Technique In Adult Patients Research Articles

Single-injection regional analgesia techniques for mastectomy surgery: A network meta-analysis.

Patients undergoing mastectomy surgery experience severe postoperative pain. Several regional techniques have been developed to reduce pain intensity but it is unclear, which of these techniques is most effective. To synthesise direct and indirect comparisons for the relative efficacy of different regional and local analgesia techniques in the setting of unilateral mastectomy. Postoperative opioid consumption at 24 h, postoperative pain at extubation, 1, 12 and 24 h, postoperative nausea and vomiting were collected. Systematic review with network meta-analysis (PROSPERO:CRD42021250651). PubMed, Scopus, the Cochrane Central Register of Controlled Trials (from inception until 7 July 2021). All randomised controlled trials investigating single-injection regional and local analgesia techniques in adult patients undergoing unilateral mastectomy were included in our study without any language or publication date restriction. Sixty-two included studies randomising 4074 patients and investigating nine techniques entered the analysis. All techniques were associated with less opioid consumption compared with controls The greatest mean difference [95% confidence interval (CI)] was associated with deep serratus anterior plane block: mean difference -16.1 mg (95% CI, -20.7 to -11.6). The greatest reduction in pain score was associated with the interpectoral-pecto-serratus plane block (mean difference -1.3, 95% CI, -1.6 to - 1) at 12 h postoperatively, and with superficial serratus anterior plane block (mean difference -1.4, 95% CI, -2.4 to -0.5) at 24 h. Interpectoral-pectoserratus plane block resulted in the greatest statistically significant reduction in postoperative nausea/vomiting when compared with placebo/no intervention with an OR of 0.23 (95% CI, 0.13 to 0.40). All techniques were associated with superior analgesia and less opioid consumption compared with controls. No single technique was identified as superior to others. In comparison, local anaesthetic infiltration does not offer advantages over multimodal analgesia alone. PROSPERO (CRD4202125065).

A comparison of intubating conditions for nasotracheal intubation with standard direct Macintosh laryngoscope versus C-MAC® video laryngoscope employing cuff inflation technique in adult patients.

Background and Aims:While performing laryngoscopy during nasotracheal intubation (NTI), the tip of the advancing endotracheal tube (ETT) generally lies along the posterior pharyngeal wall. The inflation of the ETT cuff brings it anterior towards the glottis. The present study was planned to compare the intubating conditions for NTI with standard direct Macintosh laryngoscope versus C-MAC® video laryngoscope (VL) employing ETT cuff inflation technique.Methods:This prospective randomised study was carried out on 50 patients, American Society of Anesthesiologists physical status I–II, age 18–60 years of either sex with an indication for NTI under general anaesthesia. They were randomly divided into two groups: group VL (n = 25): C-MAC® VL and group ML (n = 25): Macintosh laryngoscope. The primary outcome was to compare the total duration of NTI (T), while the secondary outcomes were to compare the need for cuff inflation or assistance with Magill forceps for successful NTI, the total number of attempts to achieve successful NTI, haemodynamic effects and complications.Results:T was significantly higher in group ML than group VL (P < 0.001). The intubation was successful with cuff inflation in all the patients in group VL, however, six patients of group ML required assistance with Magill forceps (P = 0.022). The haemodynamic parameters were all significantly higher at 3 min in group ML in comparison to group VL.Conclusion:The cuff inflation technique when used along with C-MAC® VL had more success rate, required lesser time and had minimal postoperative complications in comparison to the Macintosh laryngoscope.

