Safety and effectiveness for oral intake of carbohydrate-rich drink at preoperative 2 hours before painless colonoscopy.

The aim of this study was to evaluate the feasibility, safety, and optimal dose of oral intake of carbohydrate-rich drinks 2 hours before painless colonoscopy. All patients receiving painless colonoscopy were randomly divided into 3 groups: control group (no carbohydrate-rich drink, n = 33), low-dose group (5 mL/kg carbohydrate-rich drink, n = 30), and high-dose group (8 mL/kg carbohydrate-rich drink, n = 30). Use of vasoactive drugs, the visual analog scale including thirst and hunger, degree of satisfaction, the time required for Modified Post Anesthetic Discharge Scoring System scale, first urination time, electrolyte level (sodium, potassium, and calcium), and blood glucose level were also determined. A total of 93 patients were recruited in this study. No significant difference was observed in the cross-sectional area (CSA) of the gastric antrum area at T0 between low- and high-dose groups (P = .912). There was a significant difference in CSA of gastric antrum at 120 minutes after oral intake between the low- and high-dose groups (P = .015). No significant difference was observed in the CSA of gastric antrum at 0 minutes and 120 minutes in the low-dose group (P = .177). In the high-dose group, the CSA of gastric antrum significantly differed at 0 minutes and 120 minutes (P < .001). There was a significant difference in the visual analog scale scores of thirst and hunger at 4 and 5 hours after bowel preparation among 3 groups (P = .001, P = .029, P < .001, P = .001). The degree of satisfaction in low- and high-dose groups was significantly higher than that in the control group (both P < .001). In conclusion, it is feasible and safe to deliver an oral intake of 5 mL/kg carbohydrate-rich drink 2 hours before painless colonoscopy. The comfort level and degree of satisfaction of patients can be further improved.

Comparison of Various Regional Analgesia Methods for Postoperative Analgesic Effects in Video-assisted Thoracoscopic Surgery: A Systematic Review and Network Meta-analysis.

BACKGROUND: The optimal analgesia for video-assisted thoracoscopic surgery (VATS) is still unknown. OBJECTIVES: Our aim was to conduct a network meta-analysis and systematic review to compare the efficacy of different analgesic strategies in VATS. STUDY DESIGN: Bayesian network meta-analysis. METHODS: We searched PubMed, Embase, Medline, Springer, Google Scholar, and Web of Science to evaluate all relevant randomized controlled trials that investigated the analgesic effects of different regional analgesia methods for VATS published through July 2021. After a comprehensive search of electronic databases, the following methods were identified: epidural analgesia (EA), local anesthetics (LA), superficial serratus anterior plane block (SSAPB), deep serratus anterior plane block (DSAPB), erector spinae plane block (ESPB), paravertebral block (PVB), and intercostal nerve block (ICNB). Primary outcomes were the visual analog scale score at rest, at 2 hours, 6 hours and 24 hours postoperatively. The secondary outcomes were postoperative analgesic consumption, incidence of nausea and emesis, and pruritus. RESULT: Overall, 35 trials met our inclusion criteria. EA and PVB were relatively more advantageous in terms of analgesic effect at 2 hours and 6 hours postoperatively; the EA group was superior to the DSAPB, ESPB, and ICNB groups at 24 hours postoperatively. EA was found to be superior to other analgesia techniques for 24 hour postoperative analgesic consumption., PVB showed advantages in reducing postoperative nausea, emesis, and pruritus. LIMITATIONS: Different concentrations and volumes of local anesthetics might affect the analgesic effects of the various analgesia techniques. CONCLUSION: EA and PVB have certain advantages in analgesia, but the incidence of postoperative pruritus after EA is higher. At the same time, considering the risk of coagulation and puncture complications, PVB may be a better choice.

Postoperative analgesic effectiveness of quadratus lumborum block: systematic review and meta-analysis for adult patients undergoing hip surgery.

BACKGROUND: Quadratus lumborum block is a truncal block with several technique variations. It has been reported as providing effective analgesia for postoperative pain. The aim of this study is to determine the efficacy of the QL block in providing postoperative analgesia for hip surgery when compared with placebo or no block or other analgesic techniques. METHODS: Randomized trials evaluating quadratus lumborum block benefits in elective hip surgery were sought. The primary outcome was the 24 h opioid requirement after surgery. Two independent reviewers selected the studies and extracted the data. RESULTS: Thirteen randomized-controlled trials were included in this study. The included studies had significant heterogeneity regarding comparator groups; therefore, a limited quantitative analysis was undertaken for the comparison of QL block versus no block or placebo only. QL block reduced the opioid use by 15.78 (95% CI, 2.31 to 29.26) mg IME in the first postoperative 24 h compared with no block or placebo with no difference in static pain scores, pain grade was reduced by 2.95 (95% CI, 2.40 to 3.60) in the QL block group compared with placebo or no block in the first postoperative 24 h during movement. CONCLUSIONS: Our meta-analysis indicates that QL block may be effective for analgesia in patients after hip surgery compared with placebo or no block. There is currently limited evidence comparing QL block with other analgesic techniques for hip surgery.

