scholarly journals Processed Electroencephalogram Monitoring and Postoperative Delirium

2018 ◽  
Vol 129 (3) ◽  
pp. 417-427 ◽  
Author(s):  
Kristen K. MacKenzie ◽  
Angelitta M. Britt-Spells ◽  
Laura P. Sands ◽  
Jacqueline M. Leung
Keyword(s):  
Cognitive Dysfunction ◽  
Fixed Effects ◽  
Postoperative Delirium ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Risk Of Bias ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Google Search ◽  
The Relationship

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction. Methods A systematic search for randomized controlled trials was conducted using Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, and Google search using the keywords processed electroencephalogram, Bispectral Index, postoperative delirium, postoperative cognitive dysfunction. Screening and data extraction were conducted by two independent reviewers, and risk of bias was assessed. Postoperative delirium combined-effect estimates calculated with a fixed-effects model were expressed as odds ratios with 95% CIs. Results Thirteen of 369 search results met inclusion criteria. Postoperative cognitive dysfunction data were excluded in meta-analysis because of heterogeneity of outcome measurements; results were discussed descriptively. Five studies were included in the quantitative postoperative delirium analysis, with data pooled from 2,654 patients. The risk of bias was low in three studies and unclear for the other two. The use of processed electroencephalogram-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium (odds ratio = 0.62; P < 0.001; 95% CI, 0.51 to 0.76). Conclusions Processed electroencephalogram-guided anesthesia was associated with a decrease in postoperative delirium. The mechanism explaining this association, however, is yet to be determined. The data are insufficient to assess the relationship between processed electroencephalogram monitoring and postoperative cognitive dysfunction.

scholarly journals Does propofol ameliorate occurrence of postoperative cognitive dysfunction after general anaesthesia? A protocol of systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Xi Zhao ◽  
Ze-qing Huang
Keyword(s):  
Systematic Review ◽  
Cognitive Dysfunction ◽  
Short Term Memory ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
China National Knowledge Infrastructure

Abstract Background Postoperative cognitive dysfunction (POCD) is a common condition after general anesthesia (GA). Previous studies have reported that propofol can ameliorate the occurrence of such disorder. However, its results are still inconsistent. Therefore, this systematic review will assess the efficacy and safety of propofol on POCD after GA. Methods Literature sources will be sought from inception to the present in Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for randomized controlled trials (RCTs) assessing the administration of propofol on POCD after GA. All searches will be carried out without limitations to language and publication status. Outcomes comprise of cognitive impairments changes, impairments in short-term memory, concentration, language comprehension, social integration, quality of life, and adverse events. Cochrane risk of bias tool will be utilized to assess study quality. We will evaluate the quality of evidence for each outcome using Grading of Recommendations Assessment, Development and Evaluation approach. A narrative synthesis or a meta-analysis will be undertaken as appropriate. Discussion This study will systematically and comprehensively search literature and integrate evidence on the efficacy and safety of propofol on POCD after GA. Our findings will be of interest to clinicians and health-related policy makers. Systematic review registration PROSPERO CRD42020164096

scholarly journals YOGA IN CHRONIC NECK PAIN: AN EFFECTIVE COMPLEMENTARY THERAPEUTIC OPTION - A META - ANALYSIS

2018 ◽  
Vol 7 (2) ◽  
pp. 3-12
Author(s):  
Jaza Rizvi ◽  
Batool Hassan ◽  
Sadia Shafaq
Keyword(s):  
Neck Pain ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Chronic Neck Pain ◽  
Well Being ◽  
Risk Of Bias ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
P Value ◽  
Complementary Method

