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Heliyon Sep 2023Operating room workers are at risk of experiencing adverse effects due to occupational exposure to waste anesthetic gases (WAGs). One of the consequences of long-term...
INTRODUCTION
Operating room workers are at risk of experiencing adverse effects due to occupational exposure to waste anesthetic gases (WAGs). One of the consequences of long-term WAGs exposure is the probability of developing deoxyribonucleic acid (DNA) damage. This systematic review investigated the link between WAGs and DNA damage in operating room workers.
METHODS
PubMed, Science Direct, ProQuest, Scopus, and EbscoHost, as well as hand-searching, were used to find literature on the relationship between WAGs and DNA damage. Three independent reviewers independently assessed the study's quality. Meta-analysis was conducted for several DNA damage indicators, such as comet assay (DNA damage score, tail's length, tail's DNA percentage), micronuclei formation, and total chromosomal aberration.
RESULTS
This systematic review included 29 eligible studies (2732 participants). The majority of the studies used a cross-sectional design. From our meta-analysis, which compared the extent of DNA damage in operating room workers to the unexposed group, operating room workers exposed to WAGs had a significantly higher DNA damage indicator, including DNA damage score, comet tail's length, comet tail's DNA percentage, micronuclei formation, and total chromosomal aberration (p < 0.05) than non-exposed group.
CONCLUSION
Waste anesthetic gases have been found to significantly impact DNA damage indicators in operating room personnel, including comet assay, micronuclei development, and chromosomal aberration. To reduce the impact of exposure, hospital and operating room personnel should take preventive measures, such as by adapting scavenger method.
PubMed: 37810053
DOI: 10.1016/j.heliyon.2023.e19988 -
The Cochrane Database of Systematic... Aug 2015Local anaesthesia for cataract surgery can be provided by sub-Tenon's or topical anaesthesia. Both techniques offer possible advantages. This review, which originally... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Local anaesthesia for cataract surgery can be provided by sub-Tenon's or topical anaesthesia. Both techniques offer possible advantages. This review, which originally was published in 2007 and was updated in 2014, was undertaken to compare these two anaesthetic techniques.
OBJECTIVES
Our objectives were to compare the effectiveness of topical anaesthesia (with or without intracameral local anaesthetic) versus sub-Tenon's anaesthesia in providing pain relief during cataract surgery. We reviewed pain during administration of anaesthesia, postoperative pain, surgical satisfaction with operating conditions and patient satisfaction with pain relief provided, and we looked at associated complications.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE (last search in November 2014) and the reference lists of published articles. We looked for conferences abstracts and trials in progress and placed no constraints on language or publication status.
SELECTION CRITERIA
We included all randomized studies that compared sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery.
DATA COLLECTION AND ANALYSIS
We assessed trial quality and extracted data in the format allowing maximal data inclusion.
MAIN RESULTS
We included eight studies in this updated review but could retain in the analysis only seven studies on 742 operated eyes of 617 participants. Two cross-over trials included 125 participants, and five parallel trials included 492 participants. These studies were published between 1997 and 2005. The mean age of participants varied from 71.5 years to 83.5 years. The female proportion of participants varied from 54% to 76%. Compared with sub-Tenon's anaesthesia, topical anaesthesia (with or without intracameral injection) for cataract surgery increases intraoperative pain but decreases postoperative pain at 24 hours. The amplitude of the effect (equivalent to 1.1 on a score from 0 to 10 for intraoperative pain, and to 0.2 on the same scale for postoperative pain at 24 hours), although statistically significant, was probably too small to be of clinical relevance. The quality of the evidence was rated as high for intraoperative pain and moderate for pain at 24 hours. We did find differences in pain during administration of local anaesthetic (low level of evidence), and indications that surgeon satisfaction (low level of evidence) and participant satisfaction (moderate level of evidence) were less with topical anaesthesia. There was not enough evidence to say that one technique would result in a higher or lower incidence of intraoperative complications compared with the other.
