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PloS One 2021Urodynamic studies in rats and mice are broadly used to examine pathomechnisms of disease and identify and test therapeutic targets. This review aims to highlight the...
Urodynamic studies in rats and mice are broadly used to examine pathomechnisms of disease and identify and test therapeutic targets. This review aims to highlight the effects of the anesthetics on the lower urinary tract function and seeks to identify protocols that allow recovery from anesthesia and repeated measurements while preserving the function which is being studied. All studies published in English language, which compared the data obtained under various types of anesthesia and the urodynamics performed in awake animals were included. It appears that urethane, an anesthetic recommended extensively for the investigation of lower urinary tract function, is appropriate for acute urodynamic studies only. Major advantages of urethane are its stability and ability to preserve the micturition reflex. Due to its toxicity and carcinogenicity, urethane anesthesia should not be used for recovery procedures. This review evaluated available alternatives including propofol, isoflurane and combinations of urethane, ketamine/xylazine, ketamine/medetomidine, and/or fentanyl/fluanisone/midazolam. Different effects have been demonstrated among these drugs on the urinary bladder, the urethral sphincter, as well as on their neuroregulation. The lowest incidence of adverse effects was observed with the use of a combination of ketamine and xylazine. Although the variations in the reviewed study protocols represent a limitation, we believe that this summary will help in standardizing and optimizing future experiments.
Topics: Anesthesia; Anesthetics; Animals; Mice; Rats; Reflex; Urinary Bladder; Urination; Urodynamics
PubMed: 34166394
DOI: 10.1371/journal.pone.0253192 -
Annals of Palliative Medicine Jun 2021At present, liver cancer deaths of China account for about half of the global liver cancer deaths. The most common physiological change in anesthesia surgery for liver... (Meta-Analysis)
Meta-Analysis
BACKGROUND
At present, liver cancer deaths of China account for about half of the global liver cancer deaths. The most common physiological change in anesthesia surgery for liver cancer is liver ischemia-reperfusion injury (LIRI).
METHODS
The Chinese and English medical databases were searched using a combination of the following search terms: "propofol", "liver cancer", "anesthesia surgery", and "ischemia reperfusion injury" in Chinese or English language, respectively. The articles taking patients received propofol intravenous anesthesia surgery for LIRI in the experimental group and patients received intravenous anesthesia with non-propofol drugs for LIRI in the control group were searched. Rev Man 5.3 software was used for meta-analysis.
RESULTS
A total of 18 articles were included, and most were considered to have low-risk bias (that is, medium- and high-quality publications). The meta-analysis results indicated that the superoxide dismutase (SOD) levels from the blockage of the hepatic hilum (B-HH) to the 15-minute opening of the hepatic hilum (O-HH) showed a mean deviation (MD) of -0.33 nU/mL and 95% confidential interval (CI) of -1.81 to 1.15 nmol/L (P<0.05). The levels of malondialdehyde (MDA) from B-HH to O-HH showed a MD of 1.80 nmol/L and 95% CI of 1.53 to 2.07 nmol/l (P<0.05). The MD of alanine transaminase (ALT) levels from B-HH to O-HH was 8.24 IU/L with 95% CI 6.43 to 10.06 IU/L (P<0.05). The MD of aspartate transaminase (AST) levels from B-HH to O-HH was -11.73 IU/L with 95% CI -14.04 to -9.43 IU/L (P<0.05). The RevMan5.3 software was used to draw the funnel chart for each indicator from B-HH to OHH. The results revealed that the circles in some articles were concentrated on the midline and were basically symmetrical with the midline, indicating that the research accuracy was high and there was no bias in publication.
DISCUSSION
This meta-analysis confirmed that propofol exerted a protective effect on LIRI during anesthesia surgery with hepatic hilar blockade.
Topics: Anesthesia; Carcinoma, Hepatocellular; China; Humans; Liver; Liver Neoplasms; Propofol; Reperfusion Injury
PubMed: 34154355
DOI: 10.21037/apm-21-1242 -
Anaesthesia Oct 2021Evidence suggests that healthcare professionals are at an increased risk of dying by suicide, with anaesthetists at particularly high risk. However, much of the data on...
