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

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/855 participants in dexamethasone group and 538 participants in placebo group for the incidence of POCD, and two studies/410 participants in dexamethasone group and 420 participants in placebo group 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 0.96; 95% CI [0.68, 1.35], P = 0.80, I2 = 0%). However, both analyses had some limitations since evidence remains limited and clinical heterogeneity, 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. Trials of alternative prevent strategies for POCD/POD, and a better understanding of the pathophysiology of those complex syndrome, are still needed to make progress of this field. Trial registration number: This study is registered with PROSPERO, 23 October 2018, number CRD42018114552.

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

10.21203/rs.2.362/v1 ◽

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.

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Effects of Dexamethasone on Post-Operative Cognitive Dysfunction and Delirium in Adults Following General Anaesthesia: A Meta-Analysis of Randomised Controlled Trials

10.21203/rs.2.362/v4 ◽

2019 ◽

Author(s):

Li-Qin Li ◽

Cong Wang ◽

Mei-Dan Fang ◽

Hong-Yu Xu ◽

Hong-Liu Lu ◽

...

Keyword(s):

Placebo Group ◽

General Anesthesia ◽

Cognitive Dysfunction ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Cochrane Central Register ◽

Dexamethasone Group ◽

Significant Difference

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/855 participants in dexamethasone group and 538 participants in placebo group for the incidence of POCD, and two studies/410 participants in dexamethasone group and 420 participants in placebo group 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 0.96; 95% CI [0.68, 1.35], P = 0.80, I2 = 0%). However, both analyses had some limitations since evidence remains limited and clinical heterogeneity, 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. Trials of alternative prevent strategies for POCD/POD, and a better understanding of the pathophysiology of those complex syndrome, are still needed to make progress of this field. Trial registration number: This study is registered with PROSPERO, 23 October 2018, number CRD42018114552.

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The Effects of Intravenous Dexmedetomidine Injections on IOP in General Anesthesia Intubation: A Meta-Analysis

BioMed Research International ◽

10.1155/2017/6186832 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Chengmao Zhou ◽

Yu Zhu ◽

Zhen Liu ◽

Lin Ruan

Keyword(s):

Placebo Group ◽

Intraocular Pressure ◽

Randomized Controlled Trials ◽

General Anesthesia ◽

Intravenous Injection ◽

Meta Analysis ◽

Controlled Trials ◽

Analysis Study ◽

Randomized Controlled ◽

Significant Difference

Objective. The aim of this meta-analysis is to evaluate the effects of dexmedetomidine on intraocular pressure (IOP) in patients with general anesthesia administered via intubation. Methods. We searched randomized controlled trials (RCT) on the effects of intravenous injection of dexmedetomidine on IOP in patients with general anesthesia administered via intubation. Results. The meta-analysis study showed that (1) a statistically significant difference [WMD = −3.40 mmHg, 95% CI (−4.76, −2.04), P<0.00001] was found between IOP of the two groups. (2) The IOP of the dexmedetomidine group that was administrated succinylcholine was lower than that of placebo group which was administrated succinylcholine [WMD = −4.13 mmHg, 95% CI (−6.01, −2.25), P<0.0001]. (3) Compared with the IOP of patients in the placebo group, patients with intubation in the dexmedetomidine group maintained a lower IOP [WMD = −3.10 mmHg, 95% CI (−5.12, −1.07), P=0.003]. However, for incidences of bradycardia, the use of dexmedetomidine was higher than that of the placebo [RR = 0.23, 95% CI (0.07, 0.76), P=0.02]. Conclusion. This meta-analysis showed that, in many cases, dexmedetomidine can lower the IOP of patients with general anesthesia administered by intubation.