AUTHORS' CONCLUSIONS
Both topical anaesthesia and sub-Tenon's anaesthesia are accepted and safe methods of providing anaesthesia for cataract surgery. An acceptable degree of intraoperative discomfort has to be expected with either of these techniques. Randomized controlled trials on the effects of various strategies to prevent intraoperative pain during cataract surgery could prove useful.
Topics: Aged; Aged, 80 and over; Anesthesia, Local; Anesthetics, Local; Cataract Extraction; Female; Humans; Male; Nerve Block; Pain; Pain Measurement; Randomized Controlled Trials as Topic
PubMed: 26308931
DOI: 10.1002/14651858.CD006291.pub3 -
Journal of Science and Medicine in Sport Oct 2022To identify the prevalence, frequency, adverse effects, and reasons for analgesic use in youth athletes. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To identify the prevalence, frequency, adverse effects, and reasons for analgesic use in youth athletes.
DESIGN
Systematic review and meta-analysis.
METHODS
Systematic searches in Embase, Medline, and SPORT-Discus from inception to September 2021, screening of reference lists, and citation tracking were performed to identify observational studies including athletes aged 15-24 years and reporting data on prevalence and/or frequency of analgesic use. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effect proportion meta-analyses, stratified by type of analgesic medication and prevalence measure, estimated the prevalence of analgesic use. Data on usage frequency, adverse events, and reasons for analgesic use was synthesized narratively.
RESULTS
Forty-nine studies were included (44,381 athletes), of which 19 were good/high quality. Seven categories of analgesics were identified across 10 prevalence time-points. Meta-analyses suggested common use of NSAIDs (point prevalence 48 % [95 % CI 23 % to 73 %], in-season prevalence 92 % [95 % CI 88 % to 95 %]). The lowest prevalence was found for use of local anesthetic injections within the previous 12 months (2 % [95 % CI 1 % to 3 %]). Seven to 50 % of athletes reported weekly analgesics use. The proportion of adverse events ranged from 3.3 % to 19.2 %. Reasons for using analgesics included treatment of sports-related pain or injury, to treat illness, and to enhance performance.
CONCLUSIONS
Analgesics are commonly used in youth athletes, but estimates vary depending on type of analgesic and prevalence measure. As the majority of studies were of poor methodological quality, future high-quality research should include prospective data collection of analgesic use to understand consumption trajectories.
Topics: Adolescent; Analgesics; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Athletes; Humans; Prevalence
PubMed: 36100523
DOI: 10.1016/j.jsams.2022.08.018 -
The Journal of Clinical Pediatric... Nov 2023Over the last few years, numerous reports have lauded the efficacy of articaine hydrochloride as a local anesthetic (LA) in dental procedures. Numerous studies have... (Meta-Analysis)
Meta-Analysis
Over the last few years, numerous reports have lauded the efficacy of articaine hydrochloride as a local anesthetic (LA) in dental procedures. Numerous studies have shown that articaine outperforms lidocaine in various aspects of dental treatment, leading to its widespread adoption in both adults and children. Despite the publications of comparative studies, there remains a dearth of systematic reviews examining the adverse effects of articaine versus lidocaine in randomized controlled trials. The aim was to assess the available research on the adverse effects of articaine and lidocaine in pediatric dentistry. A comprehensive search was conducted on Cochrane Library, Pubmed, Chinese Biomedical Literature Database (CBM), Embase, Web of Science and China National Knowledge Infrastructure (CNKI). Randomized controlled trials (RCT) that compared articaine with lidocaine in pediatric dentistry were included. Methodological quality assessment and risk of bias were determined for each of the included studies. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the strength of evidence for every research. A total of 333 studies were identified through electronic searches. After conducting primary and secondary assessments, eight studies were included for the final qualitative analysis. We found no difference in the probability of adverse reactions between articaine and lidocaine after treatment in pediatric patients (risk ratio (RR) = 1.08, 95% confidence interval (CI) (0.54-2.15), = 0.83). However, a high heterogeneity was reported among the outcomes in the investigated studies (I = 57%), and the strength of the evidence was classified as "moderate" based on the GRADE approach. Besides, we found no significant difference in the probability of postoperative pain, postoperative soft tissue injury and edema between articaine and lidocaine in pediatric patients following treatment. There was moderate quality evidence suggesting no difference in the occurrence of adverse events between articaine and lidocaine when used for pediatric dental procedures.