BACKGROUND Neck pain is recognized as the fourth leading cause of disability worldwide. The severity of neck pain may lead to adverse outcomes related to individual’s health and well-being that augment the risk of disability and may severely interfere in activities of daily living (ADL’s) and participation in the society. AIM The aim of the quantitative analysis is to determine the effectiveness of yoga in relieving chronic neck pain and disability. METHODS Databases such as Google scholar, MEDLINE, PEDro, the Cochrane Library and Pub Med were explored from October-November for randomized controlled trials which assessed neck pain and related disability among chronic neck pain individuals. RESULTS Total six studies consisted of 298 participants with chronic neck pain. In risk of bias assessment, all six studies reported low risk of allocation and reporting bias, while one or two study disclosed high or unknown risk of bias in several domains. Moderate to large effect of -0.857 SMD at 95% CI suggest evidence in favor of the effectiveness of yoga; (Q 30.32, df 5, I2 83.51%) on a significant P-value of <0.0001. CONCLUSION The analysis of studies provided robust evidence with pool effect of -0.857 SMD at 95% CI (p<0.0001) concluded that yoga is an effectual and complementary method for the management of chronic or non-specific neck pain. KEYWORDS Yoga, Neck Pain, Cervical, Therapeutic, Prevention, Meditation

scholarly journals Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia: A meta-analysis

2016 ◽  
Vol 44 (6) ◽  
pp. 1182-1190 ◽  
Author(s):  
Chengmao Zhou ◽  
Yu Zhu ◽  
Zhen Liu ◽  
Lin Ruan
Keyword(s):  
General Anaesthesia ◽  
Cognitive Dysfunction ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Cochrane Library ◽  
Methodologic Quality ◽  
The Cochrane Library ◽  
State Examination

Objective We undertook a meta-analysis to investigate the effect of dexmedetomidine on postoperative cognitive dysfunction (POCD). Methods We searched PubMed, EMBASE, the Cochrane Library, CNKI and Google Scholar to find randomized controlled trials (RCTs) of the influence of dexmedetomidine on POCD in elderly adults who had undergone general anaesthesia. Two researchers independently screened the literature, extracted data, and evaluated methodologic quality against inclusion and exclusion criteria. We used RevMan 5.2 to undertake our meta-analysis. Results Thirteen RCTs were included. Compared with controls, dexmedetomidine: 1) significantly reduced the incidence of POCD (relative risk = 0.59, 95% confidence interval [CI] 0.45–2.95) and improved Mini-Mental State Examination (MMSE) score (mean difference, MD = 1.74, 95% CI 0.43–3.05) on the first postoperative day; and 2) reduced the incidence of POCD after the first postoperative day (MD = 2.73, 95% CI 1.33–4.12). Conclusion Dexmedetomidine reduces the incidence of POCD and improves postoperative MMSE score.

Prevalence of Dental Anomalies in Nonsyndromic Individuals with Cleft Lip and Palate: A Systematic Review and Meta-analysis

2012 ◽  
Vol 49 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Patricia Nivoloni Tannure ◽  
Cristiana Aroeira G.R. Oliveira ◽  
Lucianne Copie Maia ◽  
Alexandre R. Vieira ◽  
José Mauro Granjeiro ◽  
...  
Keyword(s):  
Random Effects ◽  
Fixed Effects ◽  
Cleft Lip And Palate ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Permanent Teeth ◽  
Cochrane Library ◽  
Tooth Agenesis ◽  
Dental Anomalies ◽  
Oral Clefts

Objective To assess whether individuals born with nonsyndromic oral clefts display a higher frequency of dental anomalies. Design A search of MEDLINE, BIREME, OVID ALL EMB Reviews, and The Cochrane Library was conducted. The methodologic quality of the papers selected was assessed and scored. Papers reporting observational controlled studies of nonsyndromic forms of oral cleft matched for dental anomalies in primary and/or permanent teeth were included without language restrictions. Eligible studies were scored as “A”—low risk of bias, “B”—moderate risk of bias, or “C”—high risk of bias and poor quality. Fixed and random effects models were used to aggregate individual odds ratios (OR) and to derive pooled estimates and 95% confidence intervals. Results Six studies fulfilled our selection criteria and were included in the meta-analysis. Three distinct subgroup analyses were carried out in terms of dental anomalies. In the tooth agenesis meta-analysis, a random effects model was used because of heterogeneity and showed a significant association between tooth agenesis and oral clefts (OR = 12.31; 95% confidence interval [CI] = 3.75 to 40.36). In the remaining analyses, the fixed effects model revealed a positive association between supernumerary (OR = 4.99; 95% CI, 2.58 to 9.64) and crown morphologic abnormalities (OR = 5.69; 95% CI, 3.96 to 8.19) with oral clefts. Most included studies were of low to moderate quality. Conclusion Although general limitations in study design were observed, the evidence suggests that a higher number of dental anomalies in the permanent dentition are noted in individuals born with oral clefts.

