Effects of dexmedetomidine versus midazolam for premedication in paediatric anaesthesia with sevoflurane: A meta-analysis

Background Dexmedetomidine (DEX), an α2-adrenergic receptor agonist, produces ideal sedation and early postoperative recovery for premedication in paediatric surgery, reducing preoperative anxiety and facilitating smooth induction of anaesthesia. We performed a meta-analysis to compare the effects of DEX and midazolam (MDZ) in paediatric anaesthesia with sevoflurane. Methods PubMed, Ovid, Web of Science, and Public Health Management Corporation were searched through December 2016 for randomized controlled trials (RCTs) that compared DEX and MDZ in children undergoing sevoflurane anaesthesia. The risk ratio (RR) with 95% incidence interval (95%CI) was used for dichotomous variables. Results Twelve RCTs involving 422 patients in the DEX group and 448 patients in the MDZ group were included. Patients in the DEX group had a significantly lower incidence of unsatisfactory sedation (RR [95%CI] = 0.71 [0.57–0.89]), unsatisfactory parental separation (RR [95%CI] = 0.56 [0.35–0.87]), and rescue analgesia (RR [95%CI] = 0.52 [0.35–0.77]) than patients in the MDZ group. However, both groups had a similar incidence of unsatisfactory mask acceptance, emergence agitation, and postoperative nausea and vomiting. Conclusion Compared with MDZ, DEX is beneficial in paediatric anaesthesia with sevoflurane because of its lower incidence of unsatisfactory sedation, parental separation, and rescue analgesia.

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A Systematic Review and Meta-Analysis of the SuperPATH Approach in Hip Arthroplasty

BioMed Research International ◽

10.1155/2021/5056291 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Yanzhi Ge ◽

Zuxiang Chen ◽

Qisong Chen ◽

Yanbin Fu ◽

Mengqiang Fan ◽

...

Keyword(s):

Hip Arthroplasty ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Postoperative Recovery ◽

Harris Hip Score ◽

Abduction Angle ◽

Transfusion Rate ◽

Invasive Approach ◽

Dichotomous Variables

Objective. To compare the clinical and radiographic results of the supercapsular percutaneously assisted total hip (SuperPATH) approach and the conventional approach in hip arthroplasty. Design. Based on a prepublished protocol (PROSPERO: CRD42020177717), we searched PubMed, Embase, and Cochrane for relevant literatures up to January 30, 2021. The methodological qualities were assessed using the guidelines provided by the Cochrane Collaboration for Systematic Reviews. Randomized- or fixed-effect models were used to calculate the weighted mean difference (WMD) or odds ratio (OR), respectively, for continuous and dichotomous variables. Results. 6 articles were included in the study, and 526 patients were selected, which included 233 cases in the SuperPATH groups and 279 cases in the conventional groups, and 4 cases performed two surgeries in succession. The SuperPATH group demonstrated shorter incision length ( WMD = − 7.87 , 95% CI (−10.05, −5.69), P < 0.00001 ), decreased blood transfusion rate ( OR = 0.48 , 95% CI (0.25, 0.89), P = 0.02 ), decreased visual analogue scale (VAS) ( WMD = − 0.40 , 95% CI (−0.72, −0.08), P = 0.02 ), and higher Harris hip score (HHS) ( WMD = 1.98 , 95% CI (0.18, 3.77), P = 0.03 ) than the conventional group. However, there was no difference in VAS ( P = 0.14 ) and HHS ( P = 0.86 ) between the two groups 3 months later, nor in the acetabular abduction angle ( P = 0.32 ) in either group. Conclusions. SuperPATH, as a minimally invasive approach with its reduced tissue damage, quick postoperative recovery, and early rehabilitation, demonstrates the short-term advantages of hip arthroplasty. As the evidences in favor of the SuperPATH technique were limited in a small number of studies and short duration of follow-up, more research is required to further analyze its long-term effect.

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Perioperative anesthesia

Infusion & Chemotherapy ◽

10.32902/2663-0338-2020-3.2-178-179 ◽

2020 ◽

pp. 178-179

Author(s):

І.І. Lisnyi

Keyword(s):