Topics: Adult; Humans; Child; Lidocaine; Carticaine; Pediatric Dentistry; Anesthesia, Dental; Systematic Reviews as Topic; Anesthetics, Local; Double-Blind Method; Mandibular Nerve
PubMed: 37997231
DOI: 10.22514/jocpd.2023.078 -
Acta Paediatrica (Oslo, Norway : 1992) Jun 2009Despite accumulating evidence that procedural pain experienced by newborn infants may have acute and even long-term detrimental effects on their subsequent behaviour and... (Review)
Review
UNLABELLED
Despite accumulating evidence that procedural pain experienced by newborn infants may have acute and even long-term detrimental effects on their subsequent behaviour and neurological outcome, pain control and prevention remain controversial issues. Our aim was to develop guidelines based on evidence and clinical practice for preventing and controlling neonatal procedural pain in the light of the evidence-based recommendations contained in the SIGN classification. A panel of expert neonatologists used systematic review, data synthesis and open discussion to reach a consensus on the level of evidence supported by the literature or customs in clinical practice and to describe a global analgesic management, considering pharmacological, non-pharmacological, behavioural and environmental measures for each invasive procedure. There is strong evidence to support some analgesic measures, e.g. sucrose or breast milk for minor invasive procedures, and combinations of drugs for tracheal intubation. Many other pain control measures used during chest tube placement and removal, screening and treatment for ROP, or for postoperative pain, are still based not on evidence, but on good practice or expert opinions.
CONCLUSION
These guidelines should help improving the health care professional's awareness of the need to adequately manage procedural pain in neonates, based on the strongest evidence currently available.
Topics: Analgesia; Anesthetics, Local; Humans; Infant, Newborn; Intensive Care, Neonatal; Neonatology; Pain; Pain Management
PubMed: 19484828
DOI: 10.1111/j.1651-2227.2009.01291.x -
Obstetrics and Gynecology Sep 2012To assess the effectiveness of intrauterine local anesthesia in reducing pain associated with outpatient gynecologic procedures. (Review)
Review
OBJECTIVE
To assess the effectiveness of intrauterine local anesthesia in reducing pain associated with outpatient gynecologic procedures.
DATA SOURCES
We searched online databases PubMed or MEDLINE, Embase, Google Scholar, and Clinicaltrials.gov and hand-searched reference lists from reviews evaluating pain-control methods for gynecologic office procedures. We identified randomized controlled trials using intrauterine local anesthetic in gynecologic procedures.
METHODS
Titles and abstracts were screened for 1,236 articles. We identified 45 potential articles for inclusion. We excluded 22 of these studies because: 1) they were not randomized controlled trials; 2) they did not describe a quantifiable dose of medication used in the study; 3) they did not investigate an intrauterine anesthetic; 4) they did not study a potentially awake, outpatient procedure; and 5) they did not clearly report results or represented duplicate publication. Twenty-three articles were ultimately included for review.
TABULATION, INTEGRATION, AND RESULTS
Two authors independently reviewed full search results and assessed eligibility for inclusion and independently abstracted data from all articles that met criteria for inclusion. Disagreements regarding eligibility or abstraction data were adjudicated by a third independent person. Our primary end point was the reported effect of intrauterine local anesthesia on patient-reported pain scores. As a result of heterogeneity in study methods, outcome measures, and reporting of outcomes, results could not be combined in a meta-analysis. Good evidence supports use of intrauterine anesthesia in endometrial biopsy and curettage, because five good-quality studies reported reduced pain scores, whereas only one good-quality study reported negative results. We found moderate evidence to support intrauterine anesthesia in hysteroscopy, because one good-quality study and two fair or poor quality studies reported reduced pain scores, whereas two good-quality studies had negative results. Good evidence suggests that intrauterine anesthesia is not effective in hysterosalpingography; three good-quality studies reported that pain scores were not reduced, and no good quality studies showed a beneficial effect in that procedure. Evidence was insufficient concerning first-trimester abortion, saline-infusion ultrasonogram, tubal sterilization, and intrauterine device insertion.
