ObjectivesTo systematically review the efficacy of lidocaine injected prior to tracheal extubation in preventing hemodynamic responses to tracheal extubation in general anesthesia.MethodsPubMed, Ovid, Web of Science, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of lidocaine administrated prior to extubation in preventing hemodynamic responses to tracheal extubation in patients undergoing general anesthesia from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 13.0 software.ResultsA total of 10 RCTs involving 525 patients were included. The results of meta-analysis showed that: compared with control group, lidocaine could reduce mean arterial pressure in 5 min after extubation (MD=–5.10, 95%CI –9.41 to –0.79, P=0.02), weaken the increase in systolic blood pressure caused by extubation from the moment before extubation to 5 minutes after extubation (before extubation: MD=–7.22, 95%CI –10.34 to –4.11, P<0.000 01; at extubation: MD=–14.02, 95%CI –19.42 to –8.62, P<0.000 01; 1 minutes after extubation: MD=–15.82, 95%CI –22.20 to –9.45, P<0.000 01; 3 minutes after extubation: MD=–12.55, 95%CI –20.36 to –4.74, P=0.002; and 5 minutes after extubation: MD=–12.05, 95%CI –20.35 to –3.74, P=0.004), and weakened extubation-induced increase in diastolic blood pressure at extubation (MD=–9.71, 95%CI –16.57 to –2.86, P=0.005). In addition, lidocaine inhibited heart rate in all time points except the moment of before and at 10 minutes after extubation.ConclusionsCurrent evidence shows that lidocaine can inhibit the increase in blood pressure and heart rate caused by extubation at certain times. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
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.
Objective To explore the feasibility and safety of early feeding after arthroscopic surgery with general anesthesia. Methods One hundred patients undergoing arthroscopic surgery with general anesthesia between January and December 2017 were randomly divided into the routine feeding group and the early feeding group, with 50 cases in each group. In the routine feeding group, patients were feeding after anus gas passage or 6 hours after surgery. Under full assessment, patients in the early feeding group could drink or eat when recovered from anesthesia. The nausea, vomiting, abdominal distension, and thirst incidences and the comfort degree 6 hours after surgery, the time of first stand up on foot, and the length of hospital stay between the two groups were compared. Results There was no statistical difference (P>0.05) in the incidence of disgusting (10.0%vs. 22.0%), vomiting (6.0% vs. 16.0%), abdominal distention (4.0% vs. 12.0%) or length of hospital stay [(6.44±2.28) vs. (6.34±0.94) days]. The difference in the incidence of postoperative thirst (14.0% vs. 40.0%), the comfort degree 6 hours after surgery (2.36±1.21 vs. 4.14±1.53), the time of the first stand up on foot [(17.30±10.32) vs. (20.84±3.92) hours] were statistically significant (P<0.05). Conclusions Early feeding is safe and feasible for the postoperiative arthroscopic surgery after general anesthesia, and can improve the patients’ comfort degree.
Objective To determine the efficiency and safety of dexmedetomidine in general anesthesia. Methods Trials were located through electronic searches of the PubMed, EBSCO, OVID, Springer, Foreign Journals Integration System, CNKI, CMBdisk (from the date of establishment of the databases to April 2008). Bibliographies of the retrieved articles were also checked. Result A total of 25 trials involving 1 241 patients were included. The Meta-analysis showed: dexmedetomidine reduced peri-operative heart rate and blood pressure, reduced the occurrence of postoperative nausea and vomitting [RR=0.57, 95%CI (0.38, 0.84)], postoperative agitation [RR=0.29, 95%CI (0.17, 0.51)], shivering [RR=0.45, 95%CI (0.29, 0.68)], increase the occurrence of bradycardia [RR=2.16, 95%CI (1.58, 2.95)], hypotension [RR=2.97, 95%CI (1.42, 6.18)]. Dexmedetomidine reduced administration of thiopental, isoflurane and fentanyl, while there was no difference in muscle relaxant. Dexmedetomidine showed no difference in emergency time compared with the control group. As a result of low incidence of adverse reaction, dexmedetomidine showed superior in discharge time [WMD15.17, 95%CI (3.87, 26.46)]. Conclusions The limited current evidence shows that dexmedetomidine is better in maintaining the hemodynamic balance; reducing occurrence of nausea, vomiting, agitation and shivering; and reducing doses of anesthetics. In emergency time, dexmedetomidine shows no difference except discharge time.
