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

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.

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The Effect of Intraoperative Dexmedetomidine on Cognitive Dysfunction After Surgery: A Updated Meta-Analysis

10.21203/rs.3.rs-285627/v1 ◽

2021 ◽

Author(s):

Qifan Yin ◽

Jianli Li ◽

Xuejiao Xun ◽

Jinhua He ◽

Dongdong Yu ◽

...

Keyword(s):

Cognitive Dysfunction ◽

Mmse Score ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

General Anaesthetic ◽

Neuroprotective Effects ◽

Systematic Analysis ◽

Dichotomous Data ◽

The Cochrane Library

Abstract BackgroundPostoperative 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.MethodFour 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.ResultsIn 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. ConclusionsIntraoperative 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.

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

Journal of International Medical Research ◽

10.1177/0300060516671623 ◽

2016 ◽

Vol 44 (6) ◽

pp. 1182-1190 ◽

Cited By ~ 19

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.

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EXPRESS: Stroke risk following traumatic brain injury: systematic review and meta-analysis

International Journal of Stroke ◽

10.1177/17474930211004277 ◽

2021 ◽

pp. 174749302110042

Author(s):

Grace Mary Turner ◽

Christel McMullan ◽

Olalekan Lee Aiyegbusi ◽

Danai Bem ◽

Tom Marshall ◽

...

Keyword(s):

Systematic Review ◽

Stroke Risk ◽

Meta Analysis ◽

Vitamin K Antagonists ◽

Cochrane Library ◽

Control Group ◽

Large Sample Size ◽

Hazard Ratios ◽

Increased Risk ◽

The Cochrane Library

Aims To investigate the association between TBI and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4th December 2020. We used random-effects meta-analysis to pool hazard ratios (HR) for studies which reported stroke risk post-TBI compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-TBI control group, all found TBI patients had significantly increased risk of stroke compared to controls (pooled HR 1.86; 95% CI 1.46-2.37). Findings suggest stroke risk may be highest in the first four months post-TBI, but remains significant up to five years post-TBI. TBI appears to be associated with increased stroke risk regardless of severity or subtype of TBI. There was some evidence to suggest an association between reduced stroke risk post-TBI and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants. Conclusion TBI is an independent risk factor for stroke, regardless of TBI severity or type. Post-TBI review and management of risk factors for stroke may be warranted.

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Association between serum visfatin levels and psoriasis and their correlation with disease severity: a meta-analysis

Journal of International Medical Research ◽

10.1177/03000605211002381 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052110023

Author(s):

Qian Zou ◽

Jiawei Si ◽

Yatao Guo ◽

Jiayu Yu ◽

Huijuan Shi

Keyword(s):

Body Mass Index ◽

Meta Analysis ◽

Severity Index ◽

Cochrane Library ◽

Control Group ◽

Inclusion Criteria ◽

Subgroup Analyses ◽

Mean Differences ◽

The Cochrane Library ◽

Psoriasis Severity

Objective To determine the association between serum visfatin levels and psoriasis and to evaluate the correlation between serum visfatin levels and the severity of psoriasis. Methods The electronic databases PubMed®, Embase® and the Cochrane Library were searched for articles published from inception to 1 May 2020. Data were extracted and then standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for pooled estimates. Results A total of 11 studies met the inclusion criteria and were included (448 patients diagnosed with psoriasis and 377 controls). This meta-analysis demonstrated that patients with psoriasis had significantly higher levels of visfatin than the controls (SMD = 0.90, 95% CI 0.52, 1.28). Subgroup analyses showed that differences in serum visfatin levels between the patient group and the control group were associated with ethnicity, Psoriasis Area and Severity Index (PASI) and body mass index. Additionally, a meta-analysis of correlations showed that visfatin levels in patients with psoriasis were positively correlated with PASI ( r = 0.51, 95% CI 0.14, 0.75). Conclusions This meta-analysis showed that serum visfatin levels in patients with psoriasis were significantly higher than those in the controls and a positive correlation between serum visfatin levels and psoriasis severity was observed.

