scholarly journals Dexmedetomidine and Postoperative Delirium in the Adult Cardiac Surgical Population: A Systematic Review

2018 ◽  
Author(s):  
Joanne Custodio
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Postoperative Delirium ◽  
Critical Appraisal ◽  
Major Complication ◽  
Common Complication ◽  
Study Analysis ◽  
Comprehensive Literature Review ◽  
Central Nervous System Stimulation ◽  
Critical Appraisal Skills

Postoperative delirium (POD) is a major complication following surgery and is considered the most common complication among older adults following cardiac surgery; with up to 87% of patients being affected (Whitlock, Vannucci, & Avidan, 2011). Dexmedetomidine, a highly selective α2 agonist, inhibits the release of norepinephrine presynaptically causing analgesia and inhibits central nervous system stimulation in the postsynaptic neurons causing decreased blood pressure and heart rate; together, contributing to the effects of analgesia, anesthesia, and sedation (Naaz & Ozair, 2014). The purpose of this systematic review was to analyze the current literature and examine the effects of dexmedetomidine on POD in the adult cardiac surgical population. A comprehensive literature review was completed using CINAHL, PubMed, and Medline focusing on the pathology of postoperative delirium, the physiology of cardiac surgery, and the pharmacodynamics of dexmedetomidine. Guidelines set forth by PRISMA and Inouye and Charpentier’s multifactorial model were utilized to assist in the identification of eligible studies. Study analysis was completed by creating study specific and data outcome tables. Critical appraisal of individual RCTs was performed utilizing the Critical Appraisal Skills Programme (CASP) checklist. A cross study analysis table was also created comparing the results of all eligible studies against one another. The findings of this systematic review determined that in the adult cardiac surgical population, dexmedetomidine was associated with a decreased incidence of POD; however, the results for time to extubation, ICU LOS (length of stay), and hospital LOS varied amid the studies examined.

scholarly journals Propofol Based Tiva Vs. Sevoflurane Inhalation Anesthetic for Breast Cancer Surgery: A Systematic Review

2020 ◽  
Author(s):  
Jacqueline Conte
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Immune Response ◽  
Survival Rate ◽  
Critical Appraisal ◽  
Breast Cancer Surgery ◽  
Anesthetic Technique ◽  
Study Analysis ◽  
Tumor Excision ◽  
Inhalation Anesthetic

Metastasis from breast cancer leads to a higher chance of death from that cancer. According to the National Cancer Institute (2018) breast cancer survival rates among all three SEER stages (localized, regional, and distant) was approximately 90% between the years 2008 and 2014. Among these patients, those with distant metastasis had a survival rate of 27% and those with regional metastasis had an 85% survival rate (American Cancer Society, 2019). When creating an individualized anesthetic plan for a patient presenting for tumor excision of breast cancer, the anesthesia provider should create a plan that l owers the risk of metastasis and increases the patient’s chance of survival. The purpose of this systematic review was to analyze which anesthetic technique, Propofol based total Intravenous Anesthesia (TIVA) or Sevoflurane based inhalation anesthetic, will elicit less immune response. A comprehensive literature review was completed using CINAHL, Medline Plus, and Pubmed Health focusing on propofol based TIVA and Sevoflurane for anesthesia maintenance for the removal of cancerous breast tumors. The PRISMA model was used to identify eligible studies. Study analysis was completed by creating study specific and data outcome tables. Critical appraisal of individual randomized control trials was performed using the Critical Appraisal Skills Programme (CASP) checklist. A cross study analysis table was also created to compare the results of all eligible studies. The findings of this systematic review determined that Propofol based TIVA increases recurrence free survival, however there is negligible differences in the immune response between Propofol based TIVA and Sevoflurane inhalation anesthetic for women undergoing surgery for breast cancer tumor excision.

scholarly journals Outcome Reporting in Cardiac Surgery Trials: Systematic Review and Critical Appraisal

2015 ◽  
Vol 4 (8) ◽  
Author(s):  
Michael Goldfarb ◽  
Laura Drudi ◽  
Mohammad Almohammadi ◽  
Yves Langlois ◽  
Nicolas Noiseux ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Critical Appraisal ◽  
Outcome Reporting

scholarly journals Dexmedetomidine Use in the Pediatric Postoperative Patient with Emergence Agitation: A Systemic Review

2020 ◽  
Author(s):  
Elizabeth Kittredge
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Inhibitory Neurons ◽  
Systemic Review ◽  
Emergence Agitation ◽  
Postoperative Patient ◽  
Comprehensive Literature Review ◽  
Randomized Control

