【摘要】 目的 评价α2受体激动剂是否可以降低七氟烷引起的小儿术后躁动的发生率。 方法 通过检索Medline、荷兰医学文摘、Cochrane临床试验数据库、中国生物医学文献数据库和中国期刊网全文数据库等数据库，收集可乐定或右美托咪啶对七氟烷引起的小儿术后躁动的预防作用的随机对照试验（randomized controlled trial，RCT），提取资料和评估方法学质量，采用Cochrane协作网RevMan 5.0软件进行Meta分析。 结果 最终纳入11个RCT，其中104例患儿预防性使用右美托咪啶，268例患儿使用可乐定，365例患儿使用安慰剂。Meta分析显示，可乐定组小儿术后躁动发生率的比值比（OR）为0.31，95%CI为（0.15，0.61）（P=0.000 8）；右美托咪啶组小儿术后躁动发生率的OR为0.16，95%CI为（0.08，0.31）（Plt;0.000 01）。 结论 α2受体激动剂可以显著降低七氟烷引起的小儿术后躁动的发生率。【Abstract】 Objective To determine whether alpha2-adrenoceptor agonists can decrease emergence agitation (EA) in pediatric patients after sevoflurane anesthesia. Methods The Medline, Embase, Cochrane Library, CBM and CNKI were searched. All randomized controlled trials comparing clonidine or dexmedetomidine with other interventions in preventing emergence agitation after sevoflurane anesthesia were retrieved. Study selection and assessment, data collection and analyses were undertaken. Meta-analysis was done using the Cochrane Collaboration RevMan 5.0 software. Results Eleven articles reached our inclusion criteria and were included in the Meta-analysis. A total of 104 children treated with dexmedetomidine, 268 children treated with clonidine, and 365 children treated with placebo were evaluated for the incidence of emergence agitation. The pooled odds ratio for the clonidine subgroup was 0.31, with a 95% confidence interval of 0.15-0.61 (P=0.000 8). The pooled odds ratio for the dexmedetomidine subgroup was 0.16, with a 95% confidence interval of 0.08-0.31 (Plt;0.000 01). Conclusion Alpha2-adrenoceptor agonists can significantly decrease the incidence of emergence agitation in pediatric patients after sevoflurane anesthesia.
Objective To systematically assess the effectiveness and safety of ProSeal laryngeal mask (PLMA) compared to endotracheal tube (TT) for airway management in the patients undergoing laparoscopic biliary tract surgery.Methods Using the Cochrane systematic review methods, we searched the Cochrane Controlled Trial Registers (CCTR) of The Cochrane Library, MEDLINE, VIP, and CNKI databases through May 2008. We also handsearched relevant journals and conference proceedings. Two reviewers independently selected studies and assessed the quality of the trials. Disagreements were resolved by discussion, in consultation with a third reviewer. RevMan 4.2 software provided by the Cochrane Collaboration was used for meta-analysis which was performed for combining the results of homogeneitystudies. Results Seven studies involving 493 patients undergoing laparoscopic biliary tract surgery were included. Meta analysis results showed that: ① Side effects: none of the patients experienced regurgitation or hypoventilation. ② PLMA was superior to TT in terms of less postoperative sore throat (OR=0.27, 95%CI 0.13 to 0.53, P=0.0002) and response during extubation (OR=0.01, 95%CI 0.00 to 0.03, Plt;0.00001). ③ PLMA was similar to TT in terms of effective ventilation during peritoneal insufflation (Ppeak: WMD=0.01, 95%CI -0.66 to 0.68, P=0.98; PetCO2: WMD=0.01, 95%CI -0.58 to 0.59, P=0.99) and ease of insertion (OR=0.58, 95%CI 0.23 to 1.47, P=0.25). ④ Hemodymatics changed during the procedure: PLMA was more stable than TT. Conclusion It is safe to use PLMA for ventilation in laparoscopic biliary tract surgery. However, up to now, we still cannot draw a definite conclusion due to the low quality of the included studies, and more high quality trials of PLMA airway management for laporoscopic surgery are needed.
Objective To assess the efficacy and safety of nerve-stimulator-guide needle placement in the peripheral nerve blockade. Methods The Cochrane Library, MEDLINE, OVID, VIP, CNKI and CBM were searched. The quality of the included studies was evaluated by three reviewers, and meta-analysis was performed. Results Twenty studies involving 1 287 participants related to needle placement in the peripheral nerve blockade were included. There were only 2 studies that described a detailed randomization method and allocation concealment and blinding, and the others were inadequate. Meta-analysis based on the included studies showed that: ① Absolute success ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR= 4.05, 95%CI 2.57 to 6.36, Plt;0.00001) and anatomy localization (OR=30.3, 95%CI 1.73 to 532.74, P=0.02), but lower than ultrasound-guide-localization (OR=0.27, 95%CI 0.10 to 0.74, P=0.01). ② Onset time of the block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD= –1.70, 95%CI –?4.50 to 0.95, P=0.08), faster than arteriopalmus localization (WMD= 8.38, 95%CI 0.72 to 16.04, Plt;0.000 01), but slower than ultrasound-guide-localization (WMD= 8.38, 95%CI 0.72 to 16.04, P=0.04). ③ Ratio of complication associated to block: nerve-stimulator-guide was similar to eliciting paraesthesia (OR= 1.01, 95%CI 0.55 to 1.86, P=0.97), anatomy localization (WMD= 0.06, 95%CI 0.00 to 1.21, P=0.07) and arteriopalmus localization (WMD= 8.82, 95%CI 0.10 to 4.11, P=0.65), but higher than ultrasound-guide-localization (OR= 5.03, 95%CI 1.74 to 14.49, P=0.003). ④ Time to block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD=0.02, 95%CI –0.46 to 0.51, P=0.92), shorter than arteriopalmus localization (WMD= –4.00, 95%CI –5.58 to –2.42, Plt;0.000 01) and longer than ultrasound-guide-localization (WMD= 1.90, 95%CI 0.47 to 3.33, P=0.009). ⑤ Patient-accepted ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR=2.32, 95%CI 1.02 to 5.30, P=0.05), and similar to arteriopalmus localization (OR=8.14, 95%CI 0.88 to 75.48, P=0.06). Conclusion Nerve-stimulator-guide location is a precise, effective and safe localization method. Due to moderate risk of selection bias and detection bias of included studies, the evidence is not b. Our results suggest that well-designed double-blind randomized controlled and larger-scale trials on the use of nerve stimulator in the peripheral nerve block are needed.