Acute Pain ◽

Local Anesthetics ◽

Meta Analysis ◽

Opioid Analgesic ◽

Cochrane Review ◽

Postoperative Nausea And Vomiting ◽

Early Mobilization ◽

Postoperative Recovery ◽

Improvement Program ◽

Perioperative Analgesia

Background. Ensuring adequate analgesia is a prerequisite for rapid recovery after surgery. Improving the management of acute pain is important to ensure the safe and effective analgesia needed for early mobilization and for avoidance of organ dysfunction due to inadequate analgesia. For this purpose, multimodal analgesia (MMA) is used. It includes opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAID), paracetamol or metamizole, local anesthetics and ancillary drugs. Objective. To describe modern views on perioperative analgesia. Materials and methods. Analysis of literature data on this issue. Results and discussion. MMA involves an opioid-preserving approach (reducing the dose of opioids without reducing the quality of analgesia), procedure and patient specificity. The postoperative recovery improvement program includes several items, three of which have been associated with a reduction in treatment duration, namely, multimodal prevention of postoperative nausea and vomiting, perioperative NSAID use, and post-operative opioid protocol. The combined use of NSAID and paracetamol provides a better result than the use of each of these drugs alone. At the correct dose, paracetamol (Infulgan, “Yuria-Pharm”) is an effective non-opioid analgesic for the treatment of acute pain with minimal side effects for a long time. Pre- and intraoperative administration of paracetamol is recommended in a number of guidelines. Intravenous administration of local anesthetics is an another important component of MMA. The 2016 Cochrane review showed that long-term intravenous perioperative infusion of lidocaine significantly reduced the postoperative need for opioids. However, the meta-analysis of 10 randomized controlled trials found that perioperative intravenous lidocaine did not differ from placebo in post-operative pain assessed with the help of a visual analog scale and in opioid requirements (Rollins K.E., 2020). Similar results have been obtained in other studies in recent years. Inclusion of nefopam in MMA can reduce the dose of opioids. The use of nefopam, paracetamol and deksketoprofen makes it possible to dramatically reduce the use of morphine. Neither pain nor postoperative recovery can be adequately controlled with a single treatment due to the multifactorial nature of the problem. It is recommended to use MMA, but there are no recommendations for optimal combinations of analgesics for specific procedures. Administration of paracetamol and NSAID in combination with the use of regional techniques is a golden standard of MMA. Conclusions. 1. After the surgery, the patient should be adequately anesthetized. 2. To achieve optimal, preferably non-opioid, analgesia, it is recommended to use MMA. 3. NSAID, paracetamol, nefopam and regional techniques are the important components of MMA.

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ENCHANCED RECOVERY AFTER COLECTOMY : OPIOID FREE ANESTHESIA VERSUS OPIOID BASED ANESTHESIA

10.36106/paripex/9507151 ◽

2019 ◽

pp. 1-3

Author(s):

Andrianimaro Florelia Martinetti* ◽

Razafindraibe Faneva Angelo Parfait ◽

Rabenjari Rabenjari ◽

Oger Sébastien ◽

Sztark François

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Postoperative Nausea And Vomiting ◽

Postoperative Recovery ◽

Pratiques Professionnelles ◽

Bonnes Pratiques ◽

Chirurgie Colorectale ◽

Mr Effect ◽

Double Blinded ◽

Postoperative Morphine

1. P. Alfonsi et al. Réhabilitation rapide après une chirurgie colorectale programmée.Annales Françaises d’Anesthésie et de Réanimation 33 (2014) 370–384. 2. Sophie BLANCHARD et coll. Programmes de réhabilitation rapide en chirurgie:état des lieux et perspectives - Note de cadrage.HAS / Service des bonnes pratiques professionnelles / juillet 2014. 3. Opioid free anesthesia (OFA) ou anesthésie sans morphinique.SOFIA 2017. 4. MulierJP (2015). Opioid free anaesthesia (OFA) a Paradigm shift?. Retrieved from http://www.researchgate.net/publication/278307444 5. P. Ziemann-Gimmel. Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis.British Journal of Anaesthesia 112 (5):906–11 (2014). 6. Blaudszun G, Lysakowski C, Elia N, Tramer MR. Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials.Anesthesiology 2012;116:1312-22. 7. Frauenknecht J, Kirkham KR, Jacot-Guillarmod A and al. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis. Anaesthesia. 2019 May;74(5):651-662. doi: 10.1111/ anae.14582.Epub 2019 Feb 25.] 8. Feld JM, Hoffman WE, Stechert MM, et al. Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery.J Clin Anesth 2006;18:24–8. 9. Hofer RE, Sprung J, Sarr MG, et al. Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics. Can J Anaesth 2005;52:176–80. 10. Bello M, Oger S, Bedon-Carte S and al. Effect of opioid-free anaesthesia on postoperative epidural ropivacaine requirement after thoracic surgery: A retrospective unmatched case-control study. Anaesth Crit Care Pain Med. 2019 Feb 5.pii:S2352-5568(18)30281-9. 11. Mefkur Bakana,, Tarik Umutoglua, Ufuk Topuza and al. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study.Rev Bras Anestesiol.2015;65(3):191-199 12. Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. British Journal of Surgery,2008,vol.95,no 11,p.1331-1338.

