Anaesthesia
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Review Meta Analysis
Effects of intra-operative maintenance of general anaesthesia with propofol on postoperative pain outcomes - a systematic review and meta-analysis.
Propofol is used both for induction and maintenance of anaesthesia. Recent evidence shows that propofol has analgesic properties. This meta-analysis evaluated differences in postoperative analgesia between general anaesthetic maintenance with intravenous propofol and inhalational anaesthetics. ⋯ Data were insufficient to allow a meaningful analysis regarding 24-h morphine-equivalent consumption. Propofol was associated with reduced postoperative nausea and vomiting (relative risk (95%CI) 0.446 (0.304-0.656) (p < 0.0001). In conclusion, this meta-analysis suggests that propofol improves postoperative analgesia compared with inhalational anaesthesia 24 h after surgery, with a lower incidence of nausea and vomiting.
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Review Meta Analysis
A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain.
We searched MEDLINE, Embase, CINAHL, AMED and CENTRAL databases until December 2014 and included 133 randomised controlled trials of peri-operative gabapentin vs placebo. Gabapentin reduced mean (95% CI) 24-h morphine-equivalent consumption by 8.44 (7.26-9.62) mg, p < 0.001, whereas more specific reductions in morphine equivalents were predicted (R(2) = 90%, p < 0.001) by the meta-regression equation: 3.73 + (-0.378 × control morphine consumption (mg)) + (-0.0023 × gabapentin dose (mg)) + (-1.917 × anaesthetic type), where 'anaesthetic type' is '1' for general anaesthesia and '0' for spinal anaesthesia. The type of surgery was not independently associated with gabapentin effect. ⋯ The risk ratios (95% CI) for postoperative nausea, vomiting, pruritus and sedation with gabapentin were: 0.78 (0.69-0.87), 0.67 (0.59-0.76), 0.64 (0.51-0.80) and 1.18 (1.09-1.28), respectively, p < 0.001 for all. Gabapentin reduced pre-operative anxiety and increased patient satisfaction on a 10-point scale by a mean (95% CI) of 1.52 (0.78-2.26) points and 0.89 (0.22-1.57) points, p < 0.001 and p = 0.01, respectively. All the effects of gabapentin may have been overestimated by statistically significant small study effects.
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Review Meta Analysis
A systematic review and meta-analysis of ultrasound versus electrical stimulation for peripheral nerve location and blockade.
We systematically reviewed peripheral nerve blockade guided by ultrasound versus electrical stimulation. We included 26 comparisons in 23 randomised controlled trials of 2125 participants. Ultrasound reduced the rate of pain during the procedure, relative risk (95% CI) 0.60 (0.41-0.89), p = 0.01. ⋯ The rate of rescue was unaffected by the addition of electrical stimulation to ultrasound, relative risk (95% CI) 1.07 (0.54-2.10), p = 0.85. Ultrasound, with or without electrical stimulation, reduced the pooled rate of vascular puncture, relative risk (95% CI) 0.23 (0.15-0.37), p < 0.0001. There was no difference in the rate of postoperative neurological side-effects, relative risk (95% CI) 0.76 (0.53-1.09), p = 0.13.
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Review Meta Analysis
The role of point-of-care platelet function testing in predicting postoperative bleeding following cardiac surgery: a systematic review and meta-analysis.
This systematic review and meta-analysis appraises the utility of point-of-care platelet function tests for predicting blood loss and transfusion requirements in cardiac surgical patients, and analyses whether their use within a transfusion management algorithm is associated with improved patient outcomes. We included 30 observational studies incorporating 3044 patients in the qualitative assessment, and nine randomised controlled trials including 1057 patients in the meta-analysis. ⋯ Viscoelastic methods used in combination with other platelet function tests achieved greater reduction in blood loss (mean difference -111.8 ml (95% CI -174.9 to -49.1 ml), p = 0.0005) compared with their use alone (mean difference -90.6 ml (95% CI 166.1-15.0 ml), p = 0.02). We conclude that incorporation of point-of-care platelet function tests into transfusion management algorithms is associated with a reduction in blood loss and transfusion requirements in cardiac surgery patients.
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Review Meta Analysis Comparative Study
Comparison of streamlined liner of the pharynx airway (SLIPA(™) ) and laryngeal mask airway: a systematic review and meta-analysis.
We performed a systematic review to compare the efficacy and safety of the streamlined liner of the pharynx airway and laryngeal mask airway used in adults during general anaesthesia. We included 14 studies with studies with 1273 patients in total. There was no evidence of a difference between the two devices in insertion success rate on the first attempt (13 studies, 1143 patients), insertion time (seven studies, 576 patients), ease of insertion (five studies, 466 patients), oropharyngeal leak pressure (eight studies, 771 patients) and the quality of the fibreoptic view of the larynx through the device (three studies, 281 patients). ⋯ Other adverse events were comparable. Subgroup analysis suggested that the insertion by novice users might be faster and more successful with the streamlined liner of the pharynx airway than the laryngeal mask airway; however, this was from only two studies and 186 patients. The method of size selection of the streamlined liner of the pharynx airway device might also affect the speed of insertion: choosing according to the width of the patient's thyroid cartilage, rather than height, may produce better results.