Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisHypertonic saline for peri-operative fluid management.
Fluid excess may place patients undergoing surgery at risk for various complications. Hypertonic saline (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium. ⋯ HS reduces the volume of intravenous fluid required to maintain patients undergoing surgery but transiently increases serum sodium. It is not known if HS effects patient survival and morbidity but it should be tested in randomized clinical trials that are designed and powered to test these outcomes.
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Cochrane Db Syst Rev · Jan 2010
Review Meta Analysis Comparative StudyIncision and drainage of perianal abscess with or without treatment of anal fistula.
The perianal abscess is a common surgical problem. A third of perianal abscesses may manifest a fistula-in-ano which increases the risk of abscess recurrence requiring repeat surgical drainage. Treating the fistula at the same time as incision and drainage of the abscess may reduce the likelihood of recurrent abscess and the need for repeat surgery. However, this could affect sphincter function in some patients who may not have later developed a fistula-in-ano. ⋯ The published evidence shows fistula surgery with abscess drainage significantly reduces recurrence or persistence of abscess/fistula, or the need for repeat surgery. There was no statistically significant evidence of incontinence following fistula surgery with abscess drainage. This intervention may be recommended in carefully selected patients.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisIncreased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children.
Written action plans providing guidance in the early treatment of asthma exacerbations have traditionally advocated doubling of inhaled corticosteroids (ICS) as one of the first steps in treatment. ⋯ There is very little evidence from trials in children. In adults with asthma on daily maintenance ICS, a self-initiated ICS increase to 1000 to 2000 mcg/day at the onset of an exacerbation is not associated with a statistically significant reduction in the risk of exacerbations requiring rescue oral corticosteroids. More research is needed to assess the effectiveness of increased ICS doses at the onset of asthma exacerbations (particularly in children).
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisAntioxidant micronutrients for lung disease in cystic fibrosis.
Airway infection leads to progressive damage of the lungs in cystic fibrosis (CF), partly due to oxidative stress. Supplementation of antioxidant micronutrients (vitamin E, vitamin C, ß-carotene and selenium) may help maintain an oxidant-antioxidant balance. Current literature suggests a relationship between oxidative status and lung function. ⋯ There appears to be conflicting evidence regarding the clinical effectiveness of antioxidant supplementation in CF. Based on the evidence, antioxidants appear to decrease quality of life and oxidative stress; however, few trials contributed data towards analysis. Further trials examining clinically important outcomes and elucidation of a clear biological pathway of oxidative stress in CF are necessary before a firm conclusion regarding effects of antioxidants supplementation can be drawn.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisAdjusting the pH of lidocaine for reducing pain on injection.
Lidocaine administration produces pain due to its acidic pH. ⋯ Increasing the pH of lidocaine decreased pain on injection and augmented patient comfort and satisfaction.