scholarly journals Effects of dexmedetomidine on neurocognitive disturbance after elective non-cardiac surgery in senile patients: a systematic review and meta-analysis

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110142
Author(s):  
Xiaobo Bi ◽  
Jingxia Wei ◽  
Xia Zhang
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Delirium ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Cochrane Library ◽  
Control Group ◽  
China National Knowledge Infrastructure ◽  
Neurocognitive Dysfunction ◽  
Knowledge Infrastructure ◽  
Positive Effect

Objective Senile patients often experience neurocognitive disturbance after non-cardiac surgery. Several clinical trials have investigated if the perioperative intravenous use of dexmedetomidine has a positive effect on the prevention of neurocognitive dysfunction, but the results have been inconsistent. We performed a meta-analysis to investigate the effects of dexmedetomidine on neurocognitive disturbance after elective non-cardiac surgery in senile patients. Methods The PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure databases were comprehensively searched for all randomized controlled trials published before 1 February 2020 that investigated the efficacy of dexmedetomidine in the prevention of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD). Results Sixteen studies involving 4376 patients were included in this meta-analysis. Compared with the control (i.e., saline), the perioperative intravenous use of dexmedetomidine significantly reduced the incidence of POD and POCD. However, patients in the dexmedetomidine group were more likely to develop bradycardia and hypotension during the administration of dexmedetomidine than patients in the control group. There were no differences between the two groups in the incidence of nausea and vomiting or mortality rate. Conclusion Dexmedetomidine has a positive effect on the prevention of neurocognitive disturbance in senile patients after elective non-cardiac surgery.

scholarly journals Cerebral monitoring of anaesthesia on reducing cognitive dysfunction and postoperative delirium: a systematic review

2018 ◽  
Vol 46 (10) ◽  
pp. 4100-4110 ◽  
Author(s):  
Chunmei Luo ◽  
Weiwu Zou
Keyword(s):  
Systematic Review ◽  
Cognitive Dysfunction ◽  
Postoperative Delirium ◽  
Randomized Clinical Trials ◽  
Postoperative Cognitive Dysfunction ◽  
Auditory Evoked Potential ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Significant Difference

Objective To assess the efficacy of cerebrally monitoring the depth of anaesthesia in reducing postoperative cognitive dysfunction and postoperative delirium (POD). Methods MEDLINE, EMBASE, and Cochrane Library databases were searched following PRISMA statement guidelines. We included randomized clinical trials (RCTs) comparing electroencephalogram-based and routine care-guided titration of anaesthesia in a systematic review. The risk estimate from each RCT was pooled in a meta-analysis. The primary outcome was POD and long-term cognitive dysfunction. Subgroup analyses were conducted for the subtypes of intervention group and surgery. We identified five RCTs with a total sample size of 2,868 and with bispectral index (BIS) or auditory evoked potential (AEP) as interventions. Results The odds ratio (OR) for POD and long-term cognitive decline was 0.51 (95%CI: 0.35–0.76) and 0.69 (95%CI: 0.49–0.97), respectively. Significant heterogeneity was identified in the POD data. There was no significant difference between BIS- and AEP-based titration of anaesthesia in reducing the risk of POD. Extensive heterogeneity for cardiac and thoracic surgery was identified in the study population, and significant publication bias was found among the POD results. Conclusions BIS- and AEP-guided anaesthesia are associated with significantly reduced risk of POD and long-term cognitive dysfunction.

