outcomes with ~ 50 samples (10 per moderator) to examine the influence of programming factors. Effects were evaluated based on coverage of their confidence (compatibility) limits (CL) against elected thresholds of practical importance.
RESULTS
From 908 data samples nested within 176 studies eligible for meta-analysis, the pooled effects (± 90% CL) of RST were as follows: average heart rate (HR) of 163 ± 9 bpm, peak heart rate (HR) of 182 ± 3 bpm, average oxygen consumption of 42.4 ± 10.1 mL·kg·min, end-set blood lactate concentration (B[La]) of 10.7 ± 0.6 mmol·L, deciMax session ratings of perceived exertion (sRPE) of 6.5 ± 0.5 au, average sprint time (S) of 5.57 ± 0.26 s, best sprint time (S) of 5.52 ± 0.27 s and percentage sprint decrement (S) of 5.0 ± 0.3%. When compared with a reference protocol of 6 × 30 m straight-line sprints with 20 s passive inter-repetition rest, shuttle-based sprints were associated with a substantial increase in repetition time (S: 1.42 ± 0.11 s, S: 1.55 ± 0.13 s), whereas the effect on sRPE was trivial (0.6 ± 0.9 au). Performing two more repetitions per set had a trivial effect on HR (0.8 ± 1.0 bpm), B[La] (0.3 ± 0.2 mmol·L), sRPE (0.2 ± 0.2 au), S (0.01 ± 0.03) and S (0.4; ± 0.2%). Sprinting 10 m further per repetition was associated with a substantial increase in B[La] (2.7; ± 0.7 mmol·L) and S (1.7 ± 0.4%), whereas the effect on sRPE was trivial (0.7 ± 0.6). Resting for 10 s longer between repetitions was associated with a substantial reduction in B[La] (-1.1 ± 0.5 mmol·L), S (-0.09 ± 0.06 s) and S (-1.4 ± 0.4%), while the effects on HR (-0.7 ± 1.8 bpm) and sRPE (-0.5 ± 0.5 au) were trivial. All other moderating effects were compatible with both trivial and substantial effects [i.e. equal coverage of the confidence interval (CI) across a trivial and a substantial region in only one direction], or inconclusive (i.e. the CI spanned across substantial and trivial regions in both positive and negative directions).
CONCLUSIONS
The physiological, neuromuscular, perceptual and performance demands of RST are substantial, with some of these outcomes moderated by the manipulation of programming variables. To amplify physiological demands and performance decrement, longer sprint distances (> 30 m) and shorter, inter-repetition rest (≤ 20 s) are recommended. Alternatively, to mitigate fatigue and enhance acute sprint performance, shorter sprint distances (e.g. 15-25 m) with longer, passive inter-repetition rest (≥ 30 s) are recommended.
Topics: Humans; Team Sports; Running; Fatigue; Athletes; Lactic Acid; Athletic Performance
PubMed: 37222864
DOI: 10.1007/s40279-023-01853-w -
Experimental and Therapeutic Medicine Jun 2023The most common critical incidents in pediatric anesthesia are perioperative respiratory adverse events (PRAEs). The present meta-analysis aimed to assess the preventive...
The most common critical incidents in pediatric anesthesia are perioperative respiratory adverse events (PRAEs). The present meta-analysis aimed to assess the preventive effect of dexmedetomidine on PRAEs in children. Dexmedetomidine is a highly selective α-adrenoceptor agonist that provides sedation, anxiolysis and analgesic effects without causing respiratory depression. Dexmedetomidine can diminish airway and circulatory responses during extubation in children. Original randomized controlled trial data were analyzed to study the putative effect of dexmedetomidine on PRAEs. By searched the Cochrane Library, EMBASE and PubMed, a total of ten randomized controlled trials (1,056 patients) was identified. PRAEs included cough, breath holding, laryngospasm, bronchospasm, desaturation (percutaneous oxygen saturation <95%), body movement and pulmonary rales. Compared with placebo, dexmedetomidine resulted in a significant reduction of incidence of cough, breath holding, laryngospasm and emergence agitation. The incidence of PRAEs was significantly reduced in dexmedetomidine compared with active comparators group. Moreover, dexmedetomidine decreased heart rate and increased post-anesthesia care unit stay duration by 11.18 min. The present analysis suggested that dexmedetomidine improved the airway function and decreased risks associated with general anesthesia in children. The present data demonstrated that dexmedetomidine may be a good choice to prevent PRAEs in children.
