Vasopressors for managing maternal hypotension during cesarean section under spinal anesthesia: A systematic review and network meta-analysis

2020 ◽  
Keyword(s):  
Systematic Review ◽  
Angiotensin Ii ◽  
Cesarean Section ◽  
Continuous Infusion ◽  
Spinal Anesthesia ◽  
Meta Analysis ◽  
Elective Cesarean Section ◽  
Control Group ◽  
Randomized Controlled Studies ◽  
Fetal Acidosis

Introduction: Spinal anesthesia during elective cesarean section often induces maternal hypotension, and vasopressors are the most reliable agents to counteract this. We conducted a systematic review and network meta-analysis to compare and specifically evaluate the efficacy of vasopressors in preventing maternal hypotension (effectiveness) and decreasing fetal acidosis (safety) in parturients undergoing spinal anesthesia for cesarean section. Methods: We performed a systematic and comprehensive search to identify all randomized controlled studies on vasopressors to manage maternal hypotension during cesarean section under spinal anesthesia, which had been published until June 30, 2019 and updated until September 20, 2020. A network meta-analysis was conducted to combine direct and indirect comparisons of vasopressors. The primary outcomes included minimum systolic blood pressure, the incidence of hypotension, and fetal acidosis. Stata SE 15.0 was used for the meta-analysis. Results: Forty-five studies (n = 3,369) with six different vasopressors injected using various methods were included. Based on the surface under the cumulative ranking curve (SUCRA) value, intravenous (IV) continuous infusion of mephentermine (SUCRA value 83.4%) was the most efficacious vasopressor with the lowest incidence of hypotension, followed by continuous infusion of ephedrine with norepinephrine bolus (81.6%) and norepinephrine (76.4%). Compared with an IV bolus injection, all analyzed vasopressors were more effective when they were infused continuously for managing maternal hypotension. In terms of safety, only angiotensin II as an IV continuous infusion (94.7%) was efficacious in preventing fetal acidosis, resulting in a pH closer to 7.4, and there were no significant differences in umbilical arterial pH between the test and control groups. Conclusion: Clinicians should continuously infuse vasopressors to manage maternal hypotension during cesarean section under spinal anesthesia. According to SUCRA, norepinephrine administered as an IV continuous infusion was the third most efficacious vasopressor with the lowest incidence of maternal hypotension, and it could be a potential alternative to phenylephrine. Meanwhile, only angiotensin II administered as an IV continuous infusion caused less umbilical arterial acidosis than the control group.

scholarly journals Dose-Response Relationship between Endurance Training Prescription Variables and Increases in Aerobic Performance of Healthy and Unhealthy Middle and Very Old Individuals Aged 70 Years and Older: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Life ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 121
Author(s):  
Sarah Cheour ◽  
Chouaib Cheour ◽  
Nicola Luigi Bragazzi ◽  
Liye Zou ◽  
Armin H. Paravlic ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Endurance Training ◽  
Dose Response ◽  
Meta Analysis ◽  
Aerobic Performance ◽  
Control Group ◽  
Very Old ◽  
Randomized Controlled ◽  
Randomized Controlled Studies

Background: The objectives of this systematic review and meta-analysis were to quantify the effectiveness of endurance training (ET) on aerobic performance (i.e., peak oxygen uptake (VO2peak)) in healthy and unhealthy middle and very old adults aged 70 years and older, and to provide dose–response relationships of training prescription variables (in terms of frequency, and volume). Methods: Several scholarly databases (i.e., PubMed/MEDLINE, SpringerLink, ScienceDirect Journals, and Taylor & Francis Online—Journals) were searched, identifying randomized controlled studies that investigated the effectiveness of ET on VO2peak in older adults. Standardized mean differences (SMD) were calculated. Results: In terms of changes differences between experimental and control group, ET produced significant large effects on VO2peak performance (SMD = 2.64 (95%CI 0.97–4.31)). The moderator analysis revealed that “health status” variable moderated ET effect onVO2peak performance. More specifically, ET produced larger SMD magnitudes on VO2peak performance in healthy compared with unhealthy individuals. With regard to the dose–response relationships, findings from the meta-regression showed that none of the included training prescription variables predicted ET effects on VO2peak performance. Conclusions: ET is an effective mean for improving aerobic performance in healthy older adults when compared with their unhealthy counterparts.

