Attenuation of the increase in intraocular pressure with dexmedetomidine: Systematic review with meta-analysis and trial sequential analysis

A sulfonated supramolecular host based on pillar[5]arene for succinylcholine-induced neuromuscular blockade reversal

A per-sulfonated pillar[5]arene (SP[5]A) is designed as a reversal agent to reverse neuromuscular blockade induced by succinylcholine (Sch) via host-guest recognition. SP[5]A can rapidly and specifically recognize and encapsulate Sch in vivo for elimination with a binding affinity as high as 105 M-1. SP[5]A mitigates Sch-induced adverse reactions including hyperkalemia, arrhythmias, and rhabdomyolysis.

Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthetics in Peribulbar Block: A Meta-analysis With Trial-Sequential Analysis

PURPOSE

To assess the role of dexmedetomidine as an adjuvant to local anesthetics (LA) in enhancing the duration and quality of peribulbar blocks for ophthalmic surgeries.

DESIGN

Systematic review with meta-analysis and trial sequential analysis.

METHODS

We systematically searched MEDLINE, Embase, and Cochrane for randomized controlled trials involving adult patients undergoing ophthalmic surgery under peribulbar block, comparing LA alone vs LA + dexmedetomidine. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals were computed using a random-effects model. Sensitivity and trial-sequential analyses were performed to assess inconsistencies and weight type I and II errors, and estimate the required information size of the samples for all end points.

RESULTS

Sixteen randomized controlled trials (1220 patients) were included. Compared with LA alone, dexmedetomidine was associated with prolonged (1) motor block duration (MD: 65.01 minutes, P < .001), (2) sensory block duration (MD: 81.94 minutes, P < .001), (3) reduced intraocular pressure (MD: -2.6 mm Hg, P < .001), and (4) decreased need for supplemental injections (RR: 0.44, P = .007). In addition, dexmedetomidine showed (5) longer time to analgesic request (MD: 97.15 minutes, P < .001) and (6) increased surgeon satisfaction (RR: 1.52, P = .01). Sensitivity analyses and trial-sequential analyses were consistent across all end points, and the required information size was achieved for most end points, indicating that pooled analyses were reliable and sample sizes were sufficient.

CONCLUSIONS

Compared with LA alone, dexmedetomidine significantly prolonged sensory and motor block duration and the time to the first analgesic request; moreover, it decreased intraocular pressure and the need for supplemental injections, while increasing surgeon satisfaction.

Effects of opioids administered via intravenous or epidural patient-controlled analgesia after caesarean section: A network meta-analysis of randomised controlled trials

Background

Post-caesarean section analgesia is important physiologically and psychologically for both mothers and infants. Patient-controlled analgesia is a well-established method of administering opioids for postoperative pain. However, to date, no study has systematically investigated the effects of opioids administered through intravenous patient-controlled analgesia (IVPCA) or patient-controlled epidural analgesia (PCEA) in parturients who have undergone caesarean section.

Methods

This systematic review and network meta-analysis aimed to evaluate the analgesic and adverse effects of opioids administered via IVPCA or PCEA in parturients who have undergone a caesarean section. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched from inception through 02 10, 2022 for relevant records. Randomised controlled trials (RCTs) that compared opioids administered via IVPCA or PCEA and reported outcomes of interest were included. Studies were excluded if the solution for patient-controlled analgesia contained antiemetics and/or other analgesics in addition to opioids. The methodological quality of RCTs was assessed using the revised Cochrane Risk of Bias Tool. Summary data were extracted from each eligible study. The primary outcome was pain intensity, and the secondary outcomes were opioid-related adverse effects. Frequentist network meta-analyses were performed using a contrast-based random-effects model. This study is registered with PROSPERO, CRD42021254040.

Findings

Twenty-three studies with 2589 parturients were included. Compared with IVPCA morphine as a reference treatment, PCEA fentanyl had better analgesic effects at 4 h (mean difference [MD] in the visual analogue scale score, -0.75; 95% confidence interval [CI] [-1.16, -0.34]) and 8 h (MD, -0.93; 95% CI [-1.57, -0.28]) and yielded lower odds of developing nausea/vomiting (odds ratio [OR], 0.27; 95% CI [0.09, 0.80]) and sedation/drowsiness (OR, 0.22; 95% CI [0.11, 0.45]). However, PCEA fentanyl may be more likely to cause pruritus than IVPCA treatments.

Interpretation

Considering the analgesic efficacy; opioid-induced nausea, vomiting, and sedation; and the well-being of breastfed infants, PCEA fentanyl may be the treatment of choice for post-caesarean section analgesia.

Funding

The Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (TCRD-TPE-111-27).

Effects of Short-Acting Opioids on Intraocular Pressure during General Anesthesia: Systematic Review and Network Meta-Analysis

Intraocular pressure (IOP) is crucial to the well-being of eyes. During anesthesia, the administration of succinylcholine and endotracheal intubation are associated with an increase in IOP, which may be attenuated by short-acting opioids. However, the drug of choice among the commonly used short-acting opioids is unclear. This study aimed to evaluate the effects of fentanyl, sufentanil, alfentanil, and remifentanil on IOP measured after the administration of succinylcholine and after endotracheal intubation in patients undergoing general anesthesia. Five databases were searched. Randomized controlled trials (RCTs) that compared short-acting opioids and reported at least one of the clinical outcomes of interest were included. Nine RCTs with 357 patients were included. Remifentanil (1 μg kg-1) more effectively alleviated the increase in IOP than the placebo after the administration of succinylcholine [mean difference (MD) of IOP, -3.64; confidence interval (CI), -5.47 to -1.81 and after endotracheal intubation (MD, -9.71; CI, -11.91 to -7.51). Remifentanil (1 μg kg-1) ranked the best in terms of both attenuating the increase in IOP after the administration of succinylcholine [surface under the cumulative ranking curve (SUCRA), 0.91; normalized entropy (NE), 0.47; and after endotracheal intubation (SUCRA, 0.89; NE, 0.54) among all of the treatments. Remifentanil (1 μg kg-1) should be considered the drug of choice in the circumstances where increased IOP is a great concern.