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Intravenous dexmedetomidine during spinal anaesthesia for caesarean section: A meta-analysis of randomized trials

Journal of International Medical Research ◽

10.1177/0300060517708945 ◽

2017 ◽

Vol 45 (3) ◽

pp. 924-932 ◽

Cited By ~ 2

Author(s):

Zeqing Bao ◽

Chengmao Zhou ◽

Xianxue Wang ◽

Yu Zhu

Keyword(s):

Caesarean Section ◽

Spinal Anaesthesia ◽

Randomized Trials ◽

Meta Analysis ◽

Relevant Literature ◽

Nausea And Vomiting ◽

Cochrane Library ◽

Control Group ◽

Efficacy And Safety ◽

The Cochrane Library

Objective To evaluate the efficacy and safety of spinal anaesthesia using dexmedetomidine for caesarean section. Methods PubMed, The Cochrane Library, and CNKI were searched for relevant literature. Results The incidence of nausea and vomiting in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.21, 95% CI: 0.12–0.35, P < 0.00001). No difference was found in the incidence of pruritus between the two groups (OR = 1.21, 95% CI: 0.36–4.09, P = 0.76).The dexmedetomidine group had a higher incidence of bradycardia than did the control group (OR = 2.20, 95% CI: 1.02–4.77, P = 0.05). The incidence of shivering in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.20, 95% CI: 0.13–0.32, P < 0.00001). The incidence of hypotension was not different between the two groups (OR = 0.88, 95% CI: 0.49–1.56, P = 0.65). Conclusion Dexmedetomidine can decrease the incidence of nausea, vomiting, bradycardia, and shivering with spinal anaesthesia during caesarean section.

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

Systematic Reviews ◽

10.1186/s13643-021-01610-y ◽

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

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Impact of Ketamine on Pain Management in Cesarean Section: A Systematic Review and Meta-Analysis

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/135 ◽

2020 ◽

Vol 2;23 (4;2) ◽

pp. 135-148

Author(s):

Zifeng Xu

Keyword(s):

Cesarean Section ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Control Effect ◽

Randomized Controlled ◽

Time Required ◽

The Cochrane Library

Background: The pain control effect of ketamine versus control in women during cesarean operation is not well determined. Objectives: The present meta-analysis aimed to evaluate the clinical efficacy of ketamine versus control in cesarean section anesthesia for reducing the postoperative pain and analgesia. Study Design: We used meta-analysis to address this concern. Setting: Meta-analysis-based study. Methods: The databases PubMed, Embase, and the Cochrane Library were systematically searched to identify the relevant randomized controlled trials (RCTs) of ketamine versus control in controlling pain after cesarean section from inception to August 2018. Based on the Cochrane Handbook, the combined analysis was performed using Revman 5.3 software. Results: A total of 20 RCTs with 1,737 patients who underwent cesarean section were included. Meta-analysis showed that the pain score in the ketamine group was less than that of the control group (mean difference [MD], –1.10; 95% confidence interval [CI], –1.61, –0.59; P < 0.0001). Application of ketamine during cesarean section also resulted in decreased consumption of morphine when compared with the control group (MD, –6.11 mg; 95% CI, –9.93, –2.29; P = 0.002). In addition, the first time required for analgesia was significantly longer in the ketamine group than that of the control group (MD, 72.48 minutes; 95% CI, 50.85, 94.11; P < 0.00001). Limitations: Limited patients were included with moderate strength. Conclusions: Ketamine supplementation during cesarean section reduces pain and morphine consumption and prolongs the postoperative analgesia. Key words: Ketamine, cesarean section, randomized controlled trials, meta-analysis

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A Meta-Analysis of Au/Polypropionic Acid Nanoparticles Loaded with Olacetam for the Treatment of Vascular Cognitive Impairment

Journal of Nanoscience and Nanotechnology ◽

10.1166/jnn.2020.18863 ◽

2020 ◽

Vol 20 (12) ◽

pp. 7433-7438

Author(s):

Zhen Yi ◽

Weiheng Liang ◽

Wenwen Ruan ◽

Wei Hua ◽

Xinjing Lin

Keyword(s):

Cognitive Dysfunction ◽

Meta Analysis ◽

Vascular Cognitive Impairment ◽

Effective Rate ◽

Positive Control ◽

Cochrane Library ◽

Control Group ◽

Placebo Control ◽

Checklist Score ◽

Group A

To systematically evaluate the efficacy and safety of oxetam in the treatment of vascular cognitive dysfunction and the feasibility of an Au/polypropionic acid Nanometer drug delivery system to provide evidence for clinical application. PubMed, Shanghai embase, Cochrane Library, CNKI, VIP information, and Wanfang database were searched from the establishment of the database to April 2018. Patients were divided into two groups according to whether they received olacetam: the experimental group and the control group. In addition, the control group was divided into the placebo control group and the positive control group according to whether the control group received a placebo or other medication treatment controls. In the control group, a meta-analysis, a publication bias assessment, and sensitivity analysis were performed with Revman 5.3 and Stata 14.0. The results of the meta-analysis showed that compared with placebo and other medications, oxiracetam significantly improved the mental status of patients, Concise Mental State Checklist score [mean difference (MD)= 5.29, P < 0.01] and Montreal Cognitive Assessment score (MD = 4.32, P < 0.01). The Barthel Index demonstrated that oxiracetam significantly improved the quality of the daily life of patients (MD = 18, P < 0.01), but there was no difference between olacetam and placebo or other medications in the rating of activities of daily living (ADLs). The total effective rate of olacetam was significantly higher than that of other treatments (P < 0.01). Compared with placebo and other medications, the safety of oxiracetam was not significantly different (P > 0.05). Based on the current clinical evidence, olacetam is more effective and safer than alternatives in the treatment of vascular cognitive dysfunction.