scholarly journals Convalescent Plasma Therapy in Severe and Critically Ill COVID-19 Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Penglei Yang ◽  
Jing Wang ◽  
Ruiqiang Zheng ◽  
Rui Tan ◽  
Xianghui Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Virus Disease ◽  
Therapy Group ◽  
Meta Analysis ◽  
Control Group ◽  
Plasma Therapy ◽  
Risk Of Death ◽  
Randomized Controlled ◽  
Randomized Controlled Studies

Abstract Background: Convalescent plasma treatment of severe and critically ill Corona Virus Disease 2019(COVID-19) patients is still controversial.Objective: To evaluate the efficacy and safety of convalescent plasma in patients with severe COVID-19 infection and critically ill patients, We performed a meta-analysis and systematic review of convalescent plasma therapy in severe and critically ill COVID-19 patients.Methods: We conducted a literature search in electronic data and citations of previously published systematic reviews. We included only randomized controlled studies on convalescent plasma for the treatment of severe and critically ill COVID-19 patients. Results: A total of 7 randomized controlled trials and 1363 patients were included in the meta-analysis. Compared to patients of the control group, there was no difference in clinical improvement (Four studies, RR 1.06, 95% CI 0.96 to 1.17, p = 0.22, moderate certainty) and mortality (seven studies, RR 0.86, 95% CI 0.66 to 1.11, p = 0.48, moderate certainty) for patients of convalescent plasma therapy group.Conclusion: Convalescent plasma does not reduce the improvement of symptoms and the risk of death in severely infected and critically ill COVID-19 patients

scholarly journals Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia

2018 ◽  
Vol 1 (2) ◽  
pp. 70-74
Author(s):  
Rohini Sigdel ◽  
Maya Lama ◽  
Sanish Gurung ◽  
Bishal Gurung ◽  
Anil Prasad Neupane ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Elective Cesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Operating Table ◽  
Hemodynamic Effects ◽  
Elective Cesarean ◽  
Spinal Hypotension ◽  
The Right

Background: Several methods have been used to prevent post spinal hypotension including preloading, co-loading, use of vasopressors, placement of pelvic wedge, lumbar wedge and tilting of operating table in parturients undergoing cesarean section. We conducted a randomized controlled study to determine the hemodynamic effects of a standard pelvic wedge placed below the right hip immediately after the spinal block till the delivery of baby. Methods: One hundred consenting women undergoing elective cesarean section under spinal anesthesia were randomly allocated to wedge group (N=50) and control group (N=50). A standard wedge was placed under the right pelvis soon after spinal anesthesia till the delivery of baby in wedge group whereas the control group remained supine. Hemodynamic parameters including blood pressure, heart rate, vasopressor consumption, other side effects like nausea, vomiting and neonatal outcome were also recorded. Results: The incidence of hypotension and bradycardia was similar between groups (Wedge group 60% vs Control group 75.51%, p=0.125) before the birth of baby. The use of vasopressors (p=0.212), incidence of nausea (p=0.346) and Apgar score at 1 and 5 minutes (p=0.629, p=0.442) were also not statistically significant. None of the patients had vomiting. Conclusion: In our study, the use of right pelvic wedge immediately after spinal anesthesia was not effective in preventing post spinal hypotension in elective cesarean section.

Low Complication Rate Associated with Cesarean Section under Spinal Anesthesia for HIV-1–Infected Women on Antiretroviral Therapy

2002 ◽  
Vol 97 (2) ◽  
pp. 320-324 ◽  
Author(s):  
Michael S. Avidan ◽  
Philippa Groves ◽  
Margaret Blott ◽  
Jan Welch ◽  
Theresa Leung ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Postoperative Complications ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Elective Cesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Elective Cesarean ◽  
Hiv 1

