Research - Surgery
The Effects of Perioperative Music Interventions in Pediatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- Marianne J. E. van der Heijden ,
- Sadaf Oliai Araghi,
- Monique van Dijk,
- Johannes Jeekel,
- M. G. Myriam Hunink
Music interventions are widely used, but have not yet gained a place in guidelines for pediatric surgery or pediatric anesthesia. In this systematic review and meta-analysis we examined the effects of music interventions on pain, anxiety and distress in children undergoing invasive surgery.
We searched 25 electronic databases from their first available date until October 2014.
Included were all randomized controlled trials with a parallel group, crossover or cluster design that included pediatric patients from 1 month to 18 years old undergoing minimally invasive or invasive surgical procedures, and receiving either live music therapy or recorded music.
Data Extraction and Synthesis
4846 records were retrieved from the searches, 26 full text reports were evaluated and data was extracted by two independent investigators.
Main Outcome Measures
Pain was measured with the Visual Analogue Scale, the Coloured Analogue Scale and the Facial Pain Scale. Anxiety and distress were measured with an emotional index scale (not validated), the Spielberger short State Trait Anxiety Inventory and a Facial Affective Scale.
Three RCTs were eligible for inclusion encompassing 196 orthopedic, cardiac and day surgery patients (age of 1 day to 18 years) receiving either live music therapy or recorded music. Overall a statistically significant positive effect was demonstrated on postoperative pain (SMD -1.07; 95%CI-2.08; -0.07) and on anxiety and distress (SMD -0.34 95% CI -0.66; -0.01 and SMD -0.50; 95% CI -0.84; - 0.16.
Conclusions and Relevance
This systematic review and meta-analysis indicates that music interventions may have a statistically significant effect in reducing post-operative pain, anxiety and distress in children undergoing a surgical procedure. Evidence from this review and other reviews suggests music therapy may be considered for clinical use.
Source : PLOS One
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Valerian Reduces Cognitive Dysfunction after Coronary Bypass Surgery
by Heather S. Oliff, PhD
Reviewed: Hassani S, Alipour A, Darvishi Khezri H, et al. Can Valeriana officinalis root extract prevent early postoperative cognitive dysfunction after CABG surgery? A randomized, double-blind, placebo-controlled trial. Psychopharmacology (Berl). March 2015;232(5):843-850.
One of the most commonly performed surgeries in the world is coronary artery bypass graft (CABG). A prevalent complication of the surgery is cognitive dysfunction, which occurs in 20-80% of patients. The authors of this article propose that such cognitive dysfunction is the result of brain damage caused by inflammation and other processes such as embolism (i.e., artery obstruction) and cellular debris picked up and reinfused by the cell salvage processing system. Sleep disruption is another risk factor for post-CABG cognitive dysfunction. Traditionally used as a sedative and anxiolytic, valerian (Valeriana officinalis, Caprifoliaceae) root has been shown to inhibit the inflammatory nuclear factor-kappa B (NF-κB) protein complex, stimulate serotonergic and cholinergic receptors, and improve sleep quality. Therefore, the authors hypothesized that valerian may prevent postoperative cognitive dysfunction in patients undergoing CABG surgery. This randomized, double-blind, placebo-controlled study evaluated the prophylactic effect of valerian root on the occurrence of cognitive dysfunction after CABG surgery.
Men and women aged 30-70 years who were undergoing elective CABG with cardiopulmonary bypass surgery participated in this study conducted at the Mazandaran University of Medical Sciences Mazandaran Heart Center in Sari, Iran. Patients were excluded if they required additional concurrent cardiac surgeries such as valve replacement; were undergoing reoperation; had a history of cerebrovascular disease, alcoholism, or known mental illness; used psychotherapeutic drugs in the previous three months, had hepatic failure, severe pulmonary insufficiency, acute renal failure, previous heart surgeries, or heart failure; were deaf, blind, or unable to speak; had sensitivity to valerian; or had a pH < 7.25 or serum base excess of < −6 mmol/L and coagulopathy (i.e., bleeding disorders).
