Fluid loading therapy to prevent spinal hypotension in women undergoing elective caesarean section Network meta-analysis, trial sequential analysis and meta-regression

BACKGROUND Fluid loading is one of the recognised measures to prevent hypotension due to spinal anaesthesia in women scheduled for a caesarean section. OBJECTIVE We aimed to evaluate the current evidence on fluid loading in the prevention of spinal anaesthesia-induced hypotension. DESIGN Systematic review and network meta-analysis with trial sequential analy

Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery

Background: The perioperative management of antiplatelet therapy in noncardiac surgery patients who have undergone previous percutaneous coronary intervention (PCI) remains a dilemma. Continuing dual antiplatelet therapy (DAPT) may carry a risk of bleeding, while stopping antiplatelet therapy may increase the risk of perioperative major adverse cardiovascular events (MACE). Methods: Occurrence of Bleeding and Thrombosis during Antiplatelet Therapy In Non-Cardiac Surgery (OBTAIN) was an international prospective multicentre cohort study of perioperative antiplatelet treatment, MACE, and serious bleeding in noncardiac surgery. The incidences of MACE and bleeding were compared in patients receiving DAPT, monotherapy, and no antiplatelet therapy before surgery. Unadjusted risk ratios were calculated taking monotherapy as the baseline. The adjusted risks of bleeding and MACE were compared in patients receiving monotherapy and DAPT using propensity score matching. Results: A total of 917 patients were recruited and 847 were eligible for inclusion. Ninety-six patients received no antiplatelet therapy, 526 received monotherapy with aspirin, and 225 received DAPT. Thirty-two patients suffered MACE and 22 had bleeding. The unadjusted risk ratio for MACE in patients receiving DAPT compared with monotherapy was 1.9 (0.93–3.88), P=0.08. There was no difference in MACE between no antiplatelet treatment and monotherapy 1.03 (0.31–3.46), P=0.96. Bleeding was more frequent with DAPT 6.55 (2.3–17.96) P=0.0002. In a propensity matched analysis of 177 patients who received DAPT and 177 monotherapy patients, the risk ratio for MACE with DAPT was 1.83 (0.69–4.85), P=0.32. The risk of bleeding was significantly greater in the DAPT group 4.00 (1.15–13.93), P=0.031. Conclusions: OBTAIN showed an increased risk of bleeding with DAPT and found no evidence for protective effects of DAPT from perioperative MACE in patients who have undergone previous PCI

Serum electrolytes disorders (K,Na,Cl,) after depolirizing drug administration to children