Nursing interventions to the person with cardiac disease submitted to ECMO – integrative literature review

Introduction Heart disease includes a variety of diseases, conditions, and disorders that affect the heart and blood vessels [1]. Extracorporeal Membrane Oxygenation (ECMO) is a short-term Ventricular Assist Device (VAD), indicated in cardiogenic shock and respiratory failure, when surgical or conventional therapeutic measures are not successful, and the most used in the case of heart failure is venoarterial ECMO [2,3]. The aim of this study is to understand the ECMO technique in adult patients with cardiac disease, as well as the associated Nursing Interventions. Materials and methods This study is an Integrative Literature Review by the PI[C]OD method. Available articles were searched in the Biblioteca do Conhecimento Online (B-On) and EBSCOhost databases, published between 2014 and 2019. The inclusion criteria were ECMO, person with cardiac disease and successfully nursing interventions. Of the total of twenty-seven articles, 14 were excluded by title, six by the abstract and four by full reading. Three articles were included in the corpus of the study. Results The articles included allowed to identify three main ideas: in the first article, a specific nursing care protocol was developed for patients with VAD [4]; in the second study, VADs can be an intermediary mean for cardiac transplantation [5]; however, in the last study, ECMO may present physical complications and depressive symptoms [2]. Discussion and conclusions Studies have shown that in patients with unstable cardiac pathology “ECMO is life saving, and should therefore be considered a viable extension for conventional treatment options for critical care” [3]. Although VAD is a reliable alternative to transplantation, when it is not available or when the patient's condition is hemodynamically unstable, heart transplantation remains the first-line treatment [5]. We think that the results of this study can subsidise the exercise of teaching nursing care, allowing students to build structured knowledge, which allows to identify the real needs of the person submitted to ECMO. At the level of clinical practice, it is important to discuss the results of this study within the team, ensuring patient safety and the quality of nursing care based on scientific evidence.

Tonsillectomy Outcomes for Coblation Versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis.

There is no consensus on the optimal tonsillectomy technique in adult patients. The study aims to identify all studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary outcomes were hemorrhage and postoperative pain. Secondary outcome measures included return to theatre, analgesia, intraoperative bleeding, diet, tonsillar healing, and operation time. Fixed-effects modeling was used for the analysis. Six studies were identified enrolling a total of 1824 patients. There were no significant differences in terms of reactionary hemorrhage (OR = 1.81, P = .51), delayed hemorrhage (OR = 0.72, P = .20), or postoperative pain (mean difference = -0.15, P = .45); however, there is a general trend favuring coblation. For secondary outcomes, no significant differences noted in terms of intraoperative bleeding, diet, and cases returning to theatre. Analgesia administration was either insignificant or higher in the coblation group. The coblation group had longer operation time and greater healing effect on tonsillar tissue. There were no significant differences in outcomes for coblation and bipolar diathermy for adult tonsillectomy patients in this systematic review and meta-analysis.

Effect of wrist dorsiflexion on ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients: a randomised controlled clinical trial

BackgroundIt is generally recommended to keep the wrist joint mildly dorsiflexed during radial artery catheterisation. However, wrist dorsiflexion might decrease the success rate of radial artery catheterisation with dynamic needle...

Airway management using LMA-evaluation of three insertional techniques-a prospective randomised study.

Background and Aims:Laryngeal Mask Airway [LMA] insertion has become as a basic procedural skill needed for all health care providers. Search for the most successful insertion technique continues. We evaluated the success rate of the three LMA insertion techniques- standard, 90 degree rotational and 180 degree rotational technique.Material and Methods:A total of 180 patients of ASA I-II aged 18-65 years undergoing open superficial surgical procedures with (LMA® Unique™ Airway, Teleflex®, Teleflex Medical Europe Ltd, Ireland) as an airway management device and with neuromuscular blocking agents, were randomly allocated to three groups, in this prospective randomized study. In the standard technique group (n = 60), the LMA was inserted by standard digital intraoral method. In the 90 degree rotational technique group (n = 60), the LMA was rotated counter-clockwise through 90 degree in the mouth and advanced until the resistance of the hypopharynx was felt, and then straightened out in the hypopharynx. In 180 degree rotational technique, LMA was inserted back-to-front, like a Guedel airway. The parameters studied were: the LMA placement success at first attempt, insertion time, need for more than one attempt at insertion, need for external airway manipulations, postoperative sore throat, blood staining and other post-operative (airway related) complications.Results:The first attempt success rate in the standard technique was 83.9%, in 90 degree rotational technique was 75% and 180 degree rotational was 93.5%. The first attempt success rate was higher in 180 degree rotational group compared to 90 degree rotational group (P < 0.05), but there was no statistically significant difference (P > 0.05) between 90 degree rotational group and the standard technique group. There was no statistically significant difference among the two groups in terms of the secondary outcomes.Conclusion:We conclude that 180 degree rotational technique of LMA insertion is more successful than 90 degree rotational technique in adult patients under general anaesthesia.

