Objective To assess the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia. Methods Such databases as PubMed (1966 to March 2012), The Cochrane Library (Issue 1, 2012), EBSCO (ASP) (1984 to March 2012), Journals@Ovid Full Text (1993 to March 2012), CBM (1978 to March 2012), CNKI (1979 to March 2012), VIP (1989 to March 2012), and WanFang Data (1998 to March 2012) were searched to collect randomized controlled trials (RCTs) about the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia, and the references of the included studies were also retrieved. Two researchers extracted the data and evaluated the methodological quality of the included studies independently. Then the RevMan 5.2 software was used for meta-analysis. Results A total of 16 RCTs involving 1 217 patients were included. The results of meta-analysis showed that, compared with the placebo, dexmedetomidine could reduce the occurrence of emergence agitation (OR=0.18, 95%CI 0.13 to 0.25, Plt;0.000 01) and increase the occurrence of postoperative lethargy (OR=0.14, 95%CI 0.03 to 0.68, P=0.01), but there were no differences in the occurrence of side effects including bronchospasm, bucking, breathholding, and oxygen desaturation. Dexmedetomidine could also reduce mean arterial blood pressure (MAP) and heart rate (HR) of pediatric patients during the recovery period after sevoflurane anesthesia, but it increased emergence time (MD=2.14, 95%CI 0.95 to 3.33, P=0.000 4), extubation time (MD=1.26, 95%CI 0.51 to 2.00, P=0.000 9) and the time of staying in PACU (MD=4.72, 95%CI 2.07 to 7.38, P=0.000 5). Conclusions For pediatric patients recovering from sevoflurane-based general anesthesia, dexmedetomidine can reduce the occurrence of emergence agitation, and is helpful to maintain the hemodynamic balance. But it prolongs emergence time, extubation time (or the time of using the laryngeal mask) and the time of staying in PACU, and increases the occurrence of postoperative lethargy.
Objective To systematically review the effectiveness and safety of thoracic epidural analesis (TEA) for postoperative complications after cardiac surgery. Methods Such databases as PubMed, Science Citation Index, EMbase, The Cochrane Library, CNKI and CBM were electronically searched from inception to October 2012 for collecting the randomized controlled trials on the effectiveness and safety of thoracic epidural analgesisa for postoperative complications after cardiac surgery. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Totally 14 studies were eligible, involving 1 942 patients. The results of meta-analysis showed that, TEA combined with general anesthesia (GA) was superior to GA alone in reducing the incidences of myocardial ischemia/infarction (RR=0.63, 95%CI 0.41 to 0.96, P=0.03), respiratory complications (RR=0.55, 95%CI 0.40 to 0.75, P=0.000 1), supraventricular arrhythmias (RR=0.64, 95%CI 0.47 to 0.88, P=0.005), and duration of mechanical ventilation (MD= –2.15, 95%CI –3.72 to –0.58, P=0.007), with significant differences. Conclusions Current evidence shows that, TEA after surgery is effective in reducing the incidences of myocardial ischemia/infarction, respiratory complications, supraventricular arrhythmias, and duration of mechanical ventilation. There is the lack of data on the adverse events of TEA (mainly referring to epidural hematoma). Due to limited quality and quantity of the included studies, patients’ conditions should be fully considered before applying TEA in clinical practice.
Objective To systematically review the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2012), CNKI, CBM, WanFang Data and VIP were electronically searched from inception to December 2012, for comprehensively collecting randomized controlled trials (RCTs) on the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 9 RCTs involving 692 children were included, of which, six were pooled in the meta-analysis. The results of meta-analysis showed that: a) after anesthesia induction using sevoflurane, intravenous propofol maintenance was associated with a lower incidence of emergence agitation compared with sevoflurane maintenance (RR=0.57, 95%CI 0.39 to 0.84, P=0.004); and b) patients anesthetized with total intravenous propofol had a lower incidence of emergence agitation compared with total inhalation of sevoflurane (RR=0.16, 95%CI 0.06 to 0.39, Plt;0.000 1). Conclusion The incidence of emergence agitation after general anesthesia using sevoflurane is higher than that using propofol. Due to the limited quantity and quality, the application of sevoflurane should be chosen based on full consideration into patients’ conditions in clinic.