Evidence suggests that healthcare professionals are at an increased risk of dying by suicide, with anaesthetists at particularly high risk. However, much of the data on which this is based are historical. With a focus on the epidemiology and methods used, we conducted a systematic review of evidence regarding suicide and suicidal behaviour among anaesthetists to provide a more contemporary summary. The systematic review process was adapted from a previous similar study in veterinary surgeons and was consistent with recommended guidance. We identified 54 articles published in or after 1990 that had anaesthetist-specific data and met the inclusion criteria. Seven of these reported epidemiological data, of which four were published after 2000. Although none of the more recent studies reported standardised mortality rates specific to suicide in anaesthetists, the proportion of anaesthetists dying by suicide was increased with respect to comparator groups, which is consistent with previous findings. Eleven studies that included information on suicidal behaviour reported suicidal ideation in 3.2-25% of individuals (six studies) and suicide attempts in 0.5-2% (four studies). Studies reporting methods of suicide highlighted the use of anaesthetic drugs, particularly propofol, supporting the suggestion that the increased risk of suicide in anaesthetists may be related to the availability of the means. We discuss our findings in relation to other recently published data and guidance concerning mental health problems in anaesthetists.
Topics: Anesthetists; Humans; Suicide
PubMed: 34061350
DOI: 10.1111/anae.15514 -
Medicine Apr 2021As the adjunctive anesthesia to propofol, both dezocine and fentanyl showed some potential for gastrointestinal endoscopy. This meta-analysis aimed to compare their... (Comparative Study)
Comparative Study Meta-Analysis
INTRODUCTION
As the adjunctive anesthesia to propofol, both dezocine and fentanyl showed some potential for gastrointestinal endoscopy. This meta-analysis aimed to compare their efficacy and safety.
METHODS
PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of dezocine versus fentanyl for the anesthesia of patients undergoing gastrointestinal endoscopy were included.
RESULTS
Five RCTs involving 677 patients were included in the meta-analysis. Overall, compared with fentanyl plus propofol for gastrointestinal endoscopy, dezocine plus propofol resulted in the reduction in propofol dose(mean difference [MD] = -11.72; 95% confidence interval [CI] = -22.83 to -0.61; P = .04), awakening time (std. MD = -1.79; 95% CI = -3.31 to -0.27; P = .02) and hypopnea (risk ratio [RR] = 0.16; 95% CI = 0.06-0.41; P = .0002), but had no remarkable effect on induction time (MD = 1.20; 95% CI = -0.98 to 3.39; P = .28), postoperative pain score (MD = -0.38; 95% CI = -1.00 to 0.24; P = .24), nausea or vomiting (RR = 0.45; 95% CI = 0.10-1.98; P = .29).
CONCLUSION
Dezocine plus propofol may be better for the anesthesia of gastrointestinal endoscopy than fentanyl plus propofol.
Topics: Adult; Aged; Analgesics, Opioid; Anesthetics, Intravenous; Bridged Bicyclo Compounds, Heterocyclic; Drug Therapy, Combination; Endoscopy, Gastrointestinal; Female; Fentanyl; Humans; Male; Middle Aged; Pain, Postoperative; Propofol; Randomized Controlled Trials as Topic; Tetrahydronaphthalenes; Treatment Outcome
PubMed: 33847679
DOI: 10.1097/MD.0000000000025531 -
Frontiers in Cardiovascular Medicine 2021Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed...
Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery. Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity. Twenty-two RCTs with 5,389 patients who received cardiac surgery -2,702 patients in the RIPC group and 2,687 patients in the control group-were included. Moderate heterogeneity was detected ( for Cochrane's test = 0.03, = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61-0.94, = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64-0.95, = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63-0.97, = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60-0.96, = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50-1.07, = 0.11). Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.
PubMed: 33816572
DOI: 10.3389/fcvm.2021.601470 -
BMC Anesthesiology Feb 2021In anesthesia, additive drug interactions are used for reducing dose and dose-dependent side-effects. The combination of propofol with volatile anesthetics is rather... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
In anesthesia, additive drug interactions are used for reducing dose and dose-dependent side-effects. The combination of propofol with volatile anesthetics is rather unusual but might have advantages compared to the single use regarding PONV, time to extubation, movement during surgery and postoperative pain perception.