A comparative study of sevoflurane induction using continuous tidal volume breaths versus three vital capacity breaths technique in adult patients undergoing elective surgical procedures under general anaesthesia

Introduction: Previous studies have shown stable cardiovascular parameters and minimal airway irritation with sevoflurane induction in adults. Also, time taken for induction is comparable to intravenous drugs. The authors planned to conduct a randomized, control study to compare the effect of continuous tidal volume breaths versus three vital capacity breaths for sevoflurane induction on time taken for induction, haemodynamic parameters and intubating conditions in adult patients undergoing elective surgery under general anaesthesia. Materials and Methods: Sixty patients planned to undergo elective surgical procedures under general anaesthesia were included in study. Patients were divided randomly using sealed opaque envelope method in group 1 and group 2 of thirty patients each. Group 1 patients received continuous tidal volume breath and group 2 patients received three vital capacity breaths. The statistical analysis was done using IBM SPSS Statistics Software Version 15.0. The independent samples Student t-test was used to determine the differences in basic clinical characteristics, mean Arterial Pressure, heart Rate, and intubation time between the two groups. Quantitative data were evaluated by chi square test. Any p value less than 0.05 was considered as significant. Result: Variation in heart rate between two groups was statistically significant at 1 min. (p=0.04), 2 min. (p=0.01) and 3 min. (p=0.004) after start of induction. The time taken for loss of consciousness was significantly less in vital capacity induction group. (p Conclusion: Heart rate and mean arterial pressure remain stable during sevoflurane induction in adult patients using three vital capacity breath or tidal volume breath technique. Intubating conditions are better and time taken to lose consciousness is less with vital capacity breaths. Keywords: Sevoflurane, Adult, Tidal volume, Vital capacity.

Thoracic endovascular aortic repair for traumatic aortic injuries: insight from literature and practical recommendations.

Thoracic endovascular aortic repair (TEVAR) for treatment of blunt traumatic aortic injuries (BTAIs) is nowadays the gold standard technique in adult patients, replacing gradually the use of open repair (OR). Although randomized controlled trials will never be performed comparing TEVAR to OR for BTAIs management, trauma and vascular societies guidelines today primarily recommend the former for BTAI patients with a suitable anatomy. The aim of this review was to describe past and recent data published in literature regarding pros and cons of TEVAR treatment in BTAI, and to analyze some debated issues and future perspectives. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Scale for the Assessment of Narrative Review Articles (SANRA) were used to obtain and describe selected articles on TEVAR in BTAI. Young (<50 years) men were the most operated population. The use of TEVAR increased over the years, with a progressive reduction in mortality and overall postoperative complication rates when compared with OR. Lack of information remains about the percentage of urgent cases. TEVAR is considered nowadays the treatment of choice in BTAI patients. In case of aortic rupture (grade IV) the treatment is mandatory, while intimal tear (grade I) and intramural hematoma (grade II) can be safely managed with no operative management (NOM). Debate is still ongoing on grade III (pseudoaneurysms). Unfortunately, several aspects remain not yet clarified, including disease classification, type and grade to treat, timing (urgent versus elective), priority of vascular injuries in polytrauma patients, and TEVAR use in pediatrics and young patients.

Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis.