Objective To study the influence of low-tidal volume and positive end expiratory pressure (PEEP) protective ventilation on cardiac output volume in elderly patients under general anesthesia. Methods From August 2012 to July 2014, 60 elderly patients undergoing selective surgery were divided into three groups with 20 patients in each. Group A was treated with conventional ventilation: tidal volume at 8 mL/kg, PEEP at 0 cm H2O (1 cm H2O=0.098 kPa); group B was treated with a tidal volume of 6 mL/kg and a PEEP of 5 cm H2O; group C was treated with a tidal volume of 6 mL/kg and a PEEP of 8 cm H2O. We then observed and analyzed the blood pressure, heart rate, cardiac output, arterial blood gas and airway mean pressure before induction of anesthesia (T0), 15 minutes of mechanical ventilation after the induction of anesthesia (T1), 60 minutes after anesthesia induction (T2), and 15 minutes after tracheal extubation (T3). Results In all the three groups, the mean arterial pressure and cardiac output were stable. In group B and C, central venous pressure increased significantly, the mean airway pressure and lung compliance increased, and the arterial oxygen branch pressure also increased significantly (P < 0.05). Conclusion Low-tidal volume combined with 5-cm H2O or 8-cm H2O positive end expiratory pressure lung-protective ventilation had a small influence on the cardiac output of elderly patients under anesthesia, which can be safely used.
ObjectiveTo compare the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement (TAVR).MethodsA total of 399 severe aortic stenosis patients were included, who underwent TAVR successfully in West China Hospital of Sichuan University between April 2012 and January 2019. The baseline characteristics, procedural details, postprocedural outcomes, and ultrasound data of those patients were collected. All patients were followed up and the end date of follow-up was June 20th 2020. According to anesthetic mode, the patients were divided into local anesthesia group and general anesthesia group. The differences between the two groups in incidence of postprocedural complications, hemodynamics, postprocedural 30-day mortality, and postprocedural 1-year mortality were retrospectively analyzed.ResultsOf the 399 patients, 206 (51.6%) received local anesthesia and 193 (48.4%) received general anesthesia. There was no statistical difference between the two groups in baseline characteristics. The symptoms of both groups were relieved. But the incidences of mild bleeding events (12.4% vs. 1.5%, P<0.001), severe bleeding events (10.4% vs. 0.5%, P<0.001), major vascular complications (0.5% vs. 3.6%, P=0.032), and postprocedural 30-day all causes mortality (1.9% vs. 6.7%, P=0.018) were significantly lower in the local anesthesia group than those in the general anesthesia group.ConclusionIn TAVR, compared with general anesthesia, local anesthesia is safer to use with lower incidence of postprocedural complications and postprocedural 30-day all causes mortality.
ObjectiveTo systematically review the protection effect of epidural anesthesia combined with general anesthesia versus general anesthesia alone in patients underwent cardiac surgery, so as to provide evidence for reducing complications of cardiac surgery. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2, 2015), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about epidural anesthesia combined with general anesthesia versus general anesthesia alone for patients underwent cardiac surgery from inception to February 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. ResultsA total of 35 RCTs involving 3 311 patients were included. The results of meta-analysis showed that, compared with the general anesthesia group, the combination anesthesia group had lower incidence of supraventricular tachycardias (RR=0.63, 95%CI 0.48 to 0.83, P=0.001) and shorter ICU stay time (SMD=-0.57, 95%CI -1.02 to-0.12, P=0.01), but there were no significant differences in the incidences of respiratory complications, myocardial infarction, stroke and mortality between the two groups (all P values >0.05). ConclusionCurrent evidence shows that the combination of epidural anesthesia and general anesthesia has better protection effect than general anesthesia alone in cardiac surgery, but the influence on long-term prognosis still needs to be assessed. Due to the limited quality of included studies, the above conclusion still needs to be verified by more high quality studies．
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.
ObjectiveTo explore the influence of general anesthesia with laryngeal mask and preoperative inhalation of budesonide aerosol on the incidence of respiratory adverse events during pediatric anesthesia recovery. MethodsA total of 100 child patients scheduled to undergoing inguinal hernia repair between December 2012 and February 2014 were randomly divided into two groups (group A and B) with 50 in each. All the patients underwent general anesthesia with laryngeal mask, while patients in group B inhaled budesonide aerosol before anesthesia. Then, we observed the incidence of adverse events in both groups, including laryngospasm, respiratory tract infection, and pulmonary complications. ResultsCompared with group A, patients in group B had a lower incidence of adverse events (P<0.05). ConclusionPreoperative application of budesonide aerosol inhalation can significantly reduce adverse events in the process of anesthesia recovery in children.
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.