scholarly journals Influences of remote ischemic preconditioning on postoperative delirium and cognitive dysfunction in adults after cardiac surgery: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Yuchen Jing ◽  
Bai Gao ◽  
Xi Li
Keyword(s):  
Cardiac Surgery ◽  
Randomized Controlled Trials ◽  
Cognitive Dysfunction ◽  
Ischemic Preconditioning ◽  
Postoperative Delirium ◽  
Meta Analysis ◽  
Remote Ischemic Preconditioning ◽  
Current Evidence ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background Remote ischemic preconditioning (RIPC) has been suggested to confer neuroprotective effect. However, influences of RIPC on postoperative delirium (POD) and cognitive dysfunction (POCD) in adults after cardiac surgery are less known. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of RIPC on POD and POCD. Methods Relevant studies were obtained by search of PubMed, Embase, and Cochrane’s Library databases. A random-effect model was used to pool the results. Results Ten RCTs including 2303 adults who received cardiac surgery were included. Pooled results showed that RIPC did not significantly affect the incidence of POD (six RCTs, odds ratio [OR] 1.07, 95% confidence interval [CI] 0.81 to 1.40, P = 0.65) with no significant heterogeneity (I2 = 0%). In addition, combined results showed that RIPC did not significantly reduce the incidence of POCD either (six RCTs, OR 0.64, 95% CI 0.37 to 1.11, P = 0.11) with moderate heterogeneity (I2 = 44%). Sensitivity analysis by excluding one RCT at a time showed consistent results (P values all > 0.05). Conclusions Current evidence from RCTs did not support that RIPC could prevent the incidence of POD or POCD in adults after cardiac surgery. Although these findings may be validated in large-scale RCTs, particularly for the results of POCD, based on these findings, RIPC should not be routinely used as a preventative measure for POD and POCD in adult patients after cardiac surgery.

Strategies to Prevent Acute Kidney Injury after Pediatric Cardiac Surgery

2021 ◽  
Vol 16 (10) ◽  
pp. 1480-1490
Author(s):  
Jef Van den Eynde ◽  
Nicolas Cloet ◽  
Robin Van Lerberghe ◽  
Michel Pompeu B.O. Sá ◽  
Dirk Vlasselaers ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Randomized Controlled Trials ◽  
Ischemic Preconditioning ◽  
Relative Risk Reduction ◽  
Meta Analysis ◽  
Pediatric Cardiac Surgery ◽  
Remote Ischemic Preconditioning ◽  
Controlled Trials ◽  
Content Type ◽  
Randomized Controlled

Background and objectivesAKI is a common complication after pediatric cardiac surgery and has been associated with higher morbidity and mortality. We aimed to compare the efficacy of available pharmacologic and nonpharmacologic strategies to prevent AKI after pediatric cardiac surgery.Design, setting, participants, & measurementsPubMed/MEDLINE, Embase, Cochrane Controlled Trials Register, and reference lists of relevant articles were searched for randomized controlled trials from inception until August 2020. Random effects traditional pairwise, Bayesian network meta-analyses, and trial sequential analyses were performed.ResultsTwenty randomized controlled trials including 2339 patients and 11 preventive strategies met the eligibility criteria. No overall significant differences were observed compared with control for corticosteroids, fenoldopam, hydroxyethyl starch, or remote ischemic preconditioning in traditional pairwise meta-analysis. In contrast, trial sequential analysis suggested a 80% relative risk reduction with dexmedetomidine and evidence of <57% relative risk reduction with remote ischemic preconditioning. Nonetheless, the network meta-analysis was unable to demonstrate any significant differences among the examined treatments, including also acetaminophen, aminophylline, levosimendan, milrinone, and normothermic cardiopulmonary bypass. Surface under the cumulative ranking curve probabilities showed that milrinone (76%) was most likely to result in the lowest risk of AKI, followed by dexmedetomidine (70%), levosimendan (70%), aminophylline (59%), normothermic cardiopulmonary bypass (57%), and remote ischemic preconditioning (55%), although all showing important overlap.ConclusionsCurrent evidence from randomized controlled trials does not support the efficacy of most strategies to prevent AKI in the pediatric population, apart from limited evidence for dexmedetomidine and remote ischemic preconditioning.

scholarly journals Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Zigang Liu ◽  
Yongmei Zhao ◽  
Ming Lei ◽  
Guancong Zhao ◽  
Dongcheng Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Randomized Controlled Trials ◽  
Ischemic Preconditioning ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Subgroup Analyses ◽  
Meta Regression