The goal of the present systematic review is to determine the efficacy of the quadratus lumborum block (QLB) in providing postoperative analgesia for abdominal wall and hip surgeries when compared with placebo or other analgesic techniques. Electronic databases (Medline, Embase, Cochrane Central, and Scopus) were searched for keywords and controlled vocabulary terms related to QLB from their inception to November 2019. The included studies compared ultrasound-guided single-injection QLB to placebo and other analgesic techniques in adult patients. Forty-two randomized-controlled trials provided the data for this systematic review. Eight studies were assessed as high risk of bias in at least one domain. The included studies had significant heterogeneity with regard to the type of surgery, comparator groups, and outcomes measured; therefore, a limited quantitative analysis was undertaken for the comparison of QLB vs no block or placebo in patients undergoing Cesarean delivery only. For Cesarean delivery, the QLB reduced the opioid use by 24.1 (95% confidence interval, 17.3 to 30.9) mg oral morphine equivalents in the first postoperative 24 hr compared with no block or placebo with no difference in pain scores at rest. For other surgical procedures, the pain scores and opioid use were lower in the QLB group when compared with placebo or no regional anesthesia technique. When compared with other regional anesthetic techniques, the analgesic benefit of QLB was marginal. Quadratus lumborum block provided analgesic benefits compared with placebo for use in the abdominal wall and hip surgery, with only marginal benefits compared with other regional analgesic techniques. The identified studies used different variants of QLB in many different surgery types. These findings and conclusions, therefore, should be considered preliminary. PROSPERO (CRD42018095965); registered 6 June 2018.

Terapia nutricional no paciente adulto em oxigenação por membrana extracorpórea: revisão de literatura

Introduction: Extracorporeal membrane oxygenation (ECMO) provides partial or total cardiopulmonary support to patients with severe, acute and reversible cardiac or pulmonary failure. Despite the increasing use of the technique in adult patients, information on nutritional care is scarce. The objective was to investigate available data on the nutritional support of adult patients using ECMO in order to assist in the development of institutional protocols. Methods: A narrative review of the literature was led in order to showing the management of nutritional support, reasons for low nutritional adequacy, nutritional needs and the role of nutrition in ECMO complications. Results: Search strategies identified studies published up to October 11th, 2019. Only primary studies, indexed in the MEDLINE, Scopus and Web of Science data bases were evaluated, resulting in the inclusion of 11 studies. There is evidence that early enteral nutrition is safe and well tolerated and can be initiated via the gastric route. Gastrointestinal dysfunction with high gastric residual volumes is a common finding. However, there is positive evidence of treatment with prokinetic drugs, with the option of using a nasojejunal tube and parenteral nutrition. It is possible to achieve nutritional adequacy (&gt;80%), which is associated with lower mortality. However, malnutrition is recurrent, among the main reasons is the interruption of the diet for therapeutic/diagnostic procedures. Supplemental parenteral nutrition is an important strategy, but it requires special care with the associated administration of glucose and fats. Data on nutritional needs are controversial, as well as the differences in nutritional support and intercurrences between types of ECMO (VA and VV). Conclusion: It is concluded that although most studies are observational retrospective, the evidence shows that nutrition is safe, well tolerated and is associated with lower mortality of patients on ECMO.

Kết quả sớm điều trị thoát vị bẹn ở người trưởng thành bằng phẫu thuật nội soi xuyên thành bụng đặt tấm lưới Prolen ngoài phúc mạc tại Bệnh viện Trung ương Huế - Cơ sở 2

