Abstract:
BACKGROUND:Hypotension remains a frequent complication of spinal anesthesia, increasing the risk of nausea and vomiting, altered mental status, and aspiration. The aim of this systematic review and meta-analysis was to determine whether 5-hydroxytryptamine3 (5-HT3) receptor antagonists, administered before the initiation of spinal anesthesia, mitigate hypotension. METHODS:After a systematic literature search in various databases, randomized placebo-controlled double-blind trials studying the preventive effect of 5-HT3 receptor antagonists were included. A random-effects model was applied, risk ratio (RR, binary variables) or weighted mean difference (continuous variables) with 95% confidence intervals (CIs) were calculated. The primary outcome was the incidence of hypotension. RESULTS:Seventeen trials (8 obstetric, 9 non-obstetric) reporting on 1604 patients were identified. Ondansetron in doses from 2 to 12 mg was studied in 12 trials. Prophylactic 5-HT3 administration significantly reduced the risk of hypotension in the combined analysis of 17 trials, RR 0.54 (95% CI 0.36-0.81, I = 79%). In obstetric trials, the RR was 0.52, 95% CI 0.30-0.88, I = 87% (number needed to treat 4). In non-obstetric studies, the 95% CIs were wide and included a clinically relevant reduction in the risk of hypotension (RR 0.50, 95% CI 0.22-1.16; I = 66%). Contour-enhanced funnel plots confirmed publication bias. Meta-regression showed a significant ondansetron dose response in non-obstetric patients (β = -0.355, P = .04). In the combined and in the obstetric-only analysis, the risk of bradycardia was significantly reduced as was the use of phenylephrine equivalents. CONCLUSIONS:5-HT3 antagonists are effective in reducing the incidence of hypotension and bradycardia; the effects are moderate and are only significant in the subgroup of patients undergoing cesarean delivery. The effects in the non-obstetric population are not significant.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Heesen M,Klimek M,Hoeks SE,Rossaint Rdoi
10.1213/ANE.0000000000001511subject
Has Abstractpub_date
2016-10-01 00:00:00pages
977-88issue
4eissn
0003-2999issn
1526-7598journal_volume
123pub_type
杂志文章,meta分析,评审abstract::The effects of gestational age (GA) and plasma protein concentrations on the plasma protein binding of fentanyl and alfentanil were studied in preterm and term neonates. Binding experiments were performed using split-cell equilibrium dialysis. Fentanyl and alfentanil concentrations were measured using specific radioim...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199702000-00013
更新日期:1997-02-01 00:00:00
abstract::Health care-associated infections are a hospital-wide concern associated with a significant increase in patient morbidity, mortality, and health care costs. Bacterial transmission in the anesthesia work area of the operating room environment is a root cause of 30-day postoperative infections affecting as many as 16% o...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000505
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:The perioperative assessment of right ventricular (RV) function remains a challenge. Tricuspid annular plane systolic excursion (TAPSE) using M-mode is a widely used measure of RV function. However, accurate alignment of the ultrasound beam with the direction of annular movement can be difficult with transes...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000002614
更新日期:2018-01-01 00:00:00
abstract::Acute angle closure glaucoma is a rare complication of general anesthesia. However, in case of delayed diagnosis, it may lead to blindness. We present a case of bilateral acute angle closure glaucoma after cervical spine surgery under general anesthesia in a hypermetropic patient. In this case, the most likely trigger...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182009ad6
更新日期:2011-01-01 00:00:00
abstract::A 50-micrograms/kg dose of fentanyl, given intravenously in divided doses to dogs under enflurane-nitrous oxide anesthesia caused sharp decreases in heart rate (HR), arterial blood pressure (AP), left ventricular dP/dt, and plasma levels of catecholamines. Naloxone, 20 micrograms/kg given 65-70 min later, completely a...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1983-03-01 00:00:00
abstract::A double-blind comparison of 1.1% lidocaine carbonate and 1.0% lidocaine hydrochloride was carried out in 30 healthy adult patients undergoing upper-extremity surgery under interscalene brachial plexus block. Epinephrine (1:200,000) was added to both solutions just before injection. As compared to lidocaine hydrochlor...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:
更新日期:1987-12-01 00:00:00