Emergence Agitation is a frequent complication in the pediatric postoperative population; with up to 80% incidence (Stamper, Hawks, Taicher, Bonta & Brandon, 2014). These patients will present with crying, overexcitement, thrashing, agitation and is seen within the first 30 minutes of emergence of general anesthesia (Mohkamkar, Farhoudie, Alam-Sahebpour, Mousavi, Khani & Shamomhammadi, 2014). Dexmedetomidine, a selective alpha 2 agonist, reduces norepinephrine output, initiates firing of inhibitory neurons such as the gama aminobutric acid system and reduces release of substance P and other catecholamines. These actions provide the patient with sedation, analgesia, and anesthesia (Nagelhout & Elisha, 2018). Due to the mechanism of action of dexmedetomidine, bradycardia and hypotension have been seen in pediatric patients. This has put a limit on the use of dexmedetomidine in this population. The purpose of this systematic review was to examine efficacy and side effects of various doses of dexmedetomidine to prevent emergence agitation in the pediatric postoperative patient. A comprehensive literature review was completed with the use of CINAHL Plus with full text, PubMed and Google Scholar. Preferred Reporting Items for Systematic Meta-Analysis (PRISMA), was used as guidelines to assist in proper identification of articles. The quality and critical appraisal of each randomized control trial was determined by the Critical Appraisal for Summaries of Evidence (CASE) worksheet. A cross study analysis table was created and used to analyze results of all studies. The findings of this systematic review determined dexmedetomidine was beneficial in emergence agitation prevention. Dexmedetomidine dosed at 0.5 mcg/kg-1mcg IV boluses and 1 mcg/kg – 2 mcg/kg intranasal sprays provided good relief with limited adverse effects.

A systematic review of the effectiveness of critical appraisal skills training for clinicians

2000 ◽  
Vol 34 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Rod Taylor ◽  
Barnaby Reeves ◽  
Paul Ewings ◽  
Sarah Binns ◽  
John Keast ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Skills Training ◽  
Critical Appraisal Skills

scholarly journals Smac/DIABLO can predict postoperative delirium in elderly patients after cardiac surgery : A prospective nested case-control study

2021 ◽  
Author(s):  
Xin Ding ◽  
Zeping Li ◽  
Lei Lei ◽  
Muhuo Ji ◽  
Jianjun Yang
Keyword(s):  
Oxidative Stress ◽  
Cardiac Surgery ◽  
Postoperative Delirium ◽  
Case Control Study ◽  
Critical Role ◽  
Case Control ◽  
Nervous System Diseases ◽  
Common Complication ◽  
Nested Case Control ◽  
Control Study

Background：Postoperative delirium (POD) is a common complication following cardiac surgery. Mitochondrial injury, demonstrated by excessively activated oxidative stress and regulating cell apoptosis, has been reported to contribute to POD. [Mitophagy](https://www.geenmedical.com/article?id=34752757&type=true), apoptosis, pyroptosis, ferroptosis had been known to play a critical role in degenerative nervous system diseases. However, the serum change of Smac/DIABLO in POD induced by cardiac surgery/anesthesia is still undetermined. We designed the study to determine the expression level of SMAC/DIABLO in POD patients. Methods：A nested case-control study was performed, including 21 POD patients and a matched group of 63 non-POD controls.

scholarly journals A Systematic Review of the Instruments Used for Evaluating Causal Beliefs and Perceived Heart Risk Factors

2020 ◽  
Author(s):  
Mozhgan Saeidi ◽  
Saeid Komasi ◽  
Angelo Compare
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Critical Appraisal ◽  
Web Of Science ◽  
Qualitative Evaluation ◽  
Measuring Instruments ◽  
Causal Beliefs ◽  
Male Patients ◽  
Critical Appraisal Skills ◽  
Grading Scales

Background: The etiologies and causal beliefs of heart disease are considered one of the 5 dimensions of health selfregulatory model. Thus, the present study aimed to review the literature and screen the appropriate tools for evaluating the causal beliefs and perceived heart risk factors (PHRFs). Methods: The review samples encompassed all published articles from 1992 to March 2017. A systematic search was conducted across 6 databases: the Web of Science, Scopus, Medline, EBSCO, ProQuest, PsycINFO, and Google Scholar. The qualitative evaluation of the articles was examined using the checklists of the Critical Appraisal Skills Programme (CASP) by 2 independent investigators. After the application of the criteria for inclusion in the study, 22 studies were obtained according to the PRISMA guidelines.  Results: A total of 10 504 (50.5% male) patients at an average age of 57.85±10.75 years participated in 22 studies under review. The results of the systematic review showed that 22 tools were available to measure PHRFs. The instruments were categorized into 4 groups of valid scales (6 studies), invalid questionnaires (6 studies), checklists (3 studies), and open-ended single items (7 studies). Only 23.2% of the measuring instruments were sufficiently valid. Conclusion: The results of this systematic review showed that a limited number of valid tools were available to measure PHRFs. Considering the importance of studying cardiac patients’ perception of the etiology of disease and the paucity of standards and valid grading scales, it seems necessary to design and provide tools with broader content that can cover all aspects of patients’ beliefs.  