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Faculty Opinions recommendation of Dexamethasone for the prophylaxis of postoperative nausea and vomiting associated with neuraxial morphine administration: a systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13975959.15738058 ◽

2012 ◽

Author(s):

Carolyn Weiniger

Keyword(s):

Systematic Review ◽

Postoperative Nausea ◽

Meta Analysis ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Morphine Administration

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Faculty Opinions recommendation of The Effectiveness of Midazolam for Preventing Postoperative Nausea and Vomiting: A Systematic Review and Meta-Analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725891193.793519500 ◽

2016 ◽

Author(s):

Carolyn Weiniger

Keyword(s):

Systematic Review ◽

Postoperative Nausea ◽

Meta Analysis ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting

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Effects of Dexmedetomidine as an Analgesic Adjuvant for Surgery of Femur Fracture: A Systematic Review and Meta-Analysis

Pharmacology ◽

10.1159/000515788 ◽

2021 ◽

pp. 1-9

Author(s):

Shan Deng ◽

Yonghao Yu

Keyword(s):

Femur Fracture ◽

Meta Analysis ◽

Sensory Block ◽

Cochrane Library ◽

Rescue Analgesia ◽

Block Level ◽

Block Time ◽

Sedation Scores ◽

The Difference ◽

The Cochrane Library

Patients who undergo surgery of femur fracture suffer the excruciating pain. Dexmedetomidine (DEX) is a unique α2-adrenergic receptor agonist with sedative and analgesic properties, whose efficacy and safety are still unclear for surgery of femur fracture. Randomized controlled trials comparing the effects of addition of DEX to general or local anesthesia in surgery of femur fracture were searched from MEDLINE, EMBASE, and the Cochrane Library database. Patients who received DEX infusion had a significant longer time to rescue analgesia compared with those without DEX coadministration. DEX treatment seemed to reduce the visual analog score; however, the significance did not reach any statistical difference. DEX as an analgesic adjuvant did not reduce the onset of sensory block time, shorten the time to achieve maximum sensory block level, and provide a longer duration of sensory block. The difference in mean sedation scores between 2 groups was not statistically significant. As for adverse effects, DEX therapy significantly increased the rate of hypotension. In conclusion, dexmedetomidine as a local anesthetic adjuvant in femur fracture surgery had a longer duration of rescue analgesia. However, the incidence of hypotension was markedly increased in these patients. It was worth noting that the evidence was of low to moderate quality.

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The role of perioperative intravenous low-dose dexamethasone in rapid recovery after total knee arthroplasty: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060521998220 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199822

Author(s):

Youguang Zhuo ◽

Rongguo Yu ◽

Chunling Wu ◽

Yuting Huang ◽

Jie Ye ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Low Dose ◽

Meta Analysis ◽

Postoperative Nausea And Vomiting ◽

Opioid Consumption ◽

Cochrane Library ◽

China National Knowledge Infrastructure ◽

Postoperative Rehabilitation ◽

Total Knee

Purpose The purpose of this meta-analysis was to evaluate the overall safety and effectiveness of perioperative intravenous dexamethasone to facilitate postoperative rehabilitation in patients after total knee arthroplasty (TKA). Methods A comprehensive literature search was performed using the Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for relevant randomized controlled trials (RCTs) from inception to 2020. Methodological quality of the trials was assessed using the Cochrane Risk of Bias Tool, and the relevant data were extracted using a predefined data extraction form. Results Ten RCTs with 1100 knees were included. Our study showed a significant reduction in pain using a postoperative pain visual analog scale (VAS) at 24 hours and 48 hours, total opioid consumption at 24 hours and 48 hours, postoperative nausea and vomiting (PONV), active range of motion (ROM) limitation, and passive ROM limitation at 72 hours in dexamethasone-treated groups compared with controls. Conclusion Intravenous low-dose dexamethasone is potentially useful in the perioperative setting for reducing postsurgical immediate ROM limitations, pain, opioid consumption, and PONV. There are no data that directly attribute an increase in postoperative complications to intravenous dexamethasone. More high-quality studies are necessary to draw these conclusions.

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Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis

Journal of International Medical Research ◽

10.1177/0300060517703276 ◽

2017 ◽

Vol 45 (3) ◽

pp. 904-911 ◽

Cited By ~ 2

Author(s):

Min Zhu ◽

Chengmao Zhou ◽

Bing Huang ◽

Lin Ruan ◽

Rui Liang

Keyword(s):

Laparoscopic Surgery ◽

Postoperative Nausea ◽

Adverse Reactions ◽

Meta Analysis ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Cochrane Library ◽

Randomized Controlled ◽

Laparoscopy Surgery ◽

The Cochrane Library

Objective This study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery. Methods We searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI. Results In total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopy surgery. No significant differences in adverse reactions (dizziness and headache) were found in association with dexamethasone. Conclusion Granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopic surgery, with no difference in adverse reactions between the two groups. Granisetron alone or granisetron plus dexamethasone can be used to prevent PONV in patients undergoing laparoscopic surgery.

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