ΣΚΟΠΟΣ ΗΤΑΝ Η ΜΕΛΕΤΗ ΤΩΝ ΜΕΤΑΒΟΛΩΝ ΤΩΝ ΗΛΕΚΤΡΟΛΥΤΩΝ(Κ,ΝΑ,CL) ΤΟΥ ΠΛΑΣΜΑΤΟΣ ΩΣ ΚΑΙ ΤΗΣ ΚΡΕΑΤΙΝΙΚΗΣ ΚΙΝΑΣΗΣ ΚΑΙ ΤΗΣ ΜΥΟΣΦΑΙΡΙΝΗΣ, ΜΕΤΑ ΑΠΟ ΧΟΡΗΓΗΣΗ ΣΚΧ ΣΤΑ ΠΑΙΔΙΑ.ΜΕΛΕΤΗΘΗΚΑΝ 48 ΠΑΙΔΙΑ , ASA I,ΗΛΙΚΙΑΣ 1-14 ΕΤΩΝ ΧΩΡΙΣ ΠΡΟΝΑΡΚΩΣΗ.ΤΑ ΠΑΙΔΙΑ ΚΑΤΑΝΕΜΗΘΗΚΑΝ ΤΥΧΑΙΑ ΣΕ ΔΥΟ ΟΜΑΔΕΣ,ΑΠΟ 24 ΠΑΙΔΙΑ.ΟΜΑΔΑ Ο (ΕΛΕΓΧΟΥ):ΤΑ ΠΑΙΔΙΑ ΕΛΑΒΑΝ ΑΤΡΟΠΙΝΗ 0,1MG/KG ΚΑΙ ΘΕΙΟΠΕΝΤΑΛΗ 5MG/KG.Η ΔΙΑΤΗΡΗΣΗ ΤΗΣ ΑΝΑΙΣΘΗΣΙΑΣ ΓΙΝΟΤΑΝ ΜΕ ΧΟΡΗΓΗΣΗ ΔΙΑ ΜΑΣΚΑΣ ΙΣΟΦΛΟΥΡΑΝΙΟΥ ΣΕ ΜΙΓΜΑ Ο2/Ν2Ο. ΟΜΑΔΑ Ι(ΜΕΛΕΤΗΣ):ΤΑ ΠΑΙΔΙΑ ΕΛΑΒΑΝ ΑΤΡΟΠΙΝΗ 0,1MG/KG, ΘΕΙΟΠΕΝΤΑΛΗ 5MG/KG ΚΑΙ ΣΚΧ 1,2 MG/KG.ΑΚΟΛΟΥΘΗΣΕ ΔΙΑΣΩΛΗΝΩΣΗ ΤΗΣ ΤΡΑΧΕΙΑΣ ΚΑΙ ΔΙΑΤΗΡΗΣΗ ΤΗΣ ΑΝΑΙΣΘΗΣΙΑΣ ΜΕ ΠΑΡΟΧΗ ΙΣΟΦΛΟΥΡΑΝΙΟΥ ΣΕ ΜΙΓΜΑ Ο2/Ν2Ο.ΚΑΘΕ ΟΜΑΔΑ ΔΙΑΧΩΡΙΣΘΗΚΕ ΣΕ 3 ΗΛΙΚΙΑΚΕΣ ΥΠΟΟΜΑΔΕΣ ΑΠΟ 8 ΠΑΙΔΙΑ:ΤΗΝ 1-5,ΤΗΝ 6-10 ΚΑΙ ΤΗΝ 11-14 ΕΤΩΝ.ΜΕΛΕΤΗΘΗΚΑΝ ΟΙ ΤΙΜΕΣ ΤΩΝ ΗΛΕΚΤΡΟΛΥΤΩΝ ΣΤΙΣ ΑΙΜΟΛΗΨΙΕΣ ΤΩΝ 0,1,3,5,ΚΑΙ 15 ΧΡΟΝΙΚΩΝ ΣΤΙΓΜΩΝ ΩΣ ΚΑΙ ΤΗΣ CK ΚΑΙ ΤΗΣ ΜΥΟΣΦΑΙΡΙΝΗΣ ΣΤΙΣ ΧΡΟΝΙΚΕΣ ΣΤΙΓΜΕΣ 0,5 ΚΑΙ 15 ΚΑΙ Η ΚΙΝΗΤΙΚΗ ΑΠΑΝΤΗΣΗ ΤΩΝ ΠΑΙΔΙΩΝ ΒΑΣΕΙ ΚΛΙΜΑΚΑΣ ΠΕΝΤΕ ΒΑΘΜΙΔΩΝ.Η ΚΥΡΙΑ ΜΕΘΟΔΟΣ ΣΤΑΤΙΣΤΙΚΗΣ ΑΝΑΛΥΣΗΣ ΗΤΑΝ Η RM-ANOVA.ΚΑΙ ΣΤΙΣ ΔΥΟ ΟΜΑΔΕΣ ΠΑΡΑΤΗΡΗΘΗΚΕ ΣΤΑΤΙΣΤΙΚΑ ΣΗΜΑΝΤΙΚΗ ΠΤΩΣΗ ΤΩΝ ΗΛΕΚΤΡΟΛΥΤΩΝ (Κ,ΝΑ,CL) ΤΑ ΠΡΩΤΑ ΛΕΠΤΑ,ΠΟΥ ΑΚΟΛΟΥΘΕΙΤΑΙ ΑΠΟ ΑΝΑΚΑΜΨΗ ΑΥΤΩΝ ΣΤΟ 15ΛΕΠΤΟ.ΤΟ Κ ΕΜΦΑΝΙΣΕ ΠΤΩΣΗ ΚΑΙ ΓΙΑ ΤΙΣ ΔΥΟ ΟΜΑΔΕΣ (P<0.0001) ΜΕ ΤΗΝ ΟΜΑΔΑ ΜΕΛΕΤΗΣ ΝΑ ΠΑΡΟΥΣΙΑΖΕΙ ΜΕΓΑΛΥΤΕΡΗ ΑΝΑΚΑΜΨΗ ΤΟ 15'(P=0,0318).ΤΟ ΝΑ ΕΜΦΑΝΙΣΕ ΜΕΓΑΛΥΤΕΡΗ ΠΤΩΣΗ ΤΟ 1' ΚΑΙ ΤΟ 3'(p=0,0371 KAI 0,0490 ΑΝΤΙΣΤΟΙΧΑ) ΣΤΗΝ ΟΜΑΔΑ ΜΕΛΕΤΗΣ.ΤΟ CL ΕΜΦΑΝΙΣΕ ΜΕΓΑΛΥΤΕΡΗ ΠΤΩΣΗ ΤΟ 1'(P=0,0123)ΣΤΗΝ ΟΜΑΔΑ ΜΕΛΕΤΗΣ.Η ΧΟΡΗΓΗΣΗ ΣΚΧ ΠΡΟΚΑΛΕΣΕ ΔΙΑΦΟΡΑ ΣΤΗΝ ΚΙΝΗΤΙΚΗ ΑΠΑΝΤΗΣΗ ΤΩΝ ΠΑΙΔΙΩΝ (p=0,0000123, ΕΛΕΓΧΟΣ ΤΟΥ FISHER).Η ΧΟΡΗΓΗΣΗ ΣΚΧ ΣΤΑ ΠΑΙΔΙΑ ΠΡΟΚΑΛΕΣΕ ΜΙΚΡΗ ΑΝΟΔΟ ΤΗΣ CK ΣΤΟΝ ΧΡΟΝ