METHODS
We searched PubMed, Scopus, Web of Science, and CENTRAL for relevant studies comparing combined intravenous volatile anesthesia with total intravenous or balanced anesthesia. The studies identified were summarized in a meta-analysis with the standardized mean difference or risk ratio as the effect size.
RESULTS
Ten studies provided data. The risk for PONV in the recovery room was significantly reduced for a combined anesthesia compared to a balanced anesthesia (RR 0.657, CI 0.502-0.860, p-value 0.002). There was no significant difference detected either in the time to extubation or in pain perception. Movement during surgery was significantly reduced for a combined compared to a total intravenous anesthesia (RR 0.241, CI 0.135-0.428, p-value 0.000).
CONCLUSIONS
The combination of propofol and volatiles may have some advantages in the early occurrence of PONV compared to a balanced anesthesia. To sufficiently evaluate potential advantages of a combination of volatiles and propofol further high-quality trials are needed.
TRIAL REGISTRATION
PROSPERO CRD42019126627 .
Topics: Airway Extubation; Anesthetics, Inhalation; Anesthetics, Intravenous; Drug Therapy, Combination; Humans; Intraoperative Complications; Movement; Pain, Postoperative; Postoperative Complications; Postoperative Nausea and Vomiting; Propofol; Time
PubMed: 33588751
DOI: 10.1186/s12871-021-01273-1 -
Anaesthesiology Intensive Therapy 2021One ampoule of propofol is often divided into several syringes or is sometimes combined with other drugs that may lead to incompatibility and instability. A systematic... (Review)
Review
One ampoule of propofol is often divided into several syringes or is sometimes combined with other drugs that may lead to incompatibility and instability. A systematic review of literature (PubMed, Science Direct, and Google Scholar) identified 37 pieces of research which suggest that the data on propofol stability are limited. Results of all of the identified studies indicated that the stability of propofol is less than 24 hours. Additionally, the evidence shows that glass packaging as well as storing in cold and dark conditions promote stability. What is more, propofol was proved to be incompatible with 23 of the 36 drugs tested. In conclusion, there is a relatively small body of literature that measures the physical stability of propofol. The findings of this review recommend keeping propofol in glass and storing it no longer than 24 hours. Compatibility data must be considered in co-administrations with propofol.
Topics: Humans; Pharmaceutical Preparations; Propofol; Syringes
PubMed: 33586420
DOI: 10.5114/ait.2021.103542 -
Medicine Jan 2021To investigate whether closed-loop systems under bispectral index anesthesia depth monitoring can reduce the intraoperative propofol dosage. (Meta-Analysis)
Meta-Analysis
Bispectral index monitoring of the clinical effects of propofol closed-loop target-controlled infusion: Systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
To investigate whether closed-loop systems under bispectral index anesthesia depth monitoring can reduce the intraoperative propofol dosage.
METHODS
All randomized controlled trials (RCTs) on reducing propofol dosage under closed-loop systems were collected, and the literature was screened out, the abstracts and full texts were carefully read, and the references were tracked, data extraction and quality evaluation were conducted on the included research, and the RevMan5.3 software was used for meta-analysis. The main results were propofol and the incidence of adverse reactions such as hypertensive hypotension and postoperative cognitive dysfunction. A total of 879 cases were included in 8 articles, including 450 occurrences in the closed-loop system group and 429 cases in the open-loop system group.
RESULTS
Compared with manual control, closed-loop systems under bispectral index anesthesia depth monitoring reduced the dose of propofol (MD: -0.62, 95% CI: -1.08--0.16, P = .008), with heterogeneity (I2 = 80%). Closed-loop systems significantly reduced the incidence of abnormal blood pressure (MD: -0.02, 95%CI: -0.05-0.01, P = .15, I2 = 74%) and postoperative cognitive dysfunction (MD: -0.08, 95% CI: -0.14 -0.01, P = .02, I2 = 94%).
CONCLUSION
Bispectral index monitoring of propofol closed-loop target-controlled infusion system can reduce the amount of propofol, reduce the incidence of adverse reactions such as hypertensive or hypotension and postoperative cognitive dysfunction.