Objective To evaluate the efficacy and safety of COX inhibitor flurbiprofen axetil in relieving propofol injection pain and preemptive analgesia after general anesthesia. Methods Databases such as PubMed, CBM, Springer, Ovid, CNKI and ISI were searched to identify randomized controlled trials (RCTs) about flurbiprofen axetil in relieving propofol injection pain and preemptive analgesia after general anesthesia published from 2000 to 2010. The methodological quality of the included RCTs was assessed and the data were extracted according to the Cochrane Handbook 5.0.1. Meta-analysis was performed by using RevMan 4.2.10 software. Results A total of 15 RCTs involving 1 425 patients were included. The results of meta-analyses showed that: a) Relieving propofol injection pain: Compared with the placebo group, flurbiprofen axetil could prevent the propofol injection pain (RR=3.13, 95%CI 1.08 to 9.11, P=0.04), and relieve the moderate and severe pain in injecting propofol (RR=0.57, 95%CI 0.40 to 0.81, P=0.002; RR=0.14, 95%CI 0.05 to 0.34, Plt;0.000 1, respectively), but there were no significant differences in relieving mild pain between the two groups; b) Preemptive analgesia: the visual analog scale (VAS) of post-operation at 2-hour (WMD= –2.25, 95%CI –4.20 to –0.29, P=0.02), 4-hour (WMD= –1.99, 95%CI –3.19 to –0.79, P=0.001), 8-hour (WMD= –1.39, 95%CI –1.86 to –0.93, Plt;0.000 01) and 12-hour (WMD= –2.70, 95%CI –4.73 to –0.68, P=0.009) was decreased when flurbiprofen axetil was injected before the operation, but there were no significant differences in VAS of post-operation at 48-hour between the two groups. When flurbiprofen axetil was injected at the end of the operation, VAS of post-operation at 12-hour (WMD= –0.94, 95%CI –1.73 to –0.16, P=0.02) was decreased, but there were no significant differences in VAS of post-operation at 24-hour between the two groups; flurbiprofen axetil could lessen the need for opioid analgesics (RR=0.47, 95%CI 0.27 to 0.82, P=0.008); and c) Safety: there were no significant differences in postoperative nausea, vomit and somnolence between the two groups. Conclusion Flurbiprofen axetil can significantly prevent or relieve the propofol injection pain; flurbiprofen axetil injected before operation can relieve post-operative pain at 2-, 4-, 8- and 12-hour; flurbiprofen axetil injected at the end of the operation can relieve post-operative pain at 12-hour. Yet more RCTs are required to discuss its effects on nausea, vomit and somnolence.
Objective To evaluate the effectiveness of thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) versus GA alone on intrapulmonary shunting during one-lung ventilation (OLV). Methods We searched the Cochrane Library (Issue 4, 2009), the specialized trials registered in the Cochrane anesthesia group, PubMed (1966 to Dec. 2009), EMbase (1966 to Dec. 2008), CBM (1978 to Dec. 2009), VIP (1989 to Dec. 2009), CNKI (1915 to Dec. 2009), and handsearched Clinical Anesthesia Journal and Chinese Anesthesia Journal. Randomized controlled trials (RCTs) about the effectiveness of TEA combined with GA versus GA alone on intrapulmonary shunting during OLV were included, The methodological quality of included RCTs was evaluated by two reviewers independently, Meta-analysis was conducted using RevMan 5.0 software. Results Ten RCTs involving 506 patients were included. The results of meta-analyses showed that there were no significant differences in intrapulmonary shunting during OLV at different times-points of 5, 15, 20, 30, and 60 minutes after OLV. Conclusion Both TEA combined with GA and GA alone have the same Security during OLV. But owing to the low quality and small sample size of the included studies, further more well-designed, large sample size RCTs are needed.
Objective To investigate change of bispectral index(BIS) and hemodynamic index during induction and orotracheal intubation of sevoflurane anesthesia. Methods This study was a prospective before-after study in the same patients. A total of 30 ASA physical status I and II adult patients without airway abnormalities were enrolled to receive inhalation induction of anesthesia with 8% sevoflurane. Mean arterial pressure(MAP),heart rate(HR) and BIS were recorded before anesthesia(T1),when patients loss of consciousness(T2), before intubation (T3),at 1 min(T4) and 3 min(T5) after intubation. Results BIS at T1-T5 were 96.8±1.7,70.4±8.8,39.2±8.4,43.6±12.9 and 41.6±9.3 respectively, the measurements at T2-T5 were all markedly lower than at T1(Plt;0.05). HR at T3-T5 were all markedly higher than at T1(Plt;0.05). MAP at T2 and T3 were markedly lower than at T1, but at T4 was higher than at T1(Plt;0.05), and recovered to the level at T1 at T5(Pgt;0.05).BIS,HR and MAP at T4 were all significantly higher than T3(Plt;0.05). Conclusion Anesthesia induction with sevoflurane and small dose of succinylchoiline we used can provide adequate depth of general anesthesia,but can not prevent cardiovascular adverse reactions to intubation.
Objective To systematically evaluate the effects of magnesium sulfate on postoperative pain and complications after general anesthesia. Methods A literature search was conducted in following databases as The Cochrane Library, EMbase, PubMed, EBSCO, Springer, Ovid, CNKI and CBM from the date of establishment to September 2011 to identify randomized controlled trials (RCTs) about intravenous infusion of magnesium sulfate during general anesthesia. All included RCTs were assessed and the data were extracted according to the standard of Cochrane systematic review. The homogenous studies were pooled using RevMan 5.1 software. Results A total of 11 RCTs involving 905 patients were included. The results of meta-analyses showed that compared with the control group, intravenous infusion of magnesium sulfate during general anesthesia significantly reduced the visual analog scale (VAS) scores at the time-points of 2, 4, 6, 8, 16, and 24 hours, respectively, after surgery, the postoperative 24 hours morphine requirements, and the incidents of postoperative nausea and vomiting (RR=0.61, 95%CI 0.40 to 0.91, P=0.02) and chilling (RR=0.29, 95%CI 0.14 to 0.59, P=0.000 7). Although the incidents of bradycardia (RR=1.93, 95%CI 1.05 to 3.53, P=0.03) increased, there were no adverse events or significant differences in the incidents of hypotension and serum concentration changes of magnesium. Conclusion Intravenous infusion of magnesium sulfate during general anesthesia may obviously decrease the pain intensity, and the incidents of nausea and vomiting and chilling after surgery, without increasing cardiovascular adverse events and risk of hypermagnesemia. The results still need to be confirmed by more high-quality and large-sample RCTs.