Tóm tắt Đặt vấn đề: Thoát vị bẹn là bệnh lý phổ biến trong ngoại khoa, đặc biệt lĩnh vực ngoại tiêu hóa. Từ khi phẫu thuật nội soi ra đời và ứng dụng tấm nhân tạo trong điều trị thoát vị bẹn, đã có những thay đổi trên thế giới về điều trị cho người bệnh thoát vị bẹn. Phương pháp phẫu thuật nội soi đặt tấm nhân tạo đường xuyên phúc mạc TAPP (Trans-Abdominal Pre-Peritoneal) có nhiều ưu điểm như đường cong huấn luyện ngắn, phát hiện thoát vị bẹn đối bên và điều trị cả trường hợp có biến chứng, nên được nhiều phẫu thuật viên trẻ lựa chọn. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả, theo dõi dọc 19 người bệnh với 21 trường hợp thoát vị bẹn được phẫu thuật TAPP tại Bệnh viện Trung ương Huế - Cơ sở 2 từ tháng 12/2018 đến 3/2019. Kết quả: Tuổi trung bình 66,8 ± 14,35. Thoát vị bẹn nghẹt 4,8%. Thoát vị bẹn cầm tù 9,5%. Thời gian phẫu thuật trung bình một bên 65,3 ± 19,6 phút, hai bên 102,5 ± 12,5 phút. Thời gian hậu phẫu trung bình 4,1 ± 1,6 ngày. Phát hiện 2 trường hợp thoát vị bẹn đối bên. Sau 3 tháng không có trường hợp nào tái phát. Kết luận: Phẫu thuật TAPP là một phẫu thuật an toàn, hiệu quả có thể ứng dụng rộng rãi. Abstract Introduction: Inguinal hernia repair is one of the most common operation performed in general surgery, especially in digestive field. Since the introduction of laparoscopic repair and application of synthetic mesh to treatment, the trends have changed in the last decade in treatment for inguinal hernia. The laparascopic trans-abdominal pre-peritoneal (TAPP) has a short learning cure. TAPP has many advantages, such as wide dissection, contralateral side checkup, treatment strangulated hernia and incarcerated hernia, a short learning cure has been the first choice for surgeons. Materials and Methods: Study subjects included 19 patients with 21 inguinal hernia cases treated by laparoscopic trans-abdominal pre-peritoneal (TAPP) technique at the Hue Central Hospital - Base 2 from 12/2018 though 3/2019. Descriptive and prospective follow-up study. Results: The mean age was 66,8 ± 14,35 years old. Strangulated hernia and incarcerated hernia respectively accounted for 4,8% and 9.5% of cases. The mean durations of unilateral inguinal hernia repair and bilateral inguinal repair were 65,3 ± 19,6 mins and 102,5 ± 12,5 mins, respectively. Mean duration of postoperative stay was 4,1 ± 1,6 days. 2 case (3.2%) with contralateral inguinal hernia were detected. At 3-months evaluation, there was no recurrence. Conclusion: TAPP is a safe and effective surgical technique; should be encouraged and widely applied in different levels hospitals. Keyword: inguinal hernia, TAPP, laparoscopic surgery, mesh.

Videolaryngoscopy for transesophageal echocardiography probe insertion: a systematic review and meta-analysis of randomized controlled trials.

Transesophageal echocardiography (TEE) is a well-established procedure, but serious complications may occur. This systematic review and meta-analysis assessed the utility of videolaryngoscopy-assisted technique in TEE probe insertion. We performed a systematic search in MEDLINE, EMBASE, CENTRAL, and ICTRP. We included RCTs comparing TEE probe insertion techniques assisted with videolaryngoscopy and with any other insertion technique in adult patients. Primary outcome measures were (1) the number of attempts before successful TEE probe insertion, and (2) the risk of any procedural injury to related structures. The secondary outcome measure was time to TEE probe insertion. In total, three studies (n = 266) were included in this systematic review. Overall, a significantly less number of attempts were required with videolaryngoscopy-assisted insertion (mean difference [MD] - 0.60; 95% confidence interval [CI] - 0.73, - 0.46; low quality of evidence). Videolaryngoscopy-assisted technique was also associated with smaller risk of complications (risk ratio [RR] 0.17; 95% CI 0.05, 0.62; low quality of evidence). There was no significant difference in time to probe insertion (MD - 8.57; 95% CI - 26.31, 9.16; very low quality of evidence). The use of videolaryngoscopy for TEE probe insertion is associated with a significant reduction in the number of attempts and complication rate.

Effect of pharmacist-led interventions on medication adherence and inhalation technique in adult patients with asthma or COPD: A systematic review and meta-analysis.

