ObjectiveTo systematically evaluate the benefits and harms of intraoperative positive end-expiratory pressure (PEEP) to all adult patients suffered surgery, especially on the postoperative mortality and pulmonary outcomes. MethodsWe electronically searched PubMed, EMbase, The Cochrane library (Issue 3, 2012), CBM, CNKI from inception to January 2013, for randomized controlled trials (RCTs) about PEEP for the prevention of pulmonary complications. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality of the included studies. Then meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 8 RCTs involving 336 patients were finally included. The results of meta-analysis showed that there was no difference between two groups in mortality (OR=0.95, 95%CI 0.13 to 6.92, P=0.96). However, the PEEP group had a higher PaO2/FiO2 the first day after surgery (MD=22.98, 95%CI 4.40 to 41.55, P=0.02), while there was no difference 2-3 days after surgery (MD=12.59, 95%CI-6.78 to 31.96, P=0.31). Meanwhile, postoperative atelectasis was less in the PEEP group (OR=0.27, 95%CI 0.08 to 0.9, P=0.03). ConclusionChoosing PEEP mode during general anaesthesia may improve postoperative oxygenation index in the first day after surgery, and reduce pulmonary complications, which has a protective effect on patients pulmonary function. However, it has no marked influence on the prognosis. Because of the limited quality and sampling size of the induced studies, this conclusion still needs to be further proved by more large-scale, multicenter and perspective RCTs.
ObjectiveTo systematically review the effectiveness and safety of anatomic landmarks positioning method (ALM) and real-time two-dimensional ultrasound (RTUS) guidance in the internal jugular vein cannulation. MethodsWe searched PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI for randomized controlled trials (RCTs) concerning the effectiveness and safety of ALM and RTUS in the internal jugular vein catheterization up to May 1st, 2014. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assess methodological quality of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 RCTs involving 1 973 cases were included in the metaanalysis. The results of meta-analysis showed that, compared with the ALM method, the RTUS method reduced puncture failure rate (OR=0.08, 95%CI 0.05 to 0.15, P<0.000 01). For safety, compared with the ALM method, the RTUS method was significantly lower in arterial injury rate (peto-OR=0.22, 95%CI 0.14 to 0.37, P<0.000 01), and the incidence of pneumothorax (peto-OR=0.13, 95%CI 0.04 to 0.40, P=0.000 3). ConclusionCompared to the ALM method, the RTUS method has characteristics such as causing fewer traumas, and having higher success rate and fewer complications. Due to limited quantity and quality of the included studies, the above conclusion still needs to be verified by conducting more studies.
ObjectiveTo systematically evaluate the analgesic efficacy of local infiltration analgesia versus femoral nerve block for total knee arthroplasty. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 4, 2016), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about the analgesic efficacy of local infiltration analgesia versus femoral nerve block for total knee arthroplasty from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The meta-analysis was conducted using RevMan 5.3 software. ResultsA total of 13 RCTs involving 1 001 patients were included. The results of meta-analysis showed that: There were no significant differences in pain scores at rest (SMD=0.02, 95%CI -0.23 to 0.27, P=0.86), morphine consumption on movement (MD=-1.85, 95%CI -4.67 to 0.97, P=0.20), incidence of post-operative nausea and vomiting (RD=0.02, 95%CI -0.03 to 0.08, P=0.41) and incidence of post-operative knee infection (RD=0.01, 95%CI -0.02 to 0.03, P=0.60) between the two groups, but he local infiltration analgesia group had lower length of stay than the femoral nerve block group with statistical difference (SMD=-0.24, 95%CI -0.41 to -0.07, P=0.005). ConclusionLocal infiltration analgesia provides similar postoperative analgesia after total knee arthroplasty to femoral nerve block. However, due to the limited quantity of the included studies, the above conclusion still need to be verified by more high quality studies.