scholarly journals The effect of intraoperative dexmedetomidine on cognitive dysfunction after surgery: a updated meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jianli Li ◽  
Qifan Yin ◽  
Xuejiao Xun ◽  
Jinhua He ◽  
Dongdong Yu ◽  
...  
Keyword(s):  
Cognitive Dysfunction ◽  
Mmse Score ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Cochrane Library ◽  
Control Group ◽  
General Anaesthetic ◽  
Neuroprotective Effects ◽  
Systematic Analysis ◽  
The Cochrane Library

Abstract Background Postoperative cognitive dysfunction (POCD) is one of the most common. Neuroprotective effects of dexmedetomidine (DEX) are reported in previous studies but evidence regarding the POCD is still unclear. In order to gain latest evidence, the present study analyzes the outcomes of randomized controlled trials (RCTs) which utilized DEX with general anaesthesia perioperatively. Method Four online databases (PubMed, Embase, the Cochrane Library, and CNKI) were used to find relevant RCTs to conduct systematic analysis. All studies comparing the incidence of POCD or MMSE score between the DEX group and the placebo or comparator group in patients undergoing general anaesthetic surgery were eligible for inclusion. Based on the inclusion and exclusion criteria, the studies were selected. This meta-analysis was performed using odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous data and standardized mean difference (SMD) and 95% CIs for continuous data as effective measures. Results In total of 21 studies were included in this meta-analysis. The results showed that the incidence of POCD in DEX group was significantly lower than the control group on the first (OR = 0.36, 95% CI 0.24–0.54),third (OR = 0.45,95% CI 0.33–0.61) and seventh (OR = 0.40,95% CI 0.26–0.60) postoperative days; the MMSE scores in DEX group were higher than the control group on the first (SMD = 1.24, 95% CI 1.08–1.41), third(SMD = 1.09, 95%CI 0.94–1.24) and seventh (SMD = 3.28, 95% CI 1.51–5.04) postoperative days. Conclusions Intraoperative DEX use can ameliorate the POCD of patients who received surgical operations under general anesthesia, and effectively reduce the incidence of POCD and improve MMSE score.

scholarly journals Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anesthesia: a meta-analysis of randomized controlled trials

2019 ◽  
Author(s):  
Li-Qin Li ◽  
Cong Wang ◽  
Mei-Dan Fang ◽  
Hong-Yu Xu ◽  
Hong-Liu Lu ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
General Anesthesia ◽  
Cognitive Dysfunction ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomized Controlled

Abstract Background Several studies have investigated the effects of dexamethasone on postoperative cognitive dysfunction (POCD) or postoperative delirium (POD); however, their conclusions have not been consistent. So we conducted a meta-analysis to determine the effects of dexamethasone on POCD/POD in adults following general anesthesia. Methods Cochrane Central Register of Controlled Trials (CENTRAL, 2018, Issue 11 of 12) in the Cochrane Library (searched November 17, 2018); MEDLINE OvidSP (1946 to November 16, 2018); and Embase OvidSP (1974 to November 16, 2018) were searched for randomized controlled trials that evaluated the incidence of POCD/POD following dexamethasone administration, in adults (age ≥18 years) under general anesthesia. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework to assess the quality of evidence. Results Five studies were included (three studies/1393 participants for the incidence of POCD, and two studies/809 participants for the incidence of POD). There was no significant difference between the dexamethasone group and the placebo group in terms of the incidence of POCD in 30 days after surgery (RR 1.00; 95% CI [0.51, 1.96], P = 1.00, I2 = 77%) or in the incidence of POD (RR 0.95; 95% CI [0.60, 1.50], P = 0.81, I2 = 0%). However, both analyses had some limitations, and we considered the quality of the evidence for the postoperative incidence of POCD and POD to be very low. Conclusions This meta-analysis revealed that prophylactic dexamethasone did not reduce the incidence of POCD and POD. However, additional large high-quality trials are still needed to determine the effects of dexamethasone on the incidence of POCD/POD in patients undergoing surgery.

