In Regard to Local Versus General Anesthesia for the Management of Nasal Bone Fractures: A Systematic Review and Meta-Analysis

Background: Although, some clinical trials investigated the maternal and neonatal effect of fentanyl as a premedication before induction of general anesthesia in cesarean section, to the best of our knowledge, there is no systematic review to summarize these results. Objectives: The present systematic review and meta-analysis evaluated the maternal and neonatal effect of intravenous fentanyl as a premedication before induction of general anesthesia in cesarean section. Methods: The databases of Pubmed, Embase, Scopus and Cochrane library were searched till July 2017 to identify randomized clinical trials which evaluated the effects of intravenous fentanyl as a premedication before induction of general anesthesia compared with placebo on neonate first and fifth minute Apgar score and maternal heart rate and mean arterial pressure (MAP) in cesarean section. Standard Mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity analysis. Results: The present systematic review and meta-analysis consisted of three clinical trials including 180 women in labor. Considering the results of meta-analysis, there is no significant differences between fentanyl and placebo in the case of Apgar score at 1 minute; however, the Apgar score of 5 minutes was significantly lower in fentanyl group compared with placebo (SMD -0.68, 95%CI: - 0.98, -0.38, p<0.001). In the term of maternal hemodynamics, the heart rate (SMD -0.43, 95%CI: - 0.72, -0.13, p=0.004) and MAP (SMD -0.78, 95% CI: -1.09, -0.48, p<0.001) in fentanyl group were significantly lower compared with placebo group. Conclusion: The present meta-analysis showed that using intravenous fentanyl as a premedication before induction of general anesthesia had adverse effects on neonate Apgar score. However, it had positive effects on preventing adverse consequences of intubation on maternal hemodynamics.

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Risk factors for emergence agitation in adults after general anesthesia: a systematic review and meta‐analysis

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.13774 ◽

2020 ◽

Author(s):

Bing Wei ◽

Yan Feng ◽

Wenjuan Chen ◽

Dapeng Ren ◽

Daishun Xiao ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

General Anesthesia ◽

Meta Analysis ◽

Emergence Agitation

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Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-Analysis (Preprint)

JMIR Research Protocols ◽

10.2196/32170 ◽

2021 ◽

Author(s):

Derek Roberts ◽

Hannah Dreksler ◽

Sudhir K. Nagpal ◽

Allen Li ◽

Jeanna Parsons Leigh ◽

...

Keyword(s):

Systematic Review ◽

General Anesthesia ◽

Regional Anesthesia ◽

Lower Limb ◽

Meta Analysis ◽

Revascularization Surgery

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Incidence of Postoperative Cognitive Dysfunction Following Inhalational Vs. Total Intravenous General Anesthesia: A Systematic Review and Meta-Analysis.

10.21203/rs.3.rs-1211887/v1 ◽

2022 ◽

Author(s):

Daniel Negrini ◽

Andrew Wu ◽

Atsushi Oba ◽

Ben Harnke ◽

Nicholas Ciancio ◽

...

Keyword(s):

Systematic Review ◽

General Anesthesia ◽

Cognitive Dysfunction ◽

Meta Analysis ◽

Postoperative Cognitive Dysfunction ◽

Primary Objective ◽

Intravenous Anesthesia ◽

Robust Designs ◽

Secondary Objective ◽

Intravenous General Anesthesia

Abstract Postoperative cognitive dysfunction (POCD) has been increasingly recognized as a contributor to postoperative complications. A consensus-working group recommended that POCD should be distinguished between delayed cognitive recovery, i.e., evaluations up to 30 days postoperative, and neurocognitive disorder, i.e., assessments performed between 30 days and 12 months after surgery. Additionally, the choice of the anesthetic, either inhalational or total intravenous anesthesia (TIVA) and its effect on the incidence of POCD, has become a focus of research. Our primary objective was to search the literature and conduct a meta-analysis to verify whether the choice of general anesthesia may impact the incidence of POCD in the first 30 days postoperatively. As a secondary objective, a systematic review of the literature was conducted to estimate the effects of the anesthetic on POCD between 30 days and 12 months postoperative. For the primary objective, an initial review of 1,913 articles yielded 12 studies with a total of 3,639 individuals. For the secondary objective, five studies with a total of 751 patients were selected. In the first 30 days postoperative, the odds-ratio for POCD in TIVA group was 0.60 (95% CI = 0.40 - 0.91; p = 0.02), compared to the inhalational group. TIVA was associated with a lower incidence of POCD in the first 30 days postoperatively. Regarding the secondary objective, due to the small number of selected articles and its high heterogeneity, a metanalysis was not conducted. Giving the heterogeneity of criteria for POCD, future prospective studies with more robust designs should be performed to fully address this question.

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Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-Analysis (Preprint)

10.2196/preprints.32170 ◽

2021 ◽

Author(s):

Derek Roberts ◽

Hannah Dreksler ◽

Sudhir K. Nagpal ◽

Allen Li ◽

Jeanna Parsons Leigh ◽

...

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Hospital Stay ◽

General Anesthesia ◽

Regional Anesthesia ◽

Lower Limb ◽

Meta Analysis ◽

Study Results ◽

Multicenter Randomized Controlled Trial ◽

Revascularization Surgery

BACKGROUND Patients undergoing lower limb revascularization surgery for peripheral artery disease (PAD) have a high-risk of perioperative morbidity and mortality and often have long hospital stays. Use of neuraxial or regional anesthesia instead of general anesthesia may represent one approach to improving outcomes and reducing resource use among these patients. OBJECTIVE To conduct a systematic review and meta-analysis to determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes and costs and a shorter length of hospitalization. METHODS We will search electronic bibliographic databases (MEDLINE, EMBASE, and the seven databases in Evidence-Based Medicine Reviews), review articles identified during the search, and included article bibliographies. We will include randomized and non-randomized studies comparing use of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD. Two investigators will independently evaluate risk of bias. The primary outcome will be short-term mortality (in-hospital or 30-day). Secondary outcomes will include longer-term mortality; major adverse cardiovascular, pulmonary, and renal events; delirium; deep vein thrombosis or pulmonary embolism; major adverse limb events; neuraxial or regional anesthesia-related complications; graft-related outcomes; length of operation and hospital stay; costs; and patient-reported or functional outcomes. We will calculate summary odds ratios and standardized mean differences using random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. We will assess for publication bias using Begg’s and Egger’s tests and use the trim-and-fill method to estimate the potential influence of this bias on summary estimates. Finally, we will use Grading of Recommendations, Assessment, Development, and Evaluation methodology to make an overall rating of the quality of evidence in our effect estimates. RESULTS The protocol was registered in PROSPERO, the international register of systematic reviews. CONCLUSIONS This study will synthesize existing evidence regarding whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes, graft patency, and costs, and a shorter length of hospital stay. Study results will be used to inform practice and future research, including creation of a pilot and then multicenter randomized controlled trial. CLINICALTRIAL PROSPERO CRD42021237060.

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