CONCLUSION
Intrauterine local anesthesia can reduce pain in several gynecologic procedures including endometrial biopsy, curettage, and hysteroscopy and may be effective in other procedures as well.
Topics: Ambulatory Surgical Procedures; Anesthesia, Local; Anesthesia, Obstetrical; Anesthetics, Local; Female; Gynecologic Surgical Procedures; Humans; Pain Measurement; Uterus
PubMed: 22914480
DOI: 10.1097/AOG.0b013e3182639ab5 -
Medicine Sep 2018Propofol and midazolam are widely used for the sedation of bronchoscopy. This systematic review and meta-analysis is conducted to compare the efficacy of propofol and... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Propofol and midazolam are widely used for the sedation of bronchoscopy. This systematic review and meta-analysis is conducted to compare the efficacy of propofol and midazolam for bronchoscopy.
METHODS
The databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched for collecting the randomized controlled trials (RCTs) regarding the efficacy of propofol and midazolam for bronchoscopy.
RESULTS
This meta-analysis has included 4 RCTs. Compared with midazolam intervention in patients undergoing bronchoscopy, propofol intervention is associated with remarkably reduced recovery time [standard mean difference (SMD) = -0.74; 95% confidence interval (95% CI) = -1.04 to -0.45; P < .00001], but demonstrates no significant impact on operation time (SMD = -0.01; 95% CI = -0.16 to 0.13; P = .87), induction time (SMD = -0.58; 95% CI = -1.19 to 0.03; P = .06), lowest oxyhemoglobin saturation (SpO2, SMD = 0.24; 95% CI = -0.09 to 0.58; P = .15), SpO2 <90% [risk ratio (RR) = 1.02; 95% CI = 0.82-1.25; P = .88), and major arrhythmias (RR = 0.56; 95% CI = 0.26-1.19; P = .13).
CONCLUSION
Propofol sedation is able to reduce recovery time and shows similar safety compared with midazolam sedation during bronchoscopy.
Topics: Anesthetics, Intravenous; Bronchoscopy; Humans; Hypnotics and Sedatives; Midazolam; Pain, Procedural; Propofol; Randomized Controlled Trials as Topic
PubMed: 30200147
DOI: 10.1097/MD.0000000000012229 -
PeerJ 2023Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of clinical anesthesia techniques, we conducted a systematic review and meta-analysis to compare the efficacy of intraligamentary anesthesia with other infiltration anesthesia.
METHODS
The search was carried out in PubMed Central, Cochrane Central Register of Controlled Trials, MEDLINE (via OVID), Embase (via OVID), and Scopus from the inception to March 26, 2023.
RESULTS
Seven eligible randomized controlled trials were included in the meta-analysis. The results indicated no significant difference in the success rate (RR = 0.96; 95% CI [0.81-1.14]; = 0.65; I= 73%) and visual analog scale (VAS) during dental procedures (MD = 3.81; 95% CI [-0.54-8.16]; = 0.09; I= 97%) between intraligamentary anesthesia and other infiltration anesthesia. However, intraligamentary anesthesia exhibited a higher VAS score during injection than other infiltration anesthesia (MD = 8.83; 95% CI [4.86-12.79]; < 0.0001; I= 90%). A subgroup analysis according to infiltration techniques showed that supraperiosteal anesthesia had a lower VAS score during dental procedures than intraligamentary anesthesia.
CONCLUSIONS
Intraligamentary anesthesia and other infiltration anesthesias have the same success rate and pain during dental procedures. However, the pain during injection of intraligamentary anesthesia is heavier than that of other infiltration anesthesia.
Topics: Humans; Anesthesia, Local; Anesthetics, Local; Pain; Injections; Pain Measurement
PubMed: 37520252
DOI: 10.7717/peerj.15734 -
Pain Physician Dec 2022Nalbuphine has been increasingly used as a local anesthetic adjuvant to extend the duration of analgesia in brachial plexus block (BPB). (Meta-Analysis)
Meta-Analysis
BACKGROUND
Nalbuphine has been increasingly used as a local anesthetic adjuvant to extend the duration of analgesia in brachial plexus block (BPB).