abstract::Perioperative thermal manipulations are usually directed at the skin surface because methods of directly warming the core are invasive or ineffective. However, inadequate heat flow between peripheral and core compartments will decrease the rate at which core temperature changes. We therefore determined whether core hy...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199605000-00006
更新日期:1996-05-01 00:00:00
abstract::Antagonists of the serotonergic 5-hydroxytryptamine 3A receptor (5-HT(3A)R) and muscle nicotinic acetylcholine receptors (nAChR) are widely used in anesthesia practice. Both 5-HT(3A)R and nAChR are ligand-gated ion channels with known pharmacological overlap between some of their agonists and antagonists. We studied t...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000160531.65953.77
更新日期:2005-09-01 00:00:00
abstract:UNLABELLED:Using a randomized, double-blind protocol design, we compared a new lower-lipid emulsion of propofol (Ampofol) containing propofol 1%, soybean oil 5%, and egg lecithin 0.6% with the most commonly used formulation of propofol (Diprivan) with respect to onset of action and recovery profiles, as well as intraop...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ane.0000103184.36451.d7
更新日期:2004-03-01 00:00:00
abstract:BACKGROUND:Nerve-stimulated fade in muscle is generally accepted as a prejunctional phenomenon mediated by block of prejunctional acetylcholine receptors (AChRs) at the nerve terminal, whereas decrease of twitch tension is considered a postjunctional effect due to block of muscle AChRs. Using ligands with specific pre-...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31828841e3
更新日期:2013-05-01 00:00:00
abstract:UNLABELLED:We investigated the effects of isoflurane-induced burst suppression, monitored with electroencephalography (EEG), on cerebral blood flow velocity (CBFV), cerebral oxygen extraction (COE), and autoregulation in 16 patients undergoing cardiac surgery. The experimental procedure was performed during nonpulsatil...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ane.0000086732.97924.be
更新日期:2003-11-01 00:00:00
abstract:BACKGROUND:The clinical utility of focused transthoracic echocardiography (TTE) is increasingly recognized in perioperative medicine. However its use is limited among anesthesiologists because of a lack of training. The most efficient training methods have not been determined. We hypothesized that simulation-based TTE ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e318265408f
更新日期:2012-11-01 00:00:00
abstract::Millions of human fetuses, infants, and children are exposed to anesthetic drugs every year in the United States and throughout the world. Anesthesia administered during critical stages of neurodevelopment has been considered safe and without adverse long-term consequences. However, recent reports provide mounting evi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181c6b9ca
更新日期:2010-02-01 00:00:00
abstract::Sodium nitroprusside-induced cyanide intoxication has been demonstrated in the laboratory animal and has been experienced clinically during induced hypotensive anesthesia. This is a care report of a successful resuscitation of a severe cardiovascular collapse secondary to suspected sodium nitroprusside-induced cyanide...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197707000-00015
更新日期:1977-07-01 00:00:00
abstract:UNLABELLED:Shoulder surgery is often performed with patients in the sitting position under interscalene block anesthesia. Vasovagal episodes, characterized by a sudden decrease in heart rate and/or blood pressure, have a reported incidence of 17%-24% in this setting. We performed a retrospective study to determine whet...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1999-02-01 00:00:00
abstract:BACKGROUND:Rapid establishment of a patent airway in ill or injured patients is a priority for prehospital rescue personnel. Out-of-hospital tracheal intubation can be challenging. Unrecognized esophageal intubation is a clinical disaster. METHODS:We performed an observational, prospective study of consecutive patient...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000253523.80050.e9
更新日期:2007-03-01 00:00:00
abstract::The routine preoperative evaluation of pediatric patients often includes a history, physical examination, complete blood count, and urinalysis (UA). We retrospectively reviewed the records of 486 elective surgeries in children to determine the role of abnormal preoperative laboratory test results in perioperative mana...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1990-02-01 00:00:00
abstract::Hypertonic saline improves organ perfusion and animal survival during hemorrhagic shock because it expands plasma volume and increases tissue oxygenation. Because both decreased and increased myocardial performance have been reported with hypertonic saline, the effects of hyperosmolarity and the mechanism accounting f...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199510000-00021
更新日期:1995-10-01 00:00:00
