Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisEpidural versus non-epidural or no analgesia in labour.
Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant. ⋯ Epidural analgesia appears to be effective in reducing pain during labour. However, women who use this form of pain relief are at increased risk of having an instrumental delivery. Epidural analgesia had no statistically significant impact on the risk of caesarean section, maternal satisfaction with pain relief and long-term backache and did not appear to have an immediate effect on neonatal status as determined by Apgar scores. Further research may be helpful to evaluate rare but potentially severe adverse effects of epidural analgesia on women in labour and long-term neonatal outcomes.
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Anxiety about dental treatment maybe a barrier to its uptake in children. Sedation can be used to relieve anxiety and manage behaviour, unfortunately it is difficult to determine from published research which agents, dosages and techniques are effective. ⋯ Authors were not able to reach any definitive conclusion on which was the most effective drug or method of sedation used for anxious children. A list of proposed areas of study was described.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisBulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome.
Irritable bowel syndrome (IBS) is a common health problem, often presenting in primary care as well as in internal medicine and gastroenterology outpatient clinics. Therapeutic options are dominated by drug therapies but there is uncertainty about their effectiveness. ⋯ The evidence for efficacy of drug therapies for IBS is weak. Although there is evidence of benefit for antispasmodic drugs for abdominal pain and global assessment of symptoms; it is unclear whether anti-spasmodic subgroups are individually effective. There is no clear evidence of benefit for antidepressants or bulking agents. The physician should be aware that global assessment is a construct containing various dimensions. For each individual, these will have a different weighting and treatment should be aimed at the most debilitating symptom. Stool problems are by definition part of the IBS symptom complex. Bulking agents may improve constipation and can be used empirically, but should be evaluated at an early stage for individual benefit. Future research should pay attention to study methodology and the use of valid outcome measures.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisInterventions for preoperative smoking cessation.
Smokers have a substantially increased risk of intra- and postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence. The preoperative period may be a well chosen time to offer smoking cessation interventions due to increased patient motivation. ⋯ Preoperative smoking interventions are effective for changing smoking behaviour perioperatively. Direct evidence that reducing or stopping smoking reduces the risk of complications is based on two small trials with differing results. The impact on complications may depend on how long before surgery the smoking behaviour is changed, whether smoking is reduced or stopped completely, and the type of surgery.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisCalcium antagonists for aneurysmal subarachnoid haemorrhage.
Secondary ischaemia is a frequent cause of poor outcome in patients with subarachnoid haemorrhage (SAH). Its pathogenesis has not been elucidated yet, but may be related to vasospasm. Experimental studies have indicated that calcium antagonists can prevent or reverse vasospasm and have neuroprotective properties. Several types of calcium antagonists have been studied in several clinical trials. ⋯ Calcium antagonists reduce the risk of poor outcome and secondary ischaemia after aneurysmal SAH. The results for 'poor outcome' depend largely on a single large trial with oral nimodipine; the evidence for nicardipine, AT877 and magnesium is inconclusive. The evidence for nimodipine is not beyond every doubt, but given the potential benefits and modest risks of this treatment, against the background of a devastating natural history, oral nimodipine (60 mg every 4 hours) is currently indicated in patients with aneurysmal SAH. Intravenous administration of calcium antagonists cannot be recommended for routine practice on the basis of the present evidence.