OBJECTIVES
To systematically and firstly evaluate the available evidence on the efficacy of nalbuphine as an adjuvant to local anesthetics in BPB.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
Cochrane Central Register of Controlled Clinical Trials, Cochrane Database of Systematic Reviews, Medline, Embase, Scopus, Web of Science, EBSCO, PubMed, and additional databases were searched. Randomized controlled trials comparing combination of perineural nalbuphine with local anesthetics to local anesthetics alone in BPB for upper extremity surgical procedures were eligible for inclusion.
RESULTS
Nineteen randomized controlled trials involving 1,355 patients met the inclusion criteria. Perineural use of nalbuphine prolonged the duration of analgesia in BPB (mean difference [MD], 162.5; 95% confidence interval [CI], 119.0 to 205.9; P < 0.00001; very low quality of evidence). The duration of sensory block was also extended (MD, 141.6; 95% CI, 100.3 to 182.9; P < 0.00001; very low quality of evidence). Furthermore, nalbuphine shortened the onset time of sensory block (MD, -2.6; 95% CI, -3.6 to -1.5; P < 0.00001; very low quality of evidence). There were no significant differences in side effect-related outcomes, including nausea (risk radio [RR], 1.56; 95% CI, 0.82 to 2.59; P = 0.17; moderate quality of evidence) and vomiting (RR, 1.41; 95% CI, 0.66 to 3.02; P = 0.38; moderate quality of evidence).
LIMITATIONS
The study was limited by substantial heterogeneity, a relatively small sample size and difference-in-differences in how outcomes of interest were described and assessed.
CONCLUSIONS
Perineural use of nalbuphine in BPB is an effective strategy for analgesia in adult patients undergoing upper extremity surgery.
Topics: Adult; Humans; Brachial Plexus Block; Anesthetics, Local; Nalbuphine; Adjuvants, Anesthesia; Anesthesia, Local; Pain, Postoperative
PubMed: 36608006
DOI: No ID Found -
World Journal of Surgery May 2016Globally, an estimated 2 billion people lack access to surgical and anesthesia care. We sought to pool results of anesthesia care capacity assessments in low- and... (Review)
Review
BACKGROUND
Globally, an estimated 2 billion people lack access to surgical and anesthesia care. We sought to pool results of anesthesia care capacity assessments in low- and middle-income countries (LMICs) to identify patterns of deficits and provide useful targets for advocacy and intervention.
METHODS
A systematic review of PubMed, Cochrane Database of Systematic Reviews, and Google Scholar identified reports that documented anesthesia care capacity from LMICs. When multiple assessments from one country were identified, only the study with the most facilities assessed was included. Patterns of availability or deficit were described.
RESULTS
We identified 22 LMICs (15 low- and 8 middle-income countries) with anesthesia care capacity assessments (614 facilities assessed). Anesthesia care resources were often unavailable, including relatively low-cost ones (e.g., oxygen and airway supplies). Capacity varied markedly between and within countries, regardless of the national income. The availability of fundamental resources for safe anesthesia, such as airway supplies and functional pulse oximeters, was often not reported (72 and 36 % of hospitals assessed, respectively). Anesthesia machines and the capability to perform general anesthesia were unavailable in 43 % (132/307 hospitals) and 56 % (202/361) of hospitals, respectively.
CONCLUSION
We identified a pattern of critical deficiencies in anesthesia care capacity in LMICs, including some low-cost, high-value added resources. The global health community should advocate for improvements in anesthesia care capacity and the potential benefits of doing so to health system planners. In addition, better quality data on anesthesia care capacity can improve advocacy, as well as the monitoring and evaluation of changes over time and the impact of capacity improvement interventions.
Topics: Anesthesiology; Developing Countries; Health Facilities; Health Resources; Humans; Needs Assessment
PubMed: 26822158
DOI: 10.1007/s00268-016-3430-4