Efficacy of epidural local anesthetic and dexamethasone in providing postoperative analgesia: A meta-analysis.

BACKGROUND: Dexamethasone is a potent anti-inflammatory, analgesic, and antiemetic drug. Individual randomized controlled trials found a possible benefit of epidural dexamethasone. The purpose of this meta-analysis is to estimate the benefit of epidural dexamethasone on postoperative pain and opioid consumption and to formulate a recommendation for evidence-based practice. MATERIALS AND METHODS: Prospective, randomized controlled trials comparing the analgesic efficacy of epidural local anesthetic and dexamethasone combination, with local anesthetic alone for postoperative pain management after abdominal surgery, were planned to be included in this meta-analysis. PubMed, PubMed Central, Scopus, and Central Register of Clinical Trials of the Cochrane Collaboration (CENTRAL) databases were searched for eligible controlled trials using the following search words: "Epidural", "dexamethasone", and "postoperative pain", until February 20, 2015. RESULTS: Data from five randomized control trials have been included in this meta-analysis. Epidural dexamethasone significantly decreased postoperative morphine consumption (mean difference -7.89 mg; 95% confidence interval [CI]: -11.66 to -3.71) and number of patients required postoperative rescue analgesic boluses (risk ratio: 0.51; 95% CI: 0.41-0.63). CONCLUSION: The present data shows that the addition of dexamethasone to local anesthetic in epidural is beneficial for postoperative pain management.

Lumbotomy approach for upper urinary tract surgeries in adolescents: feasibility and challenges.

OBJECTIVE: The objective of this study was to assess the feasibility and challenges in a lumbotomy approach for performing upper urinary tract surgeries in adolescent children. MATERIAL AND METHODS: Fifty-five adolescent children underwent various upper urinary tract surgeries from 2000 to 2012. In all patients, the kidneys and ureters were approached via a lumbotomy incision. The patients' characteristics were analysed from the hospital charts. Intraoperative and postoperative details were gathered from individual case files. Data were collected regarding: age, weight, gender, diagnosis, surgical procedure, anaesthetic details, any intraoperative problems encountered, postoperative pain, time to oral feed, length of hospitalisation and any complications. RESULTS: The median age at surgery was 14 years (range 10-19). There were 42 boys and 13 girls. Median weight was 41 kg (range 28-52 kg). Surgeries performed were pyeloplasty, pyelolithotomy, nephroureterectomy and heminephrectomy. Mean duration of surgery was 80 min (range 60-130 min) with no special anaesthetic requirements. No intraoperative problems were encountered. In all patients, postoperative stay was uneventful with minimal analgesic requirements and oral feeding was started the very next day. There were no incision-related complications. CONCLUSIONS: A lumbotomy incision is technically easy and safe, even in adolescent children, as an approach for upper urinary-tract surgeries.

Comparative efficacy and safety of the Ambu(®) AuraOnce(™) laryngeal mask airway during general anaesthesia in adults: a systematic review and meta-analysis.

Previous comparisons between the Ambu(®) AuraOnce(™) and other laryngeal mask airways have revealed different results across various clinical studies. We aimed to perform a systematic review with meta-analysis on the efficacy and safety of the AuraOnce compared with other laryngeal mask airways for airway maintenance in adults undergoing general anaesthesia. Our search of PubMed, PubMed Central, Scopus and the Central Register of Clinical Trials of the Cochrane Collaboration yielded nine randomised controlled trials eligible for inclusion. Comparator laryngeal mask airways were the LMA Unique(™) (four trials), the LMA Classic(®) (five trials) and the Portex(®) Soft Seal(®) (three trials). The AuraOnce provided an oropharyngeal leak pressure higher than the LMA Unique (304 participants, mean (95% CI) difference 3.1 (1.6-4.7) cmH2 O, p < 0.0001) and equivalent to the LMA Classic. The Soft Seal provided a higher leak pressure than the AuraOnce (229 participants, mean (95% CI) difference 3.5 (0.4-6.7) cmH2 O, p = 0.03). Insertion was significantly faster with the AuraOnce than the LMA Unique (304 participants, mean (95% CI) difference 5.4 (2.1-8.71) s, p = 0.001) and Soft Seal (229 participants, mean (95% CI) difference 9.5 (3.0-15.9) s, p = 0.004), but similar to the LMA Classic. The first-insertion success rate of the AuraOnce was equivalent to the LMA Unique, LMA Classic and Soft Seal. We found a higher likelihood of bloodstaining on the cuff with the Soft Seal and a higher incidence of sore throat with the LMA Classic. We conclude that the AuraOnce is an effective alternative to the LMA Classic and LMA Unique, and easier to insert than all three other devices studied.

Anaesthetic management of emergency caesarean section in a patient with seizures and likely raised intracranial pressure due to tuberculous meningitis.

We report the anaesthetic management of a term pregnant woman with active tuberculous meningitis, who had experienced seizures, had signs of raised intracranial pressure and required emergency caesarean section. Peripartum anaesthetic management of a patient with tuberculous meningitis is a rare event.