Background Elective cesarean section decreases the likelihood of vertical human immunodeficiency virus (HIV) transmission from mother to infant. This study aimed to determine whether cesarean section done with spinal anesthesia on HIV-1-infected pregnant women taking antiretroviral therapy is associated with intraoperative hemodynamic instability, postoperative complications, or changes in immune function or HIV-1 viral load. Methods A case-controlled study was conducted over a 3-year period in a London academic hospital. Forty-four women infected with HIV-1 and a control group of 45 HIV-negative women undergoing cesarean sections were included. The main outcome measures included intraoperative blood pressure, heart rate, blood loss, and ephedrine requirements, and postoperative infective complications, blood transfusion, changes in blood HIV-1 viral load and lymphocyte subsets, and time to hospital discharge. Results There were no differences in hemodynamic stability and postoperative complications between the HIV-infected group and the controls. There was an acute postoperative increase in the CD4T lymphocyte count (P = 0.01), but the CD4T:CD8T ratio and viral load did not change. Conclusions Elective cesarean section under spinal anesthesia for women infected with HIV-1 taking antiretroviral therapy was not associated with intraoperative or postoperative complications.

Sildenafil for idiopathic pulmonary fibrosis: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Tyler Pitre ◽  
Muhammad Faran Khalid ◽  
Sonya Cui ◽  
Melanie C. Zhang ◽  
Renata Husnudinov ◽  
...  
Keyword(s):  
Systematic Review ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Meta Analysis ◽  
Rate Of Change ◽  
Point Estimate ◽  
Control Group ◽  
Randomized Controlled Studies ◽  
Significant Difference ◽  
Acute Exacerbations

Abstract Background: Patients with idiopathic pulmonary fibrosis have a poor overall prognosis and there are few evidence based drug therapies that reduce mortality. Objective: This systematic review and meta-analysis aims to assess whether sildenafil reduces mortality, reduces disease progression and the adverse side effects associated with it. Methods: In this review, randomized controlled studies (RCTs) were retrieved from MEDLINE, Cochrane, and EMBASE. The primary outcome was mortality. The secondary outcomes included change in FVC, acute exacerbations and hospitalizations and adverse drug effects leading to discontinuation. We used an inverse variance random effects meta-analysis method to calculate pooled odds ratio (OR) and standardized mean difference (SMD). Results: A total of 4 studies were included. Sildenafil probably reduces mortality when compared to placebo or to standard care, [OR 0.63 (0.38,1.03), I2=0%]. Pooled results showed sildenafil does not alter the rate of change of FVC [SMD 0.02 (-0.14,0.18)], or DLCO [SMR -0.01 (-0.18,0.17)], I2=0]. Pooled results showed sildenafil may not reduce the number of hospitalizations or acute exacerbations, [OR 1.06 (0.67,1.67)], I2= 0]. There was no significant difference in drug discontinuation due to adverse effects when comparing sildenafil to the control group, [OR 0.79 (0.56, 1.11)], I2=0]. Conclusion: Sildenafil probably reduces all-cause mortality in IPF patients. More studies need to be done in order to confirm the magnitude and reliability of the point estimate.

scholarly journals Phenylephrine Effectiveness in Handling Hypotensive Issues During Spinal Anesthesia Conductance for Cesarean Section Deliveries

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Research Group ◽  
Elective Cesarean Section ◽  
Control Group ◽  
P Values ◽  
Management Protocol ◽  
Significant Difference ◽  
Elective Cesarean ◽  
The Impact