A precise navigation device for fixation of patella fractures with modified K-wire tension band:a comparative retrospective study.

BACKGROUND: Traditionally, the technique of modified tension band wires (MTBW) has been the most commonly used surgical procedure. The purpose of this study is to design a precise navigation device that can obtain a standard position of K-wires for (MTBW) and to compare the precise MTBW (P-MTBW) by a navigation device with the conventional MTBW (C-MTBW) by hands in a retrospective study. METHODS: The device was designed by solidworks2012 software (USA), which could provide a precise guidance for obtaining parallel K-wires. Besides, it could set the distance between two K-wires and the level of K-wires below patellar anterior surface. From June 2014 to August 2018, a total of 112 patients were employed in this retrospective study. The patients were divided into P-MTBW group and C-MTBW group according to the surgical technique with or without the precise navigation device. We needed to record and analyze the operation time and the number of fluoroscopy, postoperative internal fixation imaging, knee function and complications. RESULTS: There were 54 patients in P-MTBW group and 58 patients in C-MTBW group. There were statistically significant differences (P < 0.001) in the operation time between P-MTBW group (39.5 ± 4.7; range, 32-49 min) and C-MTBW group (53.7 ± 6.8; range, 42-71 min). The number of intraoperative fluoroscopy was significantly less (P < 0.001) in P-MTBW group (4.2 ± 1.4) versus that of C-MTBW group (8.3 ± 2.7). According to Iowa knee score, there was no significant difference (P = 0.268 at 1 year) in function between the two groups. According to our own evaluation criteria for MTBW, anyone in the P-MTBW group was excellent and 26 patients were excellent, 20 patients were good, and 2 patients were fair in the C-MTBW group. CONCLUSION: The navigation device can reduce operation time and intraoperative fluoroscopy frequency. P-MTBW fixation is an accurate and effective surgical procedure for patella fractures.

Small molecule inhibition of cyclic GMP-AMP synthase ameliorates sepsis-induced cardiac dysfunction in mice.

AIMS: Cardiac dysfunction is the main cause of multi-organ failure following sepsis within critical care units. The present study aimed to investigate the effects of the small molecule inhibition of cyclic GMP-AMP synthase (cGAS), RU.521, on cardiac function in mice with sepsis. MATERIALS AND METHODS: Sepsis was induced in mice via intraperitoneal lipopolysaccharide (LPS) injection (10 mg/kg, i.p.). Mice subsequently received 5 mg/kg RU.521 within 10 min form LPS injection. The cardiac function, inflammatory factor and oxidative stress of mice were examined for 24 h following LPS injection. KEY FINDINGS: RU.521 was indicated to significantly increase the cardiac function of mice with sepsis. In addition, the inflammatory responses, oxidative stress and apoptosis in hearts of sepsis mice were markedly mitigated by RU.521. Moreover, inhibition of Sirt3 inhibited the protective effects of RU.521 on mice with sepsis. SIGNIFICANCE: The current study indicated that RU.521 alleviated the inflammatory response and alleviated the damage induced by oxidative stress, leading to cardiac protection via increased Sirt3 expression in the hearts of mice with sepsis.

Clinical Outcomes in Pediatric Patients Hospitalized with Fulminant Myocarditis Requiring Extracorporeal Membrane Oxygenation: A Meta-analysis.

We conducted a meta-analysis to provide the survival rates for pediatric patients hospitalized with fulminant myocarditis requiring ECMO. The literature search was conducted using Embase, PubMed, MEDLINE and Elsevier for studies published before April 1, 2016. We focus on survival rates for pediatric patients hospitalized with fulminant myocarditis requiring ECMO, and studies that reported only on adult patients were excluded. Summary of the survival rates was obtained using fixed-effect or random-effect meta-analysis which determined by I 2. Six studies were included in the analysis, encompassing 172 patients. The minimum and maximum reported rates of survival to hospital discharge were 53.8 and 83.3%, respectively. The cumulative rate was 107/172. The calculated Cochran Q value was 3.73, which was not significant for heterogeneity (P = 0.588). The I 2 value was 0%. The pooled estimate rate was 62.9% with a 95% confidence interval of 55.3-69.8%. In pediatric patients with cardiac failure who have failed conventional therapies in FM, venoarterial ECMO should be considered. In total, 62.9% of patients with FM and either cardiogenic shock and/or cardiac arrest survived to hospital discharge with ECMO.