scholarly journals Systematic Review: Isometric Handgrip Exercise In Elderly With Hypertension

2021 ◽  
Vol 1 (2) ◽  
pp. 81-91
Author(s):  
Enisah Enisah ◽  
Diah Ernawati ◽  
Dian Hendrawati ◽  
Dian Rahayu ◽  
Evi Rachmawati
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Controlled Trial ◽  
Evidence Based ◽  
Handgrip Exercise ◽  
Isometric Handgrip ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Isometric Handgrip Exercise ◽  
Critical Appraisal Skills

Tujuan systematic review ini untuk mengetahui pengaruh isometric handgrip exercise (IHE) pada lanjuat usia yang mengalami hipertensi agar dapat diaplikasikan sebagai evidence-based practice (EBP) pada lansia dengan hipertensi di Panti Wredha Muhammadiyah Rancabolang, Kota Bandung. Metode penelitian menggunakan Critical Appraisal Skills Programme (CASP) Systematic Review yang terdiri dari 11 daftar pertanyaan. Pembuatan rumusan pertanyaan klinis menggunakan format PICOT. Hasil systematic review diperoleh sebanyak 4 bukti penelitian, dengan 2 bukti memiliki level of evidence 2 karena menggunakan desain studi randomized controlled trial (RCT). 2 bukti lainnya memiliki level of evidence 3 karena menggunakan desain studi quasi experiment. IHE dapat dilakukan secara rutin oleh lansia dengan hipertensi di Panti ini. Hal tersebut dilakukan sebagai upaya untuk mengendalikan hipertensi dan diperlukan jadwal bersama agar semua lansia dapat teratur melakukan IHE ini. Keuntungan melakukan IHE dalam waktu yang pendek secara kontinyu selama 2 menit dapat menyebabkan tekanan darah dan denyut jantung mencapai nilai yang stabil, tidak berisiko terjadi cedera, dan teknik yang dilakukan cukup mudah. IHE dapat dilakukan di mana saja, dan hanya memerlukan alat sederhana seperti menggunakan alat berbentuk bola dengan konsistensi kenyal agar bisa ditekan-tekan oleh lansia dengan hipertensi. Bahkan dapat dilakukan tanpa alat sehingga memudahkan penderita hipertensi untuk melakukan IHE tersebut.

P60 CRITICAL APPRAISAL OF GASTRIC CONDUIT ISCHAEMIC CONDITIONING PRIOR TO OESOPHAGECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Kamarajah Sivesh ◽  
Boyle Charlie ◽  
R Bundred, James ◽  
HL Tan Benjamin
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Major Complication ◽  
Gastric Conduit ◽  
High Morbidity ◽  
Anastomotic Strictures ◽  
Meta Analyses ◽  
The Impact ◽  
Ischaemic Conditioning

Abstract Aim Anastomotic leaks remain a major complication following oesophagectomy, accounting for high morbidity and mortality. Recently, gastric ischaemic conditioning (GIC) has been proposed to improve anastomotic integrity through neovascularisation of the gastric conduit. This systematic review aims to determine the impact of GIC on postoperative outcomes after oesophagectomy. Background & Methods A systematic literature search was performed to identify studies reporting GIC for any indication of oesophageal resection. Random-effects meta-analyses were conducted for main outcomes. Results Nineteen studies were included reporting GIC, of which 13 were comparative studies. GIC were performed through ligation in 13 studies and embolisation in six studies. GIC did not appear reduce anastomotic leakages (OR 0.80, CI95: 0.51 - 1.24, p=0.3), anastomotic strictures (OR 0.75, CI95: 0.35 - 1.60, p=0.5), overall complications (OR 1.02, CI95: 0.48 - 2.16, p=0.9), major complications (OR 1.06, CI95: 0.53 - 2.11, p=0.9), or in-hospital mortality (OR 0.70, CI95: 0.32 - 1.53, p=0.4). However, preconditioning reduced the rates of conduit necrosis (OR 0.30, CI95: 0.11 - 0.77, p=0.013). Conclusion Gastric preconditioning through does not appear to reduce overall rates of anastomotic leakage after oesophagectomy but seems to reduce severity of leakages. More in depth studies are recommended.

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