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Electroacupuncture for the Prevention of Postoperative Cognitive Dysfunction Among Older Adults Undergoing Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Frontiers in Medicine ◽

10.3389/fmed.2021.778474 ◽

2022 ◽

Vol 8 ◽

Author(s):

Liang Ou ◽

Zhen Shen ◽

Tiantian Zhang ◽

Zehua Chen ◽

Lin Zhang ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Cognitive Dysfunction ◽

Knee Replacement ◽

Meta Analysis ◽

Postoperative Cognitive Dysfunction ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Tnf Α

Background: Postoperative cognitive dysfunction (POCD) is a common surgical complication in elderly patients undergoing hip and knee replacement. Electroacupuncture (EA) may have a protective effect on postoperative cognitive function, but relevant evidence remains uncertain.Objective: To systematically evaluate the evidence of EA for the prevention of POCD after total joint arthroplasty.Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, and Chinese Biomedical Literature Database (CBM) databases were searched until May 1, 2021. Randomized controlled trials (RCTs) in which patients undergoing hip and knee replacement pretreated with EA for preventing POCD were included. The risk of bias was assessed by the Cochrane Collaboration tool. Meta-analysis was performed using Review Manager version 5.4.Results: A total of 11 RCTs with 949 patients were identified. Meta-analysis showed that compared with controls, EA pretreatment significantly reduced the incidence of POCD at 1, 3, and 7 days and 3 and 6 months after the operation. EA was also superior in improving the Mini-Mental State Examination (MMSE) scores on the third postoperative day, but not on the first postoperative day. Neuron-specific enolase (NSE) and interleukin-1β (IL-1β) in the EA group were significantly lower than that in the control group. There was no difference in S100β between the EA group and the control group. Compared to the control group, tumor necrosis factor-α (TNF-α) levels were not significantly lower in the EA group at postoperative hour 0, while significantly decreased at postoperative hours 24 and 48.Conclusion: Our results suggest that EA pretreatment is an effective adjunctive therapy for reducing the incidence of POCD for patients receiving total joint replacement surgery. Its effect was embodied in improving the MMSE scores and NSE, IL-1β, and TNF-α levels, whereas it had no significant effect on S100β levels. Meanwhile, the benefits of EA for improving POCD need further strengthening and support from more large-scale, high-quality, and good-homogeneity RCTs.Systematic Review Registration:https://osf.io/xb3e8.

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Comprehensive Analysis of Success Rate, Complications, Cost and Quality of Life Of Totally Implantable Venous-Access Ports: A Systematic Review and Meta-Analysis of Malignancy Populations from 21 Randomized Controlled Trials

SSRN Electronic Journal ◽

10.2139/ssrn.3562484 ◽

2020 ◽

Author(s):

Linghong Guo ◽

Ting Liu ◽

Shuang Dai ◽

Wen Guo ◽

Ting Zhang ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Randomized Controlled Trials ◽

Success Rate ◽

Meta Analysis ◽

Venous Access ◽

Comprehensive Analysis ◽

Controlled Trials ◽

Randomized Controlled

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EXPRESS: The benefit of exercise-based rehabilitation programmes in patients with pulmonary hypertension: a systematic review and meta-analysis of randomized controlled trials

Pulmonary Circulation ◽

10.1177/20458940211007810 ◽

2021 ◽

pp. 204589402110078

Author(s):

Lu Yan ◽

Wence Shi ◽

Zhi-hong Liu ◽

Qin Luo ◽

Zhihui Zhao ◽

...

Keyword(s):

