Anaesthesia
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Review Meta Analysis Comparative Study
A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and meta-analysis.
Use of propofol for ambulatory surgery results in less post-operative nausea and vomiting, though no difference in post-discharge nausea and vomiting, and with greater cost compared with volatiles.
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Peri-operative melatonin may cause small reductions in pre-operative anxiety and post-operative pain.
pearl -
Review Meta Analysis Comparative Study
A systematic review and meta-analysis of the i-gel(®) vs laryngeal mask airway in adults.
We systematically reviewed 31 adult randomised clinical trials of the i-gel(®) vs laryngeal mask airway. The mean (95% CI) leak pressure difference and relative risk (95% CI) of insertion on the first attempt were similar: 0.40 (-1.23 to 2.02) cmH2 O and 0.98 (0.95-1.01), respectively. The mean (95% CI) insertion time and the relative risk (95% CI) of sore throat were less with the i-gel: by 1.46 (0.33-2.60) s, p = 0.01, and 0.59 (0.38-0.90), p = 0.02, respectively. ⋯ All outcomes displayed substantial heterogeneity, I(2) ≥ 75%. Subgroup analyses did not decrease heterogeneity, but suggested that insertion of the i-gel was faster than for first-generation laryngeal mask airways and that the i-gel leak pressure was higher than first generation, but lower than second-generation, laryngeal mask airways. A less frequent sore throat was the main clinical advantage of the i-gel.