In patients with asthma and chronic obstructive pulmonary disease (COPD), disease control is still suboptimal-incorrect inhalation technique and medication non-adherence are two important reasons for this outcome. Pharmacists' interventions have been shown to have a positive effect on the clinical outcomes of asthma and COPD. Quantitative assessment of the efficacy of pharmacist-led interventions, mainly on inhalation techniques and medication adherence, is needed. Evidence for different interventions is not totally conclusive, and no results of theory-based adherence promotion interventions for asthma and COPD have been published. The objective of our study is to evaluate the effect of pharmacist-led interventions on asthma and COPD management, focusing mainly on inhalation technique and medication adherence, and whether the content of interventions (categorized based on Information-Motivation-Behavioural skills (IMB) model) affects the effectiveness and whether the IMB model is worthy of clinical promotion and application in adults with asthma or COPD. The PubMed, EMBASE, The Cochrane Library, Web of Science and ClinicalTrials.gov databases were searched for randomized controlled trials that involved pharmacist-led interventions among patients with asthma or COPD. We used database-specific vocabulary (eg, Medical Subject Headings) and free text terms expanding from 'asthma', 'COPD' and 'pharmacist' to identify relevant articles. Two reviewers independently selected the studies, assessed the risk of bias and extracted the data. The meta-analysis was performed in Review Manager 5.3 provided by the Cochrane Collaboration. PROSPERO registration number: CRD42019144793. Thirteen studies were eligible for qualitative analysis, and 12 studies were included in the meta-analysis. Pharmacist-led interventions showed a positive effect on medication adherence (1.34 [95% CI 1.18-1.53], P<.0001) and inhalation technique (1.85 [95% CI 1.57-2.17], P<.00001) in COPD and asthma patients. In the subgroup meta-analysis, significant medication adherence improvement was found only in COPD patients (1.41 [1.24-1.61], P<.0001). The subgroup meta-analysis also noted that interventions that included all three Information-Motivation-Behavioural skills (IMB) constructs had a significant improvement in medication adherence (1.41 [1.24-1.61], P<.0001). Subgroup meta-analysis conducted between different diseases, different intervention contents, and different measure tools did not significantly change the heterogeneity. Pharmacist-led interventions can improve inhalation technique in adult asthma and COPD patients. Significant improvement in medication adherence was found only in COPD patients. The effect among asthmatic patients requires further study. Interventions based on the IMB model may be worthy of clinical promotion and application. More future research is needed to establish solid evidence base for effective interventions and uniform measurement of medication adherence.

Ultrasound-guided caudal epidural anesthesia in adults for anorectal procedures

Introduction:Caudal epidural is a commonly performed regional anesthetic technique in children. In adults, the high-failure rates associated with landmark-based techniques deter its widespread use. Fluoroscopy-guided caudal epidural steroid injections are widely used as a treatment modality in chronic back pain. Ultrasound (US) guidance has been shown to be equally effective as fluoroscopic-guided caudal injections. We aimed to assess the feasibility of US guided caudal epidurals as a sole anesthesia technique in adult patients undergoing minor anorectal procedures.Subjects and Methods:Fifty consecutive adult patients undergoing elective minor anorectal procedures were recruited for this study. Eligible patients received US-guided caudal epidural and success rates, surgical patient and surgeon's comfort were assessed using validated tools. Any adverse events were also observed.Results:The block was successful in all patients. One patient had pain in the perianal region requiring skin infiltration. All patients were either highly satisfied or satisfied of the procedure. Surgeons rated the surgical conditions as highly satisfied (90%), satisfied (8%), or unsatisfied (2%). Two patients rated the caudal injections were of moderate pain, rest all rated it as mildly painful. One patient experienced a single episode of urinary incontinence.Conclusion:US-guided caudal epidural can be considered as an option for anorectal procedures of short duration with acceptable success rates, surgical conditions, and patient comfort.

Tracheal intubation in patients at risk for cervical spinal cord injury: A systematic review.

Tracheal intubation in patients at risk for secondary spinal cord injury is potentially difficult and risky. To compare tracheal intubation techniques in adult patients at risk for secondary cervical spinal cord injury undergoing surgery. Primary outcome was first-attempt failure rate. Secondary outcomes were time to successful intubation and procedure complications. Systematic review and meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA). Databases searched up to July 2019. Randomized controlled trials comparing different intubation techniques. We included 18 trials enrolling 1972 patients. Four studies used the "awake" approach, but no study compared awake versus non-awake techniques. In remaining 14 RCTs, intubation was performed under general anesthesia. First-attempt failure rate was similar when comparing direct laryngoscopy or fiberoptic bronchoscopy versus other techniques. A better first-attempt failure rate was found with videolaryngoscopy and when pooling all the fiberoptic techniques together. All these results appeared not significant at TSA, suggesting inconclusive evidence. Intubating lighted stylet allowed faster intubation. Postoperative neurological complications were 0.34% (no significant difference among techniques). No life-threatening adverse event was reported; mild local complications were common (19.5%). The certainty of evidence was low to very low mainly due to high imprecision and indirectness. Videolaryngoscopy and fiberoptic-assisted techniques might be associated with higher first-attempt failure rate over controls. However, low to very low certainty of evidence does not allow firm conclusions on the best tracheal intubation in patients at risk for cervical spinal cord injury.

Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis.

Previous meta-analyses assessing anesthetic techniques in adult patients undergoing hip fractures surgery are available. However, whether the anesthetic technique is associated with risk of mortality and complications in geriatric patients with hip fractures remains unclear. This study was conducted to assess postoperative outcomes of anesthesia technique in geriatric patients undergoing hip fracture surgery. Cochrane Library, PubMed, EMBASE, MEDLINE, CNKI, and CBM were searched from inception up to May 25, 2018. Observational studies and randomized controlled trials (RCTs) that assessed the perioperative outcomes of technique of anesthesia (general or regional [epidural/spinal/neuraxial]) in geriatric patients (≥60 years old) undergoing hip fracture surgery were included. Two investigators independently screened studies for inclusion and performed data extraction. Heterogeneity was assessed by the I and Chi-square tests. The odds ratio (OR) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CI) were calculated to assess the pooled data. Eleven retrospective and 2 RCTs were included. There was no difference in 30-day mortality (OR = 0.96; 95% CI 0.86-1.08; P = .51) between the general and regional anesthesia groups. In-hospital mortality (OR = 1.26; 95% CI 1.17-1.36; P < .001), acute respiratory failure (OR = 2.66; 95% CI 2.34-3.02; P < .001), length of hospital stay (MD = 0.33; 95% CI 0.24-0.42; P < .001), and readmission (OR = 1.09; 95% CI 1.01-1.18; P = .03) were significantly reduced in the regional anesthesia group. Pneumonia (OR = 0.99; 95% CI 0.91-1.07; P = .79), heart failure (OR = 0.97; 95% CI 0.86-1.09; P = .62), acute myocardial infraction (OR = 1.07; 95% CI 0.99-1.16; P = .10), acute renal failure (OR = 1.32; 95% CI 0.97-1.79; P = .07), cerebrovascular accident (OR = 1.08; 95% CI 0.82-1.42; P = .58), postoperative delirium (OR = 1.51; 95% CI 0.16-13.97; P = .72), and deep vein thrombosis/pulmonary embolism (OR = 1.42; 95% CI 0.84-2.38; P = .19) were similar between the two anesthetic techniques. General anesthesia is associated with increased risk of in-hospital mortality, acute respiratory failure, longer hospital stays, and higher readmission. There is evidence to suggest that regional anesthesia is associated with improved perioperative outcomes. Large RCTs are needed to explore the most optimal anesthetic techniques for geriatric patients with hip fractures before drawing final conclusions. CRD42018093582.

Ultrasound-Guided Artery Cannulation Technique Versus Palpation Technique in Adult Patients in Pre-Anesthesia Room: A Randomized Controlled Trial.

BackgroundThe ultrasonography-guided technique is superior to the traditional palpation technique for artery cannulation. However, considering the complexity of assembling the ultrasonography machine, this technique has not been extensively used. Here, we compared the ultrasonography-guided technique with the traditional palpation technique in adult patients in the pre-anesthesia room.Material/MethodsA total of 66 patients were enrolled and divided into 2 groups: the ultrasonography group and the palpation group. Anesthesiologists then cannulated the radial artery via either method. The primary outcomes included the first-attempt success and total success rates, as well as the cannulation duration and total procedure duration. The secondary outcome was the rate of complications attributable to cannulation.ResultsOverall, 60 patients were analyzed in the present study. The first-attempt success rate in the ultrasonography group (96.6%) was significantly higher than that in the palpation group (73.3%; P=0.03). There was no significant difference in the cannulation duration and the total procedure duration between the 2 groups. The rate of complications caused by cannulation in 2 groups was similar.ConclusionsThe ultrasonography-guided radial artery cannulation technique is more efficient for arterial cannulation in the pre-anesthesia room compared with the traditional palpation method.