Patients took capsules containing either placebo or 530 mg dried valerian root extract (Goldaru Company; Isfahan, Iran) every 12 hours, starting one day before surgery and continuing for 60 days post-surgery. The concentration and chemical characteristics of the valerian extract were not reported. The placebo capsules were prepared by emptying valerian capsules and refilling them with wheat (Triticum spp., Poaceae) flour to create a placebo with the same color, texture, taste, and odor as the valerian capsules. All patients had routine anesthesia and CABG with cardiopulmonary bypass surgery. The Mini-Mental State Examination (MMSE) was used to assess cognitive function before surgery, 10 days post-surgery, and two months post-surgery. Scores ≥ 25 were classified as normal, while scores of 21-24 were categorized as mild cognitive dysfunction. Of the 76 patients randomly assigned to receive valerian or placebo, seven in the valerian group and eight in the placebo group were lost to follow-up. No other measures (e.g., degree of inflammation) were obtained that could have provided evidence for alternate mechanisms of cognitive dysfunction.
Mean preoperative MMSE scores were within the normal range (~27) for both groups. In the valerian group (n=31), the mean MMSE score decreased slightly when assessed 10 days post-surgery (26.52) but remained within the normal range and returned to normal (27.45) after two months. In comparison, the mean MMSE score in the placebo group (n=30) decreased significantly when evaluated 10 days after surgery (24.0) and increased slightly to 24.83 after two months, indicating continuing mild cognitive dysfunction. There was a significant downward trend (P<0.05) in all MMSE scores in the placebo group, except for the attention and calculation domains. After adjusting for other variables, analysis using the generalized estimating equation indicated that valerian prophylaxis reduced the odds of cognitive dysfunction compared to the placebo group (odds ratio=0.108; 95% confidence interval [CI], 0.022-0.545). It should be noted that the MMSE is greatly affected by education level and is not very sensitive to mild cognitive impairment.
In summary, the valerian group had a significantly lower incidence of cognitive dysfunction and a greater improvement in cognitive function during the eight weeks after CABG surgery compared to the placebo group (as measured by the MMSE). The authors suggest that patients undergoing CABG surgery may also benefit from the reported anticoronaryspastic, antihypertensive, and antibronchospastic properties of valerian.
Acknowledged limitations of the study were the use of a single subjective instrument to assess cognitive function (completed only once per day), and the relatively small sample size. The authors conclude that “the use of V. officinalis root extract may prevent early postoperative cognitive dysfunction after on-pump CABG surgery.… However, further robust randomized, blinded studies with large sample sizes are required.…” More specific cognitive tests and additional measures (e.g., of inflammation) should have been used as well.
—Heather S. Oliff, PhD
Source : HerbalGram - American Botanical Council
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Acupuncture accelerates recovery after general anesthesia: a prospective randomized controlled trial
1. Marco Gemma (Department of Anesthesia and Neurointensive Care, San Raffaele Scientific Institute, 20132 Milan, Italy )
2. Elisa Nicelli (Department of Anesthesia and Neurointensive Care, San Raffaele Scientific Institute, 20132 Milan, Italy )
3. Luigi Gioia (Department of Anesthesia and Neurointensive Care, San Raffaele Scientific Institute, 20132 Milan, Italy )
4. Elena Moizo (Department of Anesthesia and Neurointensive Care, San Raffaele Scientific Institute, 20132 Milan, Italy )
5. Luigi Beretta (Department of Anesthesia and Neurointensive Care, San Raffaele Scientific Institute, 20132 Milan, Italy )
6. Maria Rosa Calvi (Department of Anesthesia and Neurointensive Care, San Raffaele Scientific Institute, 20132 Milan, Italy )
ABSTRACT BACKGROUND: Acupuncture anesthesia was created in the 1950’s in China and continues to be used there today during most major surgeries. It is widely used in China for such complex operations as brain, heart, and abdominal surgery. It is popular in China because it is economical, practical, and beneficial to the patients. With acupuncture anesthesia there is less bleeding during surgery and there is also quicker post-operative recovery.
