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NIHR Signal Melatonin shows potential for reducing delirium among older people after surgery
Taking melatonin around the time of surgery is linked with lower odds of delirium onset in older people, compared with placebo or no treatment. In a systematic review and meta-analysis, around 15% of the melatonin group developed delirium after surgery compared with around 20% of the comparison group. Delirium is an acute state of mental confusion associated with longer hospital stays and increased mortality. UK clinical guidelines do not recommend specific medications to prevent this condition...
NIHR Signal Music can reduce pain and anxiety following surgery
Recorded music played before, during or after surgery in adults reduces self-reported post-operative pain and anxiety, compared with usual care. The average effect is equivalent to a reduction in anxiety of 21 percentage points and a 10 percentage point reduction in pain within a few days of surgery. It is thought that placebo and distraction effects probably play a role, but in this review music still improved pain when used for patients under a general anaesthetic. Nearly two-thirds of patie...
NIHR Signal Alternative sedative reduces the risk of acute kidney injury following cardiac surgery
The sedative drug dexmedetomidine can reduce the risk of acute kidney injury when given during non-emergency cardiac surgery. Trial participants who received dexmedetomidine were a third less likely to develop acute kidney injury than those receiving placebo or other treatments. There was no difference in mortality or length of hospital stay. This systematic review identified 10 studies of 1,575 participants. Surgical procedures included coronary artery bypass grafting with or without valve sur...
NIHR Signal Cartoons are promising for reducing dental anxiety in children
Cartoons delivered on laptops, projectors or 3D goggles with sound can help distract anxious children who fear dental procedures. Dental anxiety can prevent children from attending the dentist for care, and this type of distraction could offer a useful tool to help them. This review looked at a range of audiovisual approaches tested in trials of healthy children receiving dental treatment under local anaesthetic. The children were assessed for physiological measures related to emotional state (...
NIHR Signal Inhaled anaesthesia with anti-sickness medication in children has the same risk of vomiting as intravenous anaesthesia
Post-operative vomiting is common in children. One strategy is to use an intravenous anaesthetic, which is known to cause lower rates of sickness than inhaled anaesthetics. There are disadvantages to this though, such as the need for injections before a child is asleep, slowing of the heart and difficulty in monitoring depth of the anaesthetic. This review of four trials included 558 children who had an operation to correct a squint. A third of children in each anaesthetic group had post-operat...
NIHR Signal Local nerve blocks can improve outcomes for people with hip fracture
Local nerve blocks around the time of hip fracture surgery reduced pain on movement within 30 minutes of injection. People had less need for opioid pain-relief and were quicker to mobilise after surgery. Also, one case of pneumonia was prevented for every seven people given pain relief using a nerve block. By injecting local anaesthetics close to the nerves to relieve pain after a hip fracture, it is hoped that the need for opioids can be reduced and people might recover more quickly. Nerve blo...
NIHR Signal Regional anaesthesia could improve fistula function for kidney dialysis
Use of regional anaesthesia when creating a fistula for vascular access may reduce the risk of failure by about 70%. Easy access to blood vessels is important when someone needs kidney dialysis and the commonest procedure is forming of an artificial link between arteries and veins, called a fistula. Unfortunately some newly formed fistulas fail because the blood vessel is not “patent” or open wide enough to work properly. This systematic review found four randomised controlled tria...
NIHR Signal Epidural anaesthesia helps return of bowel function after abdominal surgery
High quality evidence suggests that an epidural anaesthetic (with or without an opioid) promotes the return of gut function after abdominal surgery. This is when compared to an opioid based regimen, given either through an epidural or into the bloodstream. Epidural anaesthetic also gave a clinically meaningful reduction in pain. Evidence for other outcomes, including reduction in vomiting, was less reliable. Poor gut function and pain in the period following abdominal surgery are common. Opioi...
NIHR Signal A newer sedative agent may shorten length of stay in intensive care units
Adults needing mechanical ventilation who were sedated with dexmedetomidine had reduced length of stay in intensive care and reduced duration of ventilation. Various sedative drugs are available for use in England although it is unclear if one is better than the others. This review compared two alpha-2 agonist drugs (clonidine and dexmedetomidine) to other commonly used sedative drugs: propofol and the benzodiazepines midazolam and lorazepam for adults on mechanical ventilation. A 2014 survey ...
NIHR Signal Pain on injection of a widely used anaesthetic may be reduced if a common anti-sickness drug is given first
This review found that giving an anti-sickness drug, like ondansetron, before propofol, an anaesthetic, helped reduce the frequency and severity of injection pain. The intravenous anaesthetic propofol is used at the start of almost all general anaesthetics in the UK but it does often cause unpleasant pain when it is injected. This review of trials looked for trials of any drug in the group of commonly-used anti-sickness drugs called 5HT3 receptor antagonists. Ondansetron, one of these drugs, i...
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