Diagnostic imaging for acute abdominal pain in an Emergency Department in Italy

Imaging plays a key role in the diagnostic work-up of patients with non-traumatic acute abdominal pain (AAP) in emergency department (ED). We aimed to evaluate the use and diagnostic performance of imaging techniques in adult patients with AAP in an ED in Italy. Patients with non-traumatic AAP admitted at the ED of S. Orsola-Malpighi University Hospital of Bologna (Italy) from the 1st to the 30th November 2016 were included. Demographic and clinical data, data on radiological procedures and discharge diagnosis were collected. Sensitivity and specificity for detecting acute diseases were assessed using the discharge diagnosis from the ED as reference standard. Of the 578 patients (female 52.8%, mean age 51.3years) admitted to the ED for AAP, 433 (74.9%) underwent abdominal imaging. The most frequent techniques used were abdominal plain radiography and ultrasonography (US), performed in 38.4% and 37.9% of patients, respectively, followed by computed tomography (CT) in 28% of patients. Plain radiography yielded a sensitivity of 28% and specificity of 91.1%; the sensitivity increased to 79.4% in patients with small bowel obstruction. Ultrasonography's sensitivity and specificity were 61.8% and 98.4%, respectively; the sensitivity of US reached 85.2% and 90% in patients with acute cholecystitis/biliary colic and urolithiasis, respectively. The sensitivity and specificity of CT were 87.8% and 92.9%, respectively. Plain radiography is still overused in the diagnostic work-up of AAP in ED in Italy, despite its unsatisfactory sensitivity. Ultrasonography and CT has a higher sensitivity and should be used as first-level imaging in most patients.

Current approaches to pharmacological treatment of adult patients with bronchiectasis

Bronchiectasis is a chronic airway disease. Currently, no evidence-based recommendations on pharmacological treatment of bronchiectasis have been developed in the world. Published data is not sufficient to clear assessment of efficacy of pharmacological and non-pharmacological treatment for those patients. The main goals of treatment of bronchiectasis are to prevent exacerbations, to control symptoms, to improve quality of life, and to slow down progression of the disease. This article is a review of published data on efficacy and a role of selected pharmacological therapies of bronchiectasis and bronchial clearance techniques in adult patients.

Meta-analysis of patient-reported outcomes after laparoscopic versus open inguinal hernia repair

Inguinal hernia repair is a common low-risk intervention. Patient-reported outcomes (PROs) are being used increasingly as primary outcomes in clinical trials. The aim of this study was to review and meta-analyse the PROs in RCTs comparing laparoscopic versus open inguinal hernia repair techniques in adult patients. A systematic review and meta-analysis was carried out in accordance with PRISMA guidelines. Only RCTs in peer-reviewed journals were considered. PubMed, Ovid Embase, Scopus and the Cochrane Library were searched. In addition, four trial registries were searched. The search interval was between 1 January 1998 and 1 May 2018. Identified publications were reviewed independently by two authors. The review was registered in the PROSPERO database (CRD42018099552). Bias was assessed using the Cochrane Collaboration risk-of-bias tool. Some 7192 records were identified, from which 58 unique RCTs were selected. Laparoscopic hernia repair was associated with significantly less postoperative pain in three intervals: from 2 weeks to within 6 months after surgery (risk ratio (RR) 0·74, 95 per cent c.i. 0·62 to 0·88), 6 months to 1 year (RR 0·74, 0·59 to 0·93) and 1 year onwards (RR 0·62, 0·47 to 0·82). Paraesthesia (RR 0·27, 0·18 to 0·40) and patient-reported satisfaction (RR 0·91, 0·85 to 0·98) were also significantly better in the laparoscopic repair group. The data and analysis reported in this study reflect the most up-to-date evidence available for the surgeon to counsel patients. It was constrained by heterogeneity of reporting for several outcomes.