Effect of Intracuff Lidocaine on Postoperative Sore Throat and the Emergence Phenomenon: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

<div><p>Background</p><p>Postoperative sore throat and other airway morbidities are common and troublesome after endotracheal tube intubation general anesthesia (ETGA). We propose lidocaine as endotracheal tube (ETT) cuff inflation media to reduce the postintubation-related emergence phenomenon.</p><p>Methods</p><p>We searched PubMed, EMBASE, and Cochrane databases systematically for randomized controlled trials (RCTs) that have investigated the outcome of intracuff lidocaine versus air or saline in patients receiving ETGA. Using a random-effects model, we conducted a meta-analysis to assess the relative risks (RRs) and mean difference (MD) of the incidence and intensity of relevant adverse outcomes.</p><p>Results</p><p>We reviewed nineteen trials, which comprised 1566 patients. The incidence of early- and late-phase postoperative sore throat (POST), coughing, agitation, hoarseness, and dysphonia decreased significantly in lidocaine groups, with RRs of 0.46 (95% confidence interval [CI]: 0.31 to 0.68), 0.41 (95% CI: 0.25 to 0.66), 0.43 (95% CI: 0.31 to 0.62), 0.37 (95% CI: 0.25 to 0.55), 0.43 (95% CI: 0.29 to 0.63), and 0.19 (95% CI: 0.08 to 0.5), respectively, when compared with the control groups. The severity of POST also reduced significantly (mean difference [MD] -16.43 mm, 95% CI: -21.48 to -11.38) at 1 h and (MD -10.22 mm, 95% CI: -13.5 to -6.94) at 24 h. Both alkalinized and non-alkalinized lidocaine in the subgroup analyses showed significant benefits in emergence phenomena prevention compared with the control.</p><p>Conclusion</p><p>Our results indicate that both alkalinized and non-alkalinized intracuff lidocaine may prevent and alleviate POST and postintubation-related emergence phenomena.</p></div

A forest plot showing a comparison of intracuff lidocaine (alkalinized and non-alkalinized) used and the control groups, as well as the incidence of POST at 1 h.

<p>A forest plot showing a comparison of intracuff lidocaine (alkalinized and non-alkalinized) used and the control groups, as well as the incidence of POST at 1 h.</p

A forest plot showing a comparison of intracuff lidocaine (alkalinized and non-alkalinized) used and the control groups, as well as the incidence of POST at 24 h.

<p>A forest plot showing a comparison of intracuff lidocaine (alkalinized and non-alkalinized) used and the control groups, as well as the incidence of POST at 24 h.</p

A flowchart showing the selection of the randomized controlled trials for our meta-analysis.

<p>A flowchart showing the selection of the randomized controlled trials for our meta-analysis.</p

The effect of intracuff lidocaine (alkalinized and non-alkalinized) used on the POST pain score at 1 h.

<p>The effect of intracuff lidocaine (alkalinized and non-alkalinized) used on the POST pain score at 1 h.</p

Intracuff Lidocaine for Preventing Other Complications.

<p>NA = Not applicable</p><p>Intracuff Lidocaine for Preventing Other Complications.</p

Propofol versus Midazolam for Upper Gastrointestinal Endoscopy in Cirrhotic Patients: A Meta-Analysis of Randomized Controlled Trials

<div><p>Background</p><p>Sedation during gastrointestinal endoscopy is often achieved using propofol or midazolam in general population. However, impaired protein synthesis, altered drug metabolism, and compromised hepatic blood flow in patients with liver cirrhosis might affect the pharmacokinetics of sedatives, placing cirrhotic patients undergoing endoscopy at a greater risk of adverse events. The objective of this study was to assess comparative efficacies and safety of propofol and midazolam in cirrhotic patients undergoing endoscopy.</p><p>Methods</p><p>Randomized, controlled trials comparing propofol with midazolam in cirrhotic patients undergoing gastrointestinal endoscopy were selected. We performed the meta-analysis, using a random-effect model, the Review Manager, Version 5.2, statistical software package (Cochrane Collaboration, Oxford, UK) according to the PRISMA guidelines.</p><p>Results</p><p>Five studies between 2003 and 2012, including 433 patients, were included. Propofol provided a shorter time to sedation (weight mean difference: -2.76 min, 95% confidence interval: -3.00 to -2.51) and a shorter recovery time (weight mean difference -6.17 min, 95% confidence interval: -6.81 to -5.54) than midazolam did. No intergroup difference in the incidence of hypotension, bradycardia, or hypoxemia was observed. Midazolam was associated with the deterioration of psychometric scores for a longer period than propofol.</p><p>Conclusion</p><p>This meta-analysis suggests that Propofol sedation for endoscopy provides more rapid sedation and recovery than midazolam does. The risk of sedation-related side effects for propofol does not differ significantly from that of midazolam. The efficacy of propofol in cirrhotic patients undergoing endoscopy is superior to those of midazolam.</p></div

Flowchart of the study selection process.

<p>Flowchart of the study selection process.</p

Measurement of inclusive-jet cross-sections in proton-proton collisions at s=13 TeV\sqrt{s} = 13~\mathrm{TeV} centre-of-mass energy with the ATLAS detector

This note presents the measurement of inclusive-jet cross-sections in proton-proton collisions at a centre-of-mass energy of $13~\mathrm{TeV}$. The measurement uses data corresponding to an integrated luminosity of $3.2~\text{fb}^{-1}$ collected with the ATLAS detector at the Large Hadron Collider in 2015. Jets are clustered using the anti-${k_t}$ algorithm with a radius parameter value of $R = 0.4$. Double differential inclusive-jet cross-sections are presented as a function of the jet transverse momentum, covering the range from $100~\mathrm{GeV}$ to about $3.2~\mathrm{TeV}$, and of the absolute jet rapidity, up to $|y|=3$. The predictions of next-to-leading-order QCD calculations using several parton distribution function (PDF) sets and corrected for non-perturbative and electroweak effects are compared to the measured cross-sections. The predictions are consistent with the measured cross-sections within uncertainties

The Methodological Quality Assessment of Selected Trials.

<p>ETT = endotracheal tube; ITT = intention-to-treat; PP = per-protocol.</p><p>The Methodological Quality Assessment of Selected Trials.</p