ObjectiveTo systematically review the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain. MethodsDatabases such as The Cochrane Library (Issue 1, 2014), PubMed, Web of Science, CNKI, VIP, CBM and WanFang Data were searched for randomized controlled trials (RCTs) on the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain up to January 2014. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1.0 software. ResultsA total of 35 RCTs involved 3 406 patients were included. The results of meta-analysis showed that, there was no significant difference in effectiveness between transdermal fentanyl and oral morphine for moderate/severe cancer pain (OR=1.00, 95%CI 0.80 to 1.27, P=0.99). Compared with oral morphine, transdermal fentanyl was better in lowering the incidences of constipation, nausea and vomiting, lethargy and urinary retention; but transdermal fentanyl increased the incidences of skin rashes and itch (P < 0.05). ConclusionTransdermal fentanyl is as effective as oral morphine in the treatment of moderate/severe cancer pain, and transdermal fentanyl causes less side effects. Due to poor quality of the included studies, the above conclusion should be verified by further conducting more high quality RCTs.
ObjectiveTo systematically review the efficacy and safety of high-versus low-chloride content in fluid resuscitation during perioperative and critical care. MethodsDatabases including The Cochrane Library (Issue 5, 2015), Web of Science, PubMed, CNKI, VIP, CBM and WanFang Data were searched to collect relevant randomized controlled trials (RCTs) about high-versus low-chloride content in fluid resuscitation from inception to May 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 15 RCTs involving 772 participants were included. The results of meta-analysis indicated that there were no significant differences in mortality (RR=1.30, 95% CI 0.59 to 2.89, P=0.52), incidence of acute kidney injury (RR=1.66, 95% CI 0.83 to 3.31, P=0.15), the level of serum creatinine (MD=0.05, 95% CI-0.06 to 0.15, P=0.38), urine output (MD=0.61, 95% CI-1.11 to-2.33, P=0.48), transfusion volume (MD=86.01, 95% CI-37.80 to 209.82, P=0.17), hospital length of stay (LOS) (MD=-0.27, 95% CI-1.11 to 0.58, P=0.54) and ICU LOS (MD=-0.97, 95% CI-3.31 to 1.37, P=0.42) between the high-chloride content group and the low-chloride content group. While the level of serum chlorine in the high-chloride content group was higher than that in the low-chloride content group (MD=5.40, 95% CI 1.68 to 9.12, P=0.004). ConclusionCurrent evidence shows, there is no difference between high-versus low-chloride content in fluid resuscitation during perioperative and critical care. Due to the limited quality and quantity of the included studies, more high quality studies are need to verify the above conclusion.
ObjectiveTo systematically review the safety of propofol versus sevoflurane for pediatric surgery. MethodsEMbase, PubMed, The Cochrane Library, CSCD, CNKI, WanFang Data were searched to collect randomized controlled trials (RCTs) about propofol versus sevoflurane for pediatric surgery from inception to January 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then metaanalysis was performed by using RevMan 5.3 software. ResultsFifteen RCTs involving 1 065 children were included finally. Meta-analysis results showed that, compared with the sevoflurane group, the propofol group could reduce the incidence of emergence agitation (OR=0.23, 95%CI 0.16 to 0.34, P<0.000 01) and the incidence of postoperative vomiting (OR=0.32, 95%CI 0.20 to 0.51, P<0.000 01). There were no significant differences between the two groups in extubation time (MD=0.98, 95%CI -0.26 to 2.21, P=0.12), eye-opening time (MD=3.32, 95%CI -2.65 to 9.29, P=0.28) and postoperative analgesic requirements (OR=0.60, 95%CI 0.30 to 1.23, P=0.16). ConclusionIn reducing the incidence of emergence agitation and postoperative vomiting, propofol is superior to sevoflurane, so propofol is safer than sevoflurane for children's surgery.