OBJECTIVE: This randomized prospective study aims at comparing the effect of two acupoints (Yongquan, KI1 and Renzhong, DU26) with sham acupuncture and no acupuncture on the time to recovery of consciousness after general anesthesia by means of the Bispectral Index monitor (BIS).
DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This is a prospective randomized controlled study. We randomly assigned 50 patients to 5 groups during recovery from surgical anesthesia. Four groups had acupuncture on KI1 (group A), DU26 (groups B), both KI1 and DU26 (group C), and sham points (group D), and one had no acupuncture (group E).
MAIN OUTCOME MEASURES: Bispectral Index (BIS), time to spontaneous eye opening, time to tracheal extubation, and time to following commands were measured as the main outcome measures.
RESULTS: Time to spontaneous eye opening differed among groups (P=0.002), as well as time to tracheal extubation (P<0.000 1) and time to following commands (P=0.000 6). BIS values differed significantly among groups both 5 and 10 min after the end of anesthesia (P<0.000 1 and P=0.000 4, respectively). BIS values of groups D and E were lower than those of the other groups and those of group C were higher. The same pattern was observed also 15 and 30 min after the end of anesthesia, although the difference among groups was not significant at these time points (P=0.164 and P=0.104, respectively).
CONCLUSION: Acupuncture on DU26 and KI1 accelerates recovery of consciousness after general anesthesia. Moreover, a possible synergistic effect of DU26 and KI1 is suggested. This issue may play a role in the optimization of operating room management and raise interest about the usefulness of acupuncture on unconsciousness states of different nature.
Source : Journal of Chinese Integrative Medicine
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Auriculotherapy for Persisting Postoperative Pain Caused by Total Knee Replacement
Marco Romoli, MD,1,2Chrissanthi Avgerinos, MD,3Luigi Baratto, MD,3and Andrea Giommi, PhD4
Introduction:Total knee replacement (TKR) is a common procedure that entails severe postsurgical trauma,prolonged hospitalization, and impaired patient rehabilitation, especially in patients who are elderly. Among the nonpharmacologic methods used with TKR, auriculotherapy/ear acupuncture (AEA) has recently shown a favorable effect on perioperative/postoperative pain and disability in patients who have undergone TKR.
Objective:The primary aim of this study was to examine the adjuvant effects of one session of auricular acupuncture on persisting pain and disability in patients hospitalized for TKR postoperative rehabilitation. The secondary aim was to propose a simplified diagnostic method for selecting the most effective points to treat in each patient.
Materials and Methods:In 17 patients (14 females and 3 males; mean age 75.2 years) hospitalized for postoperative TKR rehabilitation, pain level and time for sit-to-stand were measured before, 30 minutes after,and 6 hours after one session of auricular acupuncture. In each patient, an electric skin resistance test (ESRT)was performed on both auricles, followed by a pain pressure test (PPT) for identifying the most sensitive points. A second PPT was consecutively performed on the previously located auricular points and only those ipsilateral to the operated knee were selected for treatment.
Results:All 17 patients reported a having lower level of pain after the AEA treatment, and this effect was still maintained after 6 hours. A better performance in the sit-to-stand test was observed after 6 hours following treatment.
Conclusions:The auricular points, which were effective for reducing pain and disability, were spread out over a broad area of the upper external ear, which overlaps both the French and Chinese somatotopic auricular representations of the knee joint.