Background: Hypotension is frequent clinical challenge during spinal mode of anesthetic induction for cesarean delivery. Requiring an effective and prompt management mode since it has unfavorable clinical outcomes such as hemodynamic cardiovascular instability issues besides reduced uteroplacental perfusion. Aim: Investigating the impact and effectiveness of different prophylacticdosages of Phenylephrine on hypotensive issues during spinal anesthesia for cesarean section deliveries. Methodology:A prospective, randomized, clinical research study involved 184 cases That are classified as American Society of Anesthesiologists physical status I and II with term singleton pregnancies scheduled for elective cesarean section under spinal anesthesia randomized to receive 0.9% saline 2 mL (Control Group) or phenylephrine1.0 ug/kg (PHE1 research Group), 1.5 ug/kg (PHE1.5 research Group), or 2.0 ug/kg (PHE2 research Group) immediately after induction of spinal anesthesia. Results: The adverse effects of prophylactic bolus ofPhenylephrine among the research groups control, Phenylephrine 1, 1.5,2 in which there was statistically significant difference as regards hypotension, rescue Phenylephrine,lowest SBP,highest SBP,early highest SBP,mean SBP, occurrence of hypertension (p values= <0.001, <0.001, 0.002, <0.001, <0.001, <0.001, <0.001consecutively) there was no statistical significant difference as regards nausea and bradycardia (p values=0.929, 0.823consecutively). Conclusions: The research findings obtained denote and imply that a prophylactic Phenylephrine 1.5 ug/kg bolus followed by additional boluses when necessary could be an alternative management protocol to decrease the frequency of hypotensive issues occurrence during spinal anesthetic mode for cesarean deliveries.

scholarly journals The Effect of Intensity, Frequency, Duration and Volume of Physical Activity in Children and Adolescents on Skeletal Muscle Fitness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 18 (18) ◽  
pp. 9640
Author(s):  
Chunchun Wu ◽  
Yongjin Xu ◽  
Zhaojing Chen ◽  
Yinhang Cao ◽  
Kehong Yu ◽  
...  
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Children And Adolescents ◽  
High Intensity ◽  
Meta Analysis ◽  
Control Group ◽  
Systematic Analysis ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Muscle Fitness

Physical activity could improve the muscle fitness of youth, but the systematic analysis of physical activity elements and muscle fitness was limited. This systematic review and meta-analysis aim to explore the influence of physical activity elements on muscle fitness in children and adolescents. We analyzed literature in Embase, EBSCO, Web of Science, and PubMed databases from January 2000 to September 2020. Only randomized controlled studies with an active control group, which examined at least 1 muscle fitness evaluation index in individuals aged 5–18 years were included. Articles were evaluated using the Jaded scale. Weighted-mean standardized mean differences (SMDs) were calculated using random-effects models. Twenty-one studies and 2267 subjects were included. Physical activity had moderate effects on improving muscle fitness (SMD: 0.58–0.96, p < 0.05). Physical activity element subgroup analysis showed that high-intensity (SMD 0.68–0.99, p < 0.05) physical activity < 3 times/week (SMD 0.68–0.99, p < 0.05), and < 60 min/session (SMD 0.66–0.76, p < 0.01) effectively improved muscle fitness. Resistance training of ≥ 3 sets/session (SMD 0.93–2.90, p < 0.01) and < 10 repetitions/set (SMD 0.93–1.29, p < 0.05) significantly improved muscle fitness. Low-frequency, high-intensity, and short-duration physical activity more effectively improves muscle fitness in children and adolescents. The major limitation of this meta-analysis was the low quality of included studies. The study was registered in PROSPERO with the registration number CRD42020206963 and was funded mainly by the Ministry of Education of Humanities and Social Science project, China.

scholarly journals Comparative evaluation of intrathecal bupivacaine alone and bupivacaine combined with dexmedetomidine in cesarean section using spinal anesthesia: a meta-analysis

2019 ◽  
Vol 47 (7) ◽  
pp. 2785-2799 ◽  
Author(s):  
Xin Liu ◽  
Xiongjie Zhang ◽  
Xujian Wang ◽  
Jinyan Wang ◽  
Hao Wang
Keyword(s):  
Confidence Interval ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Outcome Measure ◽  
Meta Analysis ◽  
Sensory Block ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Control Group ◽  
Block Level