Objective: Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery.Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity.Results: Twenty-two RCTs with 5,389 patients who received cardiac surgery −2,702 patients in the RIPC group and 2,687 patients in the control group—were included. Moderate heterogeneity was detected (p for Cochrane's Q test = 0.03, I2 = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61–0.94, p = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64–0.95, p = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63–0.97, p = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60–0.96, p = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50–1.07, p = 0.11).Conclusions: Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.

scholarly journals Dexmedetomidine reduces the incidence of postoperative delirium after cardiac surgery: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Peng Li ◽  
Lu-xi Li ◽  
Zhen-zhen Zhao ◽  
Jian Xie ◽  
Cheng-long Zhu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Randomized Controlled Trials ◽  
Postoperative Delirium ◽  
Meta Analysis ◽  
Adult Population ◽  
The Elderly ◽  
Adult Patients ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background The role of dexmedetomidine in preventing postoperative delirium (POD) after cardiac surgery remains controversial because of several recent trials with negative results. We aimed to perform an updated meta-analysis of randomized controlled trials (RCTs) to clarify this controversy. Methods RCTs investigating the perioperative administration of dexmedetomidine in cardiac surgery were retrieved from PubMed, Web of Science, and the Cochrane library until August,27,2020. Two researchers independently screened the literature, collected the data and evaluated the bias risk of the included studies. The meta-analysis was performed with the RevMan 5.3. Results A total of 15 studies including 2813 patients were included in the study. A pooled result showed that dexmedetomidine could reduce the risk of POD in adult population underwent cardiac surgery (OR 0.56, 95%CI 0.36–0.89, P = 0.0004, I2 = 64%). The subgroup analysis demonstrated that the protective effect of dexmedetomidine was only present in the patients injected with dexmedetomidine after surgery but not from the start of surgery, in the adult patients without specific age limitation but not in the elderly, and in the studies in comparison with other sedatives but not with placebo. There were no statistical differences when analyzing the secondary outcomes including hypotension (OR 1.13; 95% CI 0.54–2.37, P < 0.00001, I2 = 85%), bradycardia (OR 1.72; 95% CI 0.84–3.53, P = 0.04, I2 = 58%) and atrial fibrillation (OR 0.87; 95% CI 0.70–1.08, P = 0.43, I2 = 0). Conclusions Dexmedetomidine can reduce the incidence of POD compared to other sedatives and opioids after cardiac surgery in adult patients. The proper population and timing for perioperative use of dexmedetomidine after cardiac surgery remain to be further investigated.

Acupuncture for post-operative cognitive dysfunction: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
pp. 096452842096139
Author(s):  
Yidan Tang ◽  
Tao Wang ◽  
Lei Yang ◽  
Xuemei Zou ◽  
Jianxiong Zhou ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Cognitive Dysfunction ◽  
Surgical Complication ◽  
Meta Analysis ◽  
Acupuncture Group ◽  
Current Evidence ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Post Operative Nausea

Objective: Post-operative cognitive dysfunction (POCD) is a common post-surgical complication, which is associated with increased costs and extended hospital stays. Recently, interest in acupuncture as a potential therapy for POCD has grown. The objective of this meta-analysis was to assess the effectiveness of acupuncture for POCD. Methods: PubMed, Embase, CENTRAL, Medline, Web of Science, CNKI, Wanfang, and VIP databases were searched through March 2018. Randomized controlled trials (RCTs) in which patients with POCD treated with acupuncture (acupuncture group) were compared with those receiving a no treatment control were included. Meta-analyses were conducted using Review Manager 5.3. Results: Sixteen studies containing 1241 participants were included. POCD incidence in the acupuncture group was significantly lower than that in the control groups on the first (odds ratio (OR) = 0.32, 95% confidence interval (CI) = 0.23–0.45) and third (OR = 0.41, 95% CI = 0.30–0.56) post-operative days, with no statistically significant difference on the seventh day (OR = 0.58, 95% CI = 0.32–1.04). Acupuncture therapy also improved mini–mental state examination (MMSE) scores on the first (mean difference (MD) = 3.28, 95% CI = 2.79–3.77) and third (MD = 2.52, 95% CI = 2.18–2.87) post-operative days, with no effect on the seventh (MD = 0.14, 95% CI = –0.24 to 0.51). Visual analogue scale (VAS) scores on the first post-operative day were not impacted by acupuncture but were likely associated with post-operative nausea and vomiting on the seventh post-operative day. With respect to methodological quality, most RCTs were found to have an unclear risk of bias. Conclusion: Acupuncture may successfully treat/prevent POCD. However, the current evidence is limited and further research is needed.

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