Journal of clinical anesthesia
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Substance P is a neuropeptide with a pivotal role in pain transmission and modulation. Preclinical studies suggest that targeting substance P and inhibiting its receptor, neurokinin 1 (NK-1), is a potential avenue for pain relief. When translated into clinical settings, these preliminary findings yielded mixed results. This meta-analysis of randomized controlled trials (RCTs) aims to investigate whether a preemptive administration of NK-1 antagonists may reduce postoperative pain. ⋯ Preoperative single-administration of NK-1 antagonists reduces postoperative pain. The observed pain reduction pattern is consistent with the pharmacokinetics (half-life 9-12 h) of these inhibitors and with data from preclinical studies.
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Cognitive impairment following surgery is a significant complication, affecting multiple neurocognitive domains. The term "perioperative neurocognitive disorders" (PND) is recommended to encompass this entity. Individuals who develop PND are typically older and have increases in serum and brain pro-inflammatory cytokines notwithstanding the type of surgery undergone. ⋯ Bromo-epi-androsterone (BEA) is a potent synthetic analog of DHEA; unlike DHEA, it is non-androgenic, non-anabolic and is an effective modulator of immune dysregulation. In a randomized, placebo-controlled clinical trial, BEA effected significant and sustained decreases in IL-1β, TNFα and IL-6. This article presents BEA as a potential candidate for clinical trials targeting PND and further suggests the use of BEA in elective total hip arthroplasty as a well-documented surgical entity relevant to the management of PND.
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Review Meta Analysis Comparative Study
Postoperative delirium under general anaesthesia by remimazolam versus propofol: A systematic review and meta-analysis of randomised controlled trials.
Remimazolam, an ultra-short-acting benzodiazepine, has similar clinical effects to propofol for sedation in general anaesthesia. However, it remains uncertain whether remimazolam could increase postoperative delirium (POD) compared with propofol. ⋯ Perioperative remimazolam administration did not increase POD and reduced the risk of intraoperative hypotension compared to propofol. Further large-scale RCTs are warranted to explore the association of remimazolam and POD. Systematic review protocol: PROSPERO CRD42024544122.
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Review Meta Analysis Comparative Study
Postoperative delirium under general anaesthesia by remimazolam versus propofol: A systematic review and meta-analysis of randomised controlled trials.
Remimazolam, an ultra-short-acting benzodiazepine, has similar clinical effects to propofol for sedation in general anaesthesia. However, it remains uncertain whether remimazolam could increase postoperative delirium (POD) compared with propofol. ⋯ Perioperative remimazolam administration did not increase POD and reduced the risk of intraoperative hypotension compared to propofol. Further large-scale RCTs are warranted to explore the association of remimazolam and POD. Systematic review protocol: PROSPERO CRD42024544122.
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Review Meta Analysis Comparative Study
Comparative efficacy of intravenous treatments for perioperative shivering in patients undergoing caesarean delivery under neuraxial anaesthesia: A systematic review and Bayesian network meta-analysis of randomised-controlled trials.
Shivering affects 52 % of patients undergoing caesarean delivery under neuraxial anaesthesia. Despite extensive research focused on its prevention, there is still no consensus regarding optimal pharmacological treatment. This systematic review and network meta-analysis aims to compare available intravenous treatments of perioperative shivering in patients undergoing caesarean delivery under neuraxial anaesthesia. ⋯ This network meta-analysis identified four effective intravenous treatments for shivering in patients undergoing caesarean delivery under neuraxial anaesthesia: dexmedetomidine, tramadol, nalbuphine and meperidine. Dexmedetomidine was the top-ranked intervention for all outcomes.