Journal of anesthesia
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Journal of anesthesia · Apr 2015
Review Meta AnalysisAnesthetic effects of propofol in the healthy human brain: functional imaging evidence.
Functional imaging methods, including positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), have become important tools for studying how anesthetic drugs act in the human brain to induce the state of general anesthesia. Recent imaging studies using fMRI and PET techniques have demonstrated the regional effects of propofol on the brain. However, the pharmacological mechanism of the action of propofol in the intact human central nervous system is unclear. ⋯ During deep sedation, propofol preserves cortical sensory reactivity, the specific thalamocortical network is moderately affected, whereas the nonspecific thalamocortical network is severely suppressed. In contrast, several recent fMRI studies are consistent on the systemic decreased effects of propofol in the frontoparietal network. Accumulating evidence suggest that propofol-induced unconsciousness is associated with a global metabolic and vascular depression in the human brain and especially with a significant reduction in the thalamocortical network and the frontoparietal network.
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Journal of anesthesia · Dec 2014
Meta Analysis Comparative StudyKetamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials.
Ketamine is traditionally avoided in sedation management of patients with risk of intracranial hypertension. However, results from many clinical trials contradict this concern. We critically analyzed the published data of the effects of ketamine on intracranial pressure (ICP) and other cerebral hemodynamics to determine whether ketamine was safe for patients with hemodynamic instability and brain injuries. ⋯ The results of this study suggest that ketamine does not increase ICP compared with opioids. Ketamine provides good maintenance of hemodynamic status. Clinical application of ketamine should not be discouraged on the basis of ICP-related concerns.
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Journal of anesthesia · Dec 2014
Meta Analysis Comparative StudyCardiac damage after carotid intervention: a meta-analysis after a decade of randomized trials.
This study synthesizes evidence from randomized controlled trials of the past decade regarding the relative safety of carotid endarterectomy (CEA) versus carotid angioplasty and stenting (CAS) as concerns postoperative cardiac damage. ⋯ Compared to open surgery, CAS is associated with significantly decreased risk for symptomatic and asymptomatic cardiac damage postoperatively. Therefore, a standardized troponin measurement after CEA should be further evaluated in future studies.
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Journal of anesthesia · Jun 2014
Meta AnalysisThe impact of prophylactic intravenous lidocaine on opioid-induced cough: a meta-analysis of randomized controlled trials.
Opioids are commonly used for general anesthesia, but reflex cough can occur after an intravenous injection. We have performed a meta-analysis of randomized controlled trials (RCTs) that evaluated the effectiveness and safety of prophylactic lidocaine administered intravenously (IV) on opioid-induced cough (OIC) during induction in patients undergoing general anesthesia. ⋯ Our meta-analysis establishes the effectiveness of prophylactic lidocaine administered IV for the prevention of OIC during induction. The lowest effective dose of lidocaine on the risk of OIC appeared to be 0.5 mg/kg.
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Journal of anesthesia · Apr 2014
Review Meta AnalysisPharmacological and nonpharmacological prevention of fentanyl-induced cough: a meta-analysis.
Fentanyl-induced cough (FIC) is often observed after intravenous bolus administration of fentanyl during anesthesia induction. This meta-analysis assessed the efficacy of pharmacological and nonpharmacological interventions to reduce the incidence of FIC. We searched for randomized controlled trials comparing pharmacological or nonpharmacological interventions with controls to prevent FIC; we included 28 studies retrieved from Pub-Med, Embase, and Cochrane Library. ⋯ Lidocaine [odds ratio (OR) = 0.29, 95 % confidence interval (CI) 0.21–0.39], N-methyl-D-aspartate (NMDA) receptor antagonists (OR 0.09, 95 % CI 0.02–0.42), propofol (OR 0.07, 95 % CI 0.01–0.36), a2 agonists (OR 0.32, 95 % CI 0.21–0.48), b2 agonists (OR 0.10, 95 % CI 0.03–0.30), fentanyl priming (OR 0.33, 95 % CI 0.19–0.56), and slow injection of fentanyl (OR 0.25, 95 % CI 0.11–0.58)] were effective in decreasing the incidence of FIC, whereas atropine (OR 1.10, 95 % CI 0.58–2.11) and benzodiazepines (OR 2.04, 95 % CI 1.33–3.13) were not effective. This meta-analysis found that lidocaine, NMDA receptor antagonists, propofol, a2 agonists, b2 agonists, and priming dose of fentanyl were effective in preventing FIC, but atropine and benzodiazepines were not. Slow injection of fentanyl was effective in preventing FIC, but results depend on the speed of administration.