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The Effect of 5-Hydroxytryptamine Receptor Antagonist in Preventing Pain/Limb Shrinkage Reaction Associated with Rocuronium Injection

BioMed Research International ◽

10.1155/2018/4128415 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Qixiong He ◽

Chengmao Zhou ◽

Yu Zhu

Keyword(s):

Receptor Antagonist ◽

Incidence Rate ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Lidocaine Group ◽

Total Pain ◽

Group 5 ◽

The Cochrane Library ◽

Random Control

Objectives. To evaluate the effect and safety of 5-hydroxytryptamine (5-HT) receptor antagonist in alleviating the pain of patients under general anesthesia induced by rocuronium injection and preemptive analgesia. Methods. Meta-analysis was conducted with RevMan 5.1 software by electronically retrieving the databases of PubMed, Embase, the Cochrane Library, WanFang Data, and CNKI and collecting the published random control tests (RCTs) where 5-hydroxytryptamine receptor antagonist was used to alleviate the pain/limb shrinkage reaction associated with rocuronium injection. Results. Seven RTCs, including 556 patients, were included. The results of meta-analysis showed the following. (1) Compared to the control group, 5-HT receptor antagonist could prevent the total pain/limb shrinkage reaction associated with rocuronium injection [RR=0.62, 95% CI (0.54, 0.71), P<0.00001] and reduce the incidence rate of mild and moderate pain/limb shrinkage reaction associated with rocuronium injection [RR=0.46, 95% CI (0.33, 0.63), P<0.00001; RR=0.18, 95% CI (0.11, 0.31), P<0.000 01]. (2) Compared to the lidocaine group, the incidence rate was higher in preventing the pain/limb shrinkage reaction associated with rocuronium injection by 5-HT receptor antagonist, which was statistically significant [RR=1.33, 95% CI (1.05, 1.68), P=0.02]. Conclusion. 5-hydroxytryptamine receptor antagonist may be effective in preventing the pain/limb shrinkage reaction associated with rocuronium injection.

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Effectiveness of Lomustine Combined With Bevacizumab in Glioblastoma: A Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2020.603947 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xing Ren ◽

Di Ai ◽

Tong Li ◽

Lei Xia ◽

Lingzhi Sun

Keyword(s):

Clinical Trials ◽

Meta Analysis ◽

Treatment Options ◽

Progression Free Survival ◽

Cochrane Library ◽

Control Group ◽

Subgroup Analyses ◽

Group A ◽

Group 2 ◽

The Cochrane Library

Introduction: Despite surgical and chemotherapeutical treatment options, the prognosis for glioblastoma (GBM) remains poor. Some studies have found that using lomustine plus bevacizumab to treat GBM can prolong overall survival (OS) and progression-free survival (PFS). The aim of this study was to explore the efficacy of the two drugs in combination treatment of GBM using a meta-analysis of the existing literature to help settle the ongoing debate.Materials and Methods: PubMed, EMBASE, and the Cochrane Library were searched for the effectiveness of lomustine plus bevacizumab in GBM literature, updated on June 6, 2020. The main outcomes analyzed included PFS and OS; the effects of this drug combination on the 6-month PFS, which represents the percentage of patients who had PFS for 6 months, were also analyzed. All the data were pooled: OS and PFS with the mean difference (MD) and 6-month PFS with the risk ratio (RR). Because there were different control groups and dose groups, two subgroup analyses were run to ensure they were comparable. All statistical analyses were performed using the Review Manager Version 5.3 software.Results: Six clinical trials were identified which included 1,095 patients (treatment group: 516; control group: 579). The group treated with lomustine and bevacizumab showed an improvement in OS (MD =1.37; 95% CI, 0.49–2.25; p = 0.002), PFS (MD = 0.23; 95% CI, 0.13–0.34; p < 0.00001), and 6-month PFS (RR = 2.29; 95% CI, 1.43–3.65; p = 0.0005). Two subgroup analyses of the main outcome, OS, show that the results of Control group A (p = 0.01) and Dose group 2 (p = 0.003) are significantly different from those of the other control or dose groups.Conclusion: This study shows that lomustine and bevacizumab can effectively increase OS, PFS, and 6-month PFS in patients with GBM. The encouraging results of the lomustine and bevacizumab combination therapy for GBM should be studied in more clinical trials in the future.

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