Quality Of Life ◽

Pulmonary Hypertension ◽

Randomized Controlled Trials ◽

Exercise Capacity ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

The Mean ◽

Quality Evidence

Background: Several studies have suggested that exercise capacity and quality of life are reduced in patients with pulmonary hypertension (PH), and exercise-based rehabilitation can improve exercise capacity and quality of life in patients with PH. The aim of this study is to assess the efficacy and safety of exercise-based rehabilitation in patients with PH through a meta-analysis of randomized controlled trials. Methods: We searched PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials up to November 2018. All randomized controlled trials (RCTs) comparing exercise capacity and quality of life between patients undergoing exercise-based rehabilitation and those undergoing non-exercise training were included. Data were extracted separately and independently by two investigators, and discrepancies were arbitrated by the third investigator. We used the random-effects model to analyze the results, the GRADE to assess the risk of bias in the included studies, and I Â² statistic to estimate the degree of heterogeneity. Results: Nine RCTs are included, however, only seven RCTs were able to extract data. Including inpatients and outpatients, the total number of participants was 234, most of whom were diagnosed as pulmonary artery hypertension (PAH). The study duration ranged from 3 to15 weeks. The mean six-minute walk distance after exercise training was 51.94 metres higher than control (27.65 to 76.23 metres, n=234, 7 RCTs, low quality evidence), the mean peakÂ oxygen uptakeÂ Â was 2.96 ml/kg/minute higher (2.49 to 3.43 ml/kg/minute, n=179, 4 RCTs, low-quality evidence) than in the control groupÂ . Concluded: Our finding suggest that an exercise-based training program positively influences exercise capacity in patients with PH.

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Sa1143 Enhanced Instructions Improve the Quality of Bowel Preparation for Colonoscopy: A Meta-Analysis of Randomized Controlled Trials

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.03.308 ◽

2016 ◽

Vol 83 (5) ◽

pp. AB229

Author(s):

Xiaoyang Guo ◽

Zhiping Yang ◽

Hui Jia ◽

Yanglin Pan ◽

Xuegang Guo

Keyword(s):

Randomized Controlled Trials ◽

Bowel Preparation ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled

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Technology-Based Interventions in Oral Anticoagulation Management: Meta-Analysis of Randomized Controlled Trials (Preprint)

10.2196/preprints.18386 ◽

2020 ◽

Author(s):

Caiyun Zheng ◽

Hengfen Dai ◽

Chun Lin ◽

Yan Zhang ◽

Hong Zhang ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Oral Anticoagulation ◽

Meta Analysis ◽

Controlled Trials ◽

Minor Bleeding ◽

Bleeding Events ◽

Anticoagulation Management ◽

Randomized Controlled ◽

Clinical Benefits

BACKGROUND An increasing number of patients have received prophylactic or therapeutic oral anticoagulants (OACs) for thromboembolic complications of diseases. The use of OACs is associated with both clinical benefits and risks. Considering the challenges imposed by this class of drugs, as well as the enormous progress made in portable device technology, it is possible that technology-based interventions may improve clinical benefits for patients and optimize anticoagulation management. OBJECTIVE This study was designed to comprehensively evaluate the role of technology-based interventions in the management of OACs. METHODS We searched 6 databases—PubMed, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO—to retrieve relevant studies published as of November 1, 2019, to evaluate the effect of technology-based interventions on oral anticoagulation management. RevMan (version 5.3; Cochrane) software was used to evaluate and analyze clinical outcomes. The methodological quality of studies was assessed by the Cochrane risk of bias tool. RESULTS A total of 15 randomized controlled trials (RCTs) were selected for analysis. They reported data for 2218 patients (1110 patients in the intervention groups and 1108 patients in the control groups). A meta-analysis was performed on the effectiveness and safety data reported in the RCTs. Technology-based interventions significantly improved the effectiveness of oral anticoagulation management (mean difference [MD]=6.07; 95% CI 0.84-11.30; I2=72%; P=.02). The safety of oral anticoagulation management was also improved, but the results were not statistically significant. Bleeding events were reduced (major bleeding events MD=1.02; 95% CI 0.78-1.32; I2=0%; P=.90; minor bleeding events MD=1.06, 95% CI 0.77-1.44; I2=41%; P=.73) and thromboembolism events were reduced (MD=0.71; 95% CI 0.49-1.01; I2=0%; P=.06). In general, patients were more satisfied with technology-based interventions, which could also improve their knowledge of anticoagulation management, improve their quality of life, and reduce mortality and hospitalization events. CONCLUSIONS Using technology to manage OACs can improve the effectiveness and safety of oral anticoagulation management, result in higher patient satisfaction, and allow greater understanding of anticoagulation.

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