Journal of clinical anesthesia
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Review Meta Analysis
Quadratus lumborum block for postoperative analgesia after cesarean delivery: A systematic review with meta-analysis and trial-sequential analysis.
The aim of this study was to investigate the analgesic efficacy of Quadratus lumborum block (QLB) versus controls, transversus abdominis plane (TAP) block and neuraxial morphine, or when added to neuraxial morphine in women undergoing cesarean delivery. ⋯ QLB improves post-cesarean delivery analgesia in parturients not receiving neuraxial morphine. Addition of QLB to parturients receiving neuraxial morphine has no significant analgesic benefit. Insufficient data are available to draw firm conclusions of QLB compared to TAP blocks or neuraxial morphine.
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Activated clotting time (ACT) is a non-specific test to evaluate the adequacy of systemic heparinization whose value could be influenced by many factors. Tranexamic acid (TXA) is a widely used antifibrinolytic agent worldwide and whether TXA influences ACT value in cardiac surgical patients remains unknown. Current study was performed to address this question. ⋯ This meta-analysis suggested that, TXA administration did not influence ACT value, heparin and protamine doses, but significantly reduced post-operative blood loss and transfusion requirement in cardiac surgical patients.
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Randomized Controlled Trial
Outcomes of individualized goal-directed therapy based on cerebral oxygen balance in high-risk patients undergoing cardiac surgery: A randomized controlled trial.
To investigate whether optimizing individualized goal-directed therapy (GDT) based on cerebral oxygen balance in high-risk surgical patients would reduce postoperative morbidity. ⋯ In high-risk patients undergoing cardiac surgery, individualized GDT therapy did not yield better outcomes, however, the achievement of preoperative individual targets may be associated with less morbidity.
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Meta Analysis
Sugammadex versus neostigmine for routine reversal of rocuronium block in adult patients: A cost analysis.
This report analyzes the comparative costs, efficacy and side effects of a newer, more expensive reversal drug, sugammadex, with its generic counterpart, neostigmine combined with glycopyrrolate, or no reversal agent when used routinely to reverse rocuronium-induced neuromuscular blockade in adult patients. ⋯ Routine reversal with sugammadex is preferable to choosing neostigmine or no reversal drug when accounting for potential savings in OR time. Sugammadex might also be a reasonable choice for patients at high risk of UPMV. If the cost of OR time is not considered, the analysis does not support the routine use of sugammadex in patients with perceived increased risk or solely to reduce PONV.