Comparison of ultrasound-guided versus anatomical landmark-guided cannulation of the femoral vein at the optimum position in infants

Background Femoral vein cannulation may be required during major surgery in infants and children and may prove to be life saving under certain conditions. This study compared ultrasound (US)-guided cannulation of the femoral vein in infants with the traditional anatomical landmark-guided technique.Methods Eighty infants who had been prepared for a major elective surgery under general anesthesia were randomly assigned to either group I, in which the femoral vein cannulation was guided by anatomical landmarks in optimally positioned patients, or group II, in which an US-guided technique was used for cannulation.Results The procedure was successful in 35 cases in group I and in all cases in group II. The number of needle passes was higher in group I compared with that in group II [four (1–22) vs. one (1–8); P = 0.001]. First-pass success was achieved in 20 cases in group I and in 35 cases in group II. The time to complete cannulation was significantly shorter in group II compared with that in group I [145 (40–650) s vs. 350 (40–1600) s; P = 0.02]. Three cases of arterial puncture occurred in group I, whereas there were no complications in group II.Conclusion US-guided techniques for femoral vein cannulation are useful as they result in greater success, shorter cannulation times, less number of attempts, and lower complication rates. Keywords: anatomical, cannulation, femoral vein, infants, ultrasoni

The impact of peri-operative intravenous lidocaine on postoperative outcome after elective colorectal surgery: A meta-analysis of randomised controlled trials

BACKGROUND There has recently been increasing interest in the use of peri-operative intravenous lidocaine (IVL) due to its analgesic, anti-inflammatory and opioid-sparing effects. However, these potential benefits are not well established in elective colorectal surgery. OBJECTIVES To examine the effect of peri-operative IVL infusion on postoperative outcome in patients undergoing elective colorectal surgery. DESIGN A meta-analysis of randomised controlled trials (RCTs) comparing peri-operative IVL with placebo infusion in elective colorectal surgery. The primary outcome measure was postoperative pain scores up to 48 h. The secondary outcome measures included time to return of gastrointestinal function, postoperative morphine requirement, anastomotic leak, local anaesthetic toxicity and hospital length of stay. DATA SOURCES PubMed, Scopus and the Cochrane Library databases were searched on 5 November 2018. ELIGIBILITY CRITERIA Studies were included if they were RCTs evaluating the role of peri-operative IVL vs. placebo in adult patients undergoing elective colorectal surgery. Exclusion criteria were paediatric patients, noncolorectal or emergency procedures, non-RCT methodology or lack of relevant outcome measures. RESULTS A total of 10 studies were included (n = 508 patients; 265 who had undergone IVL infusion, 243 who had undergone placebo infusion). IVL infusion was associated with a significant reduction in time to defecation (mean difference −12.06 h, 95% CI −17.83 to −6.29, I2 = 93%, P = 0.0001), hospital length of stay (mean difference −0.76 days, 95% CI −1.32 to −0.19, I2 = 45%, P = 0.009) and postoperative pain scores at early time points, although this difference does not meet the threshold for a clinically relevant difference. There was no difference in time to pass flatus (mean difference −5.33 h, 95% CI −11.53 to 0.88, I2 = 90%, P = 0.09), nor in rates of surgical site infection or anastomotic leakage. CONCLUSION This meta-analysis provides some support for the administration of peri-operative IVL infusion in elective colorectal surgery. However, further evidence is necessary to fully elucidate its potential benefits in light of the high levels of study heterogeneity and mixed quality of methodology

Postoperative ileus following major colorectal surgery

Background: Postoperative ileus (POI) is characterized by delayed gastrointestinal recovery following surgery. Current knowledge of pathophysiology, clinical interventions and methodological challenges was reviewed to inform modern practice and future research. Methods: A systematic search of MEDLINE and Embase databases was performed using search terms related to ileus and colorectal surgery. All RCTs involving an intervention to prevent or reduce POI published between 1990 and 2016 were identified. Grey literature, non-full-text manuscripts, and reanalyses of previous RCTs were excluded. Eligible articles were assessed using the Cochrane tool for assessing risk of bias. Results: Of 5614 studies screened, 86 eligible articles describing 88 RCTs were identified. Current knowledge of pathophysiology acknowledges neurogenic, inflammatory and pharmacological mechanisms, but much of the evidence arises from animal studies. The most common interventions tested were chewing gum (11 trials) and early enteral feeding (11), which are safe but of unclear benefit for actively reducing POI. Others, including thoracic epidural analgesia (8), systemic lidocaine (8) and peripheral μ antagonists (5), show benefit but require further investigation for safety and cost-effectiveness. Conclusion: POI is a common condition with no established definition, aetiology or treatment. According to current literature, minimally invasive surgery, protocol-driven recovery (including early feeding and opioid avoidance strategies) and measures to avoid major inflammatory events (such as anastomotic leak) offer the best chances of reducing POI