Objective This meta-analysis was performed to evaluate the effect of spinal anesthesia (SA) using bupivacaine combined with dexmedetomidine (DEX) in cesarean section, analyze the adverse drug reactions induced by this mixture, and provide a reference for rational drug use. Methods Randomized controlled trials were obtained from the PubMed, Cochrane Library, and Embase databases. The primary outcome measure was the time to the highest sensory block level (min), and the secondary outcome measure was adverse effects. Results The time to the highest sensory block level was significantly shorter in the bupivacaine-DEX group than in the control group (standardized mean difference, −0.23; 95% confidence interval, −0.43 to −0.03). The incidence of shivering during the process of anesthesia, especially at a dose of 5 µg DEX, was significantly lower in the bupivacaine-DEX group than in the control group (odds ratio, 0.26; 95% confidence interval, 0.14–0.49). No significant differences were observed in the symptoms of hypotension, bradycardia, nausea/vomiting, or pruritus. Conclusion Compared with the use of bupivacaine alone for SA in cesarean section, adding dexmedetomidine during SA can significantly shorten the onset time and decrease the rate of shivering during anesthesia.

scholarly journals Effect of Intrathecal Lipophilic Opioids on the Incidence of Shivering in Women Undergoing Cesarean Delivery after Spinal Anesthesia: A Systematic Review and Bayesian Network Meta- analysis of Randomized Controlled Trials.

2020 ◽  
Author(s):  
Yamini Subramani ◽  
Mahesh Nagappa ◽  
Kamal Kumar ◽  
Lee-Anne Fochesato ◽  
Moaz Bin Yunus Chohan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Lower Incidence ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Fentanyl Group

Abstract Background: Shivering is a common side effect in women having cesarean delivery (CD) under spinal anesthesia, which can be bothersome to the patient, and it can also interfere with perioperative monitoring. In several studies, the intrathecal (IT) addition of a lipophilic opioid to local anesthetics has been shown to decrease the incidence of shivering.Objective: We performed this network meta-analysis to evaluate the effects of intrathecal lipophilic opioids in preventing the incidence of shivering in patients undergoing CD. Methods: This review was planned according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guidelines. An English literature search of multiple electronic databases was conducted. We included randomized controlled trials (RCTs) that reported on the incidence of shivering, with study groups receiving either IT fentanyl, sufentanil, or meperidine in women undergoing CD under spinal anesthesia. Quality of the studies was assessed using the modified Oxford scoring system. Using random-effects modeling, dichotomous data were extracted and summarized using odds ratio (OR) with a 95% credible interval (CrI). Statistical analysis was conducted using R studio version 1.0.153 - Inc. Results: Twenty-one studies consisting of 1433 patients (Control group: 590 patients in twenty-one studies; Fentanyl group:199 patients in seven studies; Sufentanil group: 156 patients in five studies; Meperidine group: 488 patients in ten studies) met the inclusion criteria for this systematic review investigating the effect of intrathecal lipophilic opioids in preventing the incidence of shivering in women undergoing cesarean delivery under spinal anesthesia. Methodological validity scores ranged from 3 to 7. The Bayesian mixed network estimate showed the incidence of shivering was significantly lower with IT fentanyl (pooled odds ratio (OR): 0.13; 95% credible interval (CrI): 0.04 to 0.35; P = 0.0004) and IT meperidine (OR: 0.12; 95% CrI: 0.05 to 0.29; P < 0.00001), but not with IT sufentanil (OR: 0.37; 95% CrI: 0.11 to 1.22; P = 0.23). The IT fentanyl group had a significantly lower incidence of intraoperative discomfort [Risk Ratio (RR): 0.19; 95% CI: 0.10-0.35; P < 0.00001], the IT sufentanil group had a significantly higher incidence of pruritus (RR: 6.18; 95% CI: 1.18-32.46; P = 0.03) The IT meperidine group had a significantly lower incidence of intraoperative discomfort (2.7% vs. 13.6%; RR: 0.22; 95% CI: 0.09-0.55; P = 0.001), but there was a significant increase in nausea and vomiting (IT meperidine group vs. Control group: 42.7% vs. 19.4%; RR: 2.56; 95% CI: 1.14-5.75; P = 0.02). Meta-regression analysis based on the opioid dose and quality of the study did not impact the final inference of our result. Conclusion: IT fentanyl significantly decreased the incidence of shivering in women undergoing CD under spinal anesthesia without increasing maternal adverse events, confirming that routine use in this patient population is a good choice. IT sufentanil did not decrease the incidence of shivering. IT meperidine decreased the incidence and severity of shivering, but its use was also associated with significant nausea and vomiting.

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