PubMed: 37206556
DOI: 10.3892/etm.2023.11985 -
Arquivos Brasileiros de Cardiologia Mar 2023Central blood pressure (cBP) is considered an independent predictor of organ damage, cardiovascular events and all-cause mortality. Evidence has shown that high... (Meta-Analysis)
Meta-Analysis
Central blood pressure (cBP) is considered an independent predictor of organ damage, cardiovascular events and all-cause mortality. Evidence has shown that high intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) for improving cardiorespiratory fitness and vascular function. However, the effects of these aerobic training modalities on cBP have not yet been properly reviewed.This meta-analysis aims to investigate to effects of HIIT versus MICT on cBP.We conducted a meta-analysis of randomized controlled trials that compared HIIT versus MICT on cBP. Primary outcomes were measures of central systolic blood pressure (cSBP) and central diastolic blood pressure (cDBP). Peripheral systolic blood pressure (pSBP) and diastolic blood pressure (pDBP), pulse wave velocity (PWV) and maximal oxygen uptake (VO2max) were analyzed as second outcomes. Meta-analysis of mean differences (MD) was conducted using the random effects model.Our study included 163 patients enrolled in six trials. We found that HIIT was superior to MICT in reducing the cSBP (MD = -3.12 mmHg, 95% CI: -4.75 to -1.50, p = 0.0002) and SBP (MD = -2.67 mmHg, 95% CI: -5.18 to -0.16, p = 0.04), and increasing VO2max(MD = 2.49 mL/kg/min, 95% CI: 1.25 to 3.73, p = 0.001). However, no significant differences were reported for cDBP, DBP and PWV.HIIT was superior to MICT in reducing the cSBP, which suggests its potential role as a non-pharmacological therapy for high blood pressure.
Topics: Humans; Blood Pressure; High-Intensity Interval Training; Pulse Wave Analysis; Hypertension; Cardiorespiratory Fitness
PubMed: 37098987
DOI: 10.36660/abc.20220398 -
Human Vaccines & Immunotherapeutics Dec 2023Debate regarding vaccinating high-risk infants with penta- and hexavalent vaccines persists, despite their good immunogenicity and acceptable safety profile in healthy...
Debate regarding vaccinating high-risk infants with penta- and hexavalent vaccines persists, despite their good immunogenicity and acceptable safety profile in healthy full-term infants. We report the findings of a systematic literature search that aimed to present data on the immunogenicity, efficacy, effectiveness, safety, impact, compliance and completion of penta- and hexavalent vaccination in high-risk infants, including premature newborns. Data from the 14 studies included in the review showed that the immunogenicity and the safety profile of penta- and hexavalent vaccines in preterm infants was generally similar to those seen in full-term infants, with the exception of an increase in cardiorespiratory adverse events such as apnea, bradycardia and desaturation following vaccination in preterm infants. Despite recommendations of vaccinating preterm infants according to their actual age, and the relatively high completion rate of the primary immunization schedule, vaccination was often delayed, increasing the vulnerability of this high-risk population to vaccine-preventable diseases.
Topics: Infant; Infant, Newborn; Humans; Infant, Premature; Vaccines, Combined; Vaccination; Infant, Newborn, Diseases; Immunization Schedule; Rubiaceae
PubMed: 37076111
DOI: 10.1080/21645515.2023.2191575 -
Frontiers in Psychology 2023The practice of racket sports has had an exponential growth in the last decade, along with it, the scientific interest in researching the different disciplines:... (Review)
Review
The practice of racket sports has had an exponential growth in the last decade, along with it, the scientific interest in researching the different disciplines: badminton, padel, table tennis, tennis, and squash. However, most research has focused on the technical and tactical field. Therefore, the aim of this review is to analyze and compare the indicators of the internal load of each sport: heart rate (HR), maximum oxygen consumption (VO), oxygen consumption (VO), and lactate (LA) in order to reset physiological references to adjust the training of the players and also use these references to propose the practice of these sports for healthy purposes to the general population. PRISMA Guidelines for Systematic Review were used to search for articles that met the inclusion criteria in three databases: Web of Science, Pubmed, and Sportdiscus. The search was performed between January 2010, and September 2022. Finally, a total 27 records were included for analysis in this study. The main findings were related to the differences in the intensity rates between sports. The highest lactate concentrations and heart values were found in badminton in the intensity of effort values (whose highest values were found in badminton) 10.11 (±4.99) mmol/L and 182.6 (±2.7) bpm respectively, whereas table tennis showed the lowest ones 1.2 (± 0.4) mmol/L, and 103.99 (±15.09) bpm, respectively. The highest mean VO was found in table tennis with a value of 36.8 (±13.2) ml/kg/min and the lowest in tennis with a value of 26.6 (±2.7) ml/kg/min. The highest VO was found in tennis players 58.0 (±4.6) ml/kg/min, and the lowest value was in table tennis with a value of 42.9 (±4.2) ml/kg/min. Since most of the studies were carried out on elite men players, future research should focus on amateur and women level players.
PubMed: 37063547
DOI: 10.3389/fpsyg.2023.1149295