Topics: Anesthesia, Intravenous; Anesthetics, Intravenous; Consciousness Monitors; Dose-Response Relationship, Drug; Humans; Postoperative Cognitive Complications; Propofol; Randomized Controlled Trials as Topic
PubMed: 33530193
DOI: 10.1097/MD.0000000000023930 -
Anesthesia and Pain Medicine Jan 2021Postoperative delirium (POD) is a condition of cerebral dysfunction and a common complication after surgery. This study aimed to compare and determine the relative...
BACKGROUND
Postoperative delirium (POD) is a condition of cerebral dysfunction and a common complication after surgery. This study aimed to compare and determine the relative efficacy of pharmacological interventions for preventing POD using a network meta-analysis.
METHODS
We performed a systematic and comprehensive search to identify and analyze all randomized controlled trials until June 29, 2020, comparing two or more pharmacological interventions, including placebo, to prevent or reduce POD. The primary outcome was the incidence of POD. We performed a network meta-analysis and used the surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of the pharmacological interventions evaluated.
RESULTS
According to the SUCRA value, the incidence of POD decreased in the following order: the combination of propofol and acetaminophen (86.1%), combination of ketamine and dexmedetomidine (86.0%), combination of diazepam, flunitrazepam, and pethidine (84.8%), and olanzapine (75.6%) after all types of anesthesia; combination of propofol and acetaminophen (85.9%), combination of ketamine and dexmedetomidine (83.2%), gabapentin (82.2%), and combination of diazepam, flunitrazepam, and pethidine (79.7%) after general anesthesia; and ketamine (87.1%), combination of propofol and acetaminophen (86.0%), and combination of dexmedetomidine and acetaminophen (66.3%) after cardiac surgery. However, only the dexmedetomidine group showed a lower incidence of POD than the control group after all types of anesthesia and after general anesthesia.
CONCLUSIONS
Dexmedetomidine reduced POD compared with the control group. The combination of propofol and acetaminophen and the combination of ketamine and dexmedetomidine seemed to be effective in preventing POD. However, further studies are needed to determine the optimal pharmacological intervention to prevent POD.
PubMed: 33445233
DOI: 10.17085/apm.20079 -
PloS One 2021To determine the effectiveness of pharmacologic interventions for preventing postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy. (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
To determine the effectiveness of pharmacologic interventions for preventing postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy.
DESIGN
Systematic review and network meta-analysis (NMA).
DATA SOURCES
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar.
ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS
Randomized clinical trials that investigated the efficacy of pharmacologic interventions in preventing PONV in patients undergoing thyroidectomy were included. The primary endpoints were the incidences of postoperative nausea and vomiting (PONV), postoperative nausea (PON), postoperative vomiting (POV), use of rescue antiemetics, and incidence of complete response in the overall postoperative phases. The secondary endpoints were the same parameters assessed in the early, middle, and late postoperative phases. The surface under the cumulative ranking curve (SUCRA) values and rankograms were used to present the hierarchy of pharmacologic interventions.
RESULTS
Twenty-six studies (n = 3,467 patients) that investigated 17 different pharmacologic interventions were included. According to the SUCRA values, the incidence of PONV among the overall postoperative phases was lowest with propofol alone (16.1%), followed by palonosetron (27.5%), and with tropisetron (28.7%). The incidence of PON among the overall postoperative phases was lowest with propofol alone (11.8%), followed by tropisetron and propofol combination (14%), and ramosetron and dexamethasone combination (18.0%). The incidence of POV among the overall postoperative phases was lowest with tropisetron and propofol combination (2.2%), followed by ramosetron and dexamethasone combination (23.2%), and tropisetron alone (37.3%). The least usage of rescue antiemetics among the overall postoperative phases and the highest complete response was observed with tropisetron and propofol combination (3.9% and 96.6%, respectively).
CONCLUSION
Propofol and tropisetron alone and in combination, and the ramosetron and dexamethasone combination effectively prevented PONV, PON, POV in patients undergoing thyroidectomy, with some heterogeneity observed in this NMA of full-text reports. Their use minimized the need for rescue antiemetics and enhanced the complete response.
TRIAL REGISTRATION NUMBER
CRD42018100002.
Topics: Antiemetics; Drug Therapy, Combination; Humans; Network Meta-Analysis; Postoperative Nausea and Vomiting; Randomized Controlled Trials as Topic; Thyroidectomy; Treatment Outcome
PubMed: 33428643
DOI: 10.1371/journal.pone.0243865