scholarly journals Effect of Ulinastatin on Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Surgery: A Systemic Review and Meta-Analysis

2021 ◽  
Vol 15 ◽  
Author(s):  
Mei Duan ◽  
Fangyan Liu ◽  
Huiqun Fu ◽  
Shuai Feng ◽  
Xue Wang ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cognitive Dysfunction ◽  
Inflammatory Responses ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Systemic Review ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Major Surgery ◽  
Tnf Α

Background: Postoperative cognitive dysfunction (POCD) is associated with neuroinflammation by triggering the systemic inflammatory responses. Related studies have demonstrated that ulinastatin, which is a urinary trypsin inhibitor, inhibited the release of inflammatory mediators and improved postoperative cognitive function in elderly patients undergoing major surgery. However, there are controversial results put forwarded by some studies. This systemic review aimed to evaluate the effect of ulinastatin on POCD in elderly patients undergoing surgery.Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, and Ovid to find relevant randomized controlled trials (RCTs) of ulinastatin on POCD in elderly patients undergoing surgery. The primary outcomes included the incidence of POCD and the Mini-Mental State Examination (MMSE) scores. The secondary outcome was the levels of inflammatory cytokines such as tumor necrosis factor (TNF)-α, S100β, C-reactive protein (CRP), interleukin (IL)-6, and IL-10. RevMan 5.3 was used to conduct the meta-analysis.Results: Ten RCTs were included finally. Compared with controls, ulinastatin significantly reduced the incidence of POCD [risk ratio (RR) = 0.29, 95% CI 0.21–0.41, test of RR = 1: Z = 7.05, p &lt; 0.00001]. In addition, patients in the ulinastatin group have lower levels of TNF-α, S100β, CRP, and IL-6 and higher level of IL-10 in serum following surgery.Conclusion: These findings suggested that ulinastatin can be used as an anti-inflammatory drug for POCD prevention in elderly patients undergoing surgery.Systematic Review Registration Number: CRD42019137449.

scholarly journals Associations of dyslipidaemia and lipid-lowering treatment with risk of postoperative cognitive dysfunction: a systematic review and meta-analysis

2018 ◽  
Vol 72 (6) ◽  
pp. 499-506 ◽  
Author(s):  
Insa Feinkohl ◽  
Georg Winterer ◽  
Tobias Pischon
Keyword(s):  
Systematic Review ◽  
Cognitive Dysfunction ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Lipid Lowering ◽  
Relative Risks ◽  
Age Related ◽  
Inverse Variance ◽  
Age Range

BackgroundLipid imbalance is linked to age-related cognitive impairment, but its role in postoperative cognitive dysfunction (POCD) is unknown. Here, we present a systematic review and meta-analysis on dyslipidaemia, lipid-lowering treatment and POCD risk.MethodsPubMed, Ovid SP and Cochrane databases were searched for longitudinal studies that reported on associations of any measure of dyslipidaemia and/or lipid-lowering treatment with POCD as relative risks (RRs) or ORs. Fixed-effects inverse variance models were used to combine effects.ResultsOf 205 articles identified in the search, 17 studies on 2725 patients (grand mean age 67 years; mean age range 61–71 years) with follow-up periods of 1 day to 4 years (median 7 days; IQR 1–68 days) were included. Studies focused almost exclusively on hypercholesterolaemia as a measure of dyslipidaemia and on statins as lipid-lowering treatment. Across 12 studies on hypercholesterolaemia, we found no association with POCD risk (RR 0.93; 95% CI 0.80 to 1.08; P=0.34). Statin use before surgery was associated with a reduced POCD risk across eight studies (RR 0.81; 95% CI 0.67 to 0.98; P=0.03), but data on treatment duration were lacking.ConclusionStatin users appear to be at reduced risk of POCD although hypercholesterolaemia per se may not be associated with POCD risk. Trial studies are needed to evaluate the usefulness of statins in POCD prevention.

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