Anesthesia Related Toxic Effects on in Vitro Fertilization Outcome: Burden of Proof

Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the in vitro fertilization (IVF) procedures. There are many studies investigating the influence of anesthesia on IVF success. This review article provides an overview of published data regarding the potential toxic effects of different anesthetic techniques (Loco-regional, general anesthesia (GA), and monitored anesthesia care (MAC)), different anesthetic agents, and alternative medicine approach (principally acupuncture) on the IVF outcome. From our analysis, evidence of serious toxicity in humans is not well established. Trials regarding different anesthetic techniques ended up without clear conclusions. Studies about GA came up with conflicting results. A few trials relate GA with lower pregnancy rates, although some others failed to prove this conclusion. Furthermore, detectable amounts of some anesthetic agents are measurable in the follicular fluid but these findings are not strongly associated with toxicity. MAC and Loco-regional anesthesia appear as safe alternative choices and there is evidence of improved outcome. Whereas acupuncture may provide assistance increasing IVF success according to some trials, some others could not obtain these effects. Questions about the appropriate time of application and the underlying mechanism of action are not answered yet, so further investigation should be done. © 2015 Paraskevi Matsota et al

Anesthesia Related Toxic Effects on In Vitro Fertilization Outcome: Burden of Proof

Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the in vitro fertilization (IVF) procedures. There are many studies investigating the influence of anesthesia on IVF success. This review article provides an overview of published data regarding the potential toxic effects of different anesthetic techniques (Loco-regional, general anesthesia (GA), and monitored anesthesia care (MAC)), different anesthetic agents, and alternative medicine approach (principally acupuncture) on the IVF outcome. From our analysis, evidence of serious toxicity in humans is not well established. Trials regarding different anesthetic techniques ended up without clear conclusions. Studies about GA came up with conflicting results. A few trials relate GA with lower pregnancy rates, although some others failed to prove this conclusion. Furthermore, detectable amounts of some anesthetic agents are measurable in the follicular fluid but these findings are not strongly associated with toxicity. MAC and Loco-regional anesthesia appear as safe alternative choices and there is evidence of improved outcome. Whereas acupuncture may provide assistance increasing IVF success according to some trials, some others could not obtain these effects. Questions about the appropriate time of application and the underlying mechanism of action are not answered yet, so further investigation should be done