Objective To assess the effectiveness and safety of laryngeal mask airway (LMA) and endotracheal tube (ETT) for airway management in pediatric general anesthesia. Methods Randomized controlled trials were collected through electronic searches of the PubMed, The Cochrane Library, EMbase, CBM, WanFang Data, VIP, CNKI from the date of establishment to November 2010. All the related data that matched the standards were abstracted by two reviewers independently. The quality of the included trials was evaluated according to the Cochrane Handbook 5.0. RevMan 5.0 software was used for meta-analysis of the complications, success of insertion on the first attempt and hemodynamic changes. Results A total of 39 trials involving 2 612 patients were included. The results of meta-analyses showed that LMA was superior to ETT in terms of less cough (RR=0.21, 95%CI 0.15 to 0.28, Plt;0.000 01), laryngospasm or bronchospasm (RR=0.37, 95%CI 0.18 to 0.77, P=0.008) and agitation (RR=0.14, 95%CI 0.09 to 0.22, Plt;0.000 01) during emergency. The incidence of postoperative sore throat (RR=0.32, 95%CI 0.19 to 0.55, Plt;0.000 1), hoarse voice (RR=0.09, 95%CI 0.03 to 0.27, Plt;0.000 1), nausea and vomiting (RR=0.46, 95%CI 0.26 to 0.80, P=0.006) was significantly lower in the LMA group. The hemodynamic changes during insertion and extraction of LMA were more stable than ETT, such as the heart rate changes in insertion, extraction and post-extraction period (SMD= –1.18, 95%CI –1.59 to –0.77, Plt;0.000 01; SMD= –1.29 95%CI –1.72 to –0.86, Plt;0.000 01; and SMD= –1.51 95%CI –2.15 to –0.87, Plt;0.000 01, respectively) and the MAP changes in insertion, extraction and post-extraction period (SMD= –1.21, 95%CI –1.39 to –1.02, Plt;0.000 01; SMD= –1.31, 95%CI –1.77 to –0.85, Plt;0.000 01; and SMD= –0.85, 95%CI –1.24 to –0.46, Plt;0.000 1, respectively); but no significant differences in postoperative regurgitation and aspiration (RR=3.00, 95%CI 0.62 to 14.61, P=0.17) and successful insertion on the first attempt (RR=0.99, 95%CI 0.94 to 1.05, P=0.84) were found between the LMA and ETT groups. Conclusion Current evidence indicates that the laryngeal mask airway is superior to endotracheal tube in terms of fewer complications during emergency and after operation as well as stable hemodynamic changes. So, it is a selective, safe and effective airway management for children.
Objective To evaluate the influence of combined general and epidural anesthesia on the prognosis of patients undergoing cancer surgery. Methods Such database as PubMed, OVID, EBSCO, The Cochrane Library and CNKI were searched, and other relevant journals and references of the included literature were also hand searched from 1986 to 2011. Two evaluators independently screened the studies in accordance with the inclusion and exclusion criteria, extracted the data and assessed the methodology quality. RevMan 5.0 software was used for meta-analyses. Results Seven studies involving 2 513 patients were included. The results of meta-analyses showed that compared with the single general anesthesia, the combined general and epidural anesthesia had no significant differences in postoperative recurrence and metastasis rate (OR=0.71, 95%CI 0.44 to 1.17, P=0.18). Based on the following four factors i.e. category of cancer, time of follow-up, having preoperative metastais or not, and patients’ age, the sensitivity analysis showed significant differences in the postoperative recurrence and metastasis rate between the two anesthesia methods were found in the group of patients at or above 64 years old and the group with follow-up equal to or less than two years (OR=1.46, 95%CI 1.00 to 2.14, P=0.05; OR=1.55, 95%CI 1.06 to 2.26, P=0.02; respectively). Nevertheless, there was no significant difference in the groups of patients with colorectal cancer or without preoperative metastasis (OR=1.00, 95%CI 0.62-1.61, P=0.99; OR=1.26, 95%CI 0.86 to 1.86, P=0.23; respectively). Conclusion Compared with single general anesthesia, the combined general and epidural anesthesia cannot reduce the recurrence and metastasis rate for cancer patients, and has no marked improvement in prognosis of patients with colorectal cancer or without preoperative metastasis, but it obviously decreases the probability of forward recurrence and metastasis for the patients at or above 64 years old and the patients with follow-up equal to or less than two years.