abstract::The sedative effects of epidural anesthesia without volatile and IV anesthetics and quantification of the degree of epidural anesthesia-induced sedation have not been investigated. In the current study we evaluated the effects of epidural anesthesia on the bispectral index (BIS) during the awake phase and during gener...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ANE.0000159868.06847.47
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:Chronic pain is one of the most common complaints in patients with human immunodeficiency virus (HIV)-associated sensory neuropathy. Ryanodine receptor (RyR) and mitochondrial oxidative stress are involved in neuropathic pain induced by nerve injury. Here, we investigated the role of RyR and mitochondrial su...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003916
更新日期:2019-07-01 00:00:00
abstract:UNLABELLED:Endovascular repair of the aorta (EVAR) is a promising alternative to open repair. Transesophageal echocardiography (TEE) is a sensitive imaging modality for aortic disease. We reviewed our experience with TEE in thoracic EVAR. Seven patients underwent thoracic EVAR under general anesthesia. Intraoperative a...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ane.0000086894.01129.93
更新日期:2003-12-01 00:00:00
abstract::A method involving sodium fusion and analysis by fluoride electrode, which has been used for the determination of total fluorinated metabolites of fluorine-containing drugs in physiologic fluids, is shown to be inapplicable to volatile fluorinated metabolites of volatile fluorinated anesthetic agents. The yields of in...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1982-09-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to identify optimal target propofol and remifentanil concentrations to avoid a gag reflex in response to insertion of an upper gastrointestinal endoscope. METHODS:Patients presenting for endoscopy received target-controlled infusions (TCI) of both propofol and remifentanil for ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000000756
更新日期:2015-07-01 00:00:00
abstract:UNLABELLED:We examined the effects of two perioperative pain management techniques on recovery after laparotomy, as assessed by body weight (BW) and food consumption (FC). All rats received a preoperative intrathecal mixture of morphine plus bupivacaine combined with one of two treatments: (a) injection of slow-release...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000167771.98680.a7
更新日期:2005-10-01 00:00:00
abstract:UNLABELLED:The calcium channel blocker nifedipine has analgesic properties that are enhanced by nicotine. Although it is not known how this analgesic state might affect the awareness of anginal pain and impending myocardial infraction, recent studies have shown an increased mortality associated with the use of large do...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199811000-00023
更新日期:1998-11-01 00:00:00
abstract::Morphine anesthesia is often recommended in patients with reduced cardiac reserve. As the effect of morphine on the balance between myocardial oxygen supply and demand is not well understood, the effect of large doses of morphine (3 mg/kg, subcutaneously) on experimental myocardial infarction size in the rat was evalu...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1982-10-01 00:00:00
abstract:UNLABELLED:There has been growing interest in determining the possible immune consequences of opioid administration for the management of postoperative pain. We studied the effects of morphine and tramadol on pain and immune function during the postoperative period in 30 patients undergoing abdominal surgery for uterin...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-200006000-00028
更新日期:2000-06-01 00:00:00
abstract:BACKGROUND:Midazolam has hypnotic and sedative activities, which may be mediated by different neuronal structures. We investigated the time course effect of a hypnotic dose of midazolam on conscious motor behavior and on patterns of brain metabolism. METHODS:Loss of nociceptive reflexes and impairment of spontaneous l...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e31816a64a8
更新日期:2008-05-01 00:00:00
abstract::The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research, established by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the US Food and Drug Administration, convened a meeting of sedation e...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001566
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Previous animal and human studies suggested that nicotine might have an antinociceptive effect. We hypothesized that the preoperative application of a 7 mg nicotine patch would result in reduced postoperative analgesic requirements in patients undergoing radical retropubic prostatectomy (RRP) under general a...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e31816f2616
更新日期:2008-09-01 00:00:00