Source : Medical Acupuncture
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The Effect of the Kampo Medicine Yokukansan on Preoperative Anxiety and Sedation Levels
Young-Chang Arai,1,2 Jun Kawanishi,1 Yoshikazu Sakakima,1 Satoshi Sueoka,1 Akihiro Ito,1 Yusuke Tawada,1 Yuki Maruyama,1 Shinya Banno,1 Hitomi Takayama,1 Makoto Nishihara,2 Takashi Kawai,2 and Tatsunori Ikemoto2
1Department of Surgery, Toki General Hospital, Gifu 509-5193, Japan
2Multidisciplinary Pain Centre, School of Medicine, Aichi Medical University, 21 Karimata, Nagakutecho, Aichigun, Aichi 480-1195, Japan
Background. Preoperative anxiety can lead to unfavorable physiological response such as tachycardia and hypertension. Prevention of preoperative anxiety improves surgical outcome and decreases inpatient stay. Yokukansan is one of prescriptions in Kampo, traditional Japanese herbal medicine, and is known to exert anxiolytic effects. The aim of the present study was to compare the effects of diazepam and Yokukansan on preoperative anxiety, salivary amylase activity, and sedation levels.
Methods. Seventy American Society of Anesthesiologists physical status I or II patients presenting for hemicolectomy under general anesthesia combined with epidural anesthesia were enrolled. The Diazepam group received diazepam 5 mg orally and the Yokukansan group received Yokukansan 2.5 g orally.
Results. Although levels of anxiety and salivary amylase activity were not different between the two groups, the modified Observer’s Assessment of Alertness/Sedation Scale of the Yokukansan group was significantly higher compared to that of the Diazepam group.
Conclusion. Yokukansan alleviated preoperative anxiety without undesirable sedation, when compared with diazepam.
Source : Evidence Based Complementary and Alternative Medicine Journal
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The Effectiveness of Acupuncture in Prevention and Treatment of Postoperative Nausea and Vomiting - A Systematic Review and Meta-Analysis
Kah Bik Cheong, Ji-ping Zhang, Yong Huang mail,Zhang-jin Zhang
Acupuncture therapy for preventive and treatment of postoperative nausea and vomiting(PONV), a condition which commonly present after anaesthesia and surgery is a subject of growing interest.
This paper included a systematic review and meta-analysis on the effect of different type of acupuncture and acupoint selection in PONV prevention and treatment.
Randomised controlled trials(RCTs) comparing acupuncture with non-acupuncture treatment were identified from databases PubMed, Cochrane, EBSCO, Ovid, CNKI and Wanfangdata. Meta-analysis on eligible studies was performed using fixed-effects model with RevMan 5.2. Results were expressed as RR for dichotomous data, with 95%CI.
Thirty RCTs, 1276 patients (intervention) and 1258 patients (control) were identified. Meta-analysis showed that PC6 acupuncture significantly reduced the number of cases of early vomiting (postoperative 0-6h) (RR=0.36, 95%CI 0.19,0.71; P=0.003) and nausea (postoperative 0-24h) (RR=0.25, 95%CI 0.10,0.61; P=0.002), but not early nausea (postoperative 0-6h) (RR=0.64, 95%CI 0.34,1.19; P=0.150) and vomiting (postoperative 0-24h) (RR=0.82, 95%CI 0.48,1.38; P=0.450). PC6 acupressure significantly reduced the number of cases of nausea (RR=0.71, 95%CI 0.57,0.87; P=0.001) and vomiting (RR=0.62, 95%CI 0.49,0.80; P=0.000) at postoperative 0-24h. PC6 electro-acupoint stimulation significantly reduced the number of cases of nausea (RR=0.49, 95%CI 0.38,0.63; P<0.000) and vomiting (RR=0.50, 95%CI 0.36,0.70; P<0.000) at postoperative 0-24h. Stimulation of PC6 with other acupoint(s) significantly reduced the number of cases of nausea and vomiting (RR=0.29, 95%CI 0.17,0.49; P<0.000) at postoperative 0-24h. Stimulation of other acupoint(s)(non PC6) also significantly reduced the number of cases of nausea and vomiting (RR=0.63, 95%CI 0.49,0.81; P=0.000) at postoperative 0-24h. However, the quality of study was generally low in studies of PC6 combined with other acupoint(s) and other acupoint(s). Details of blinding were not reported in most reports.
Besides PC6, PC6 combined with other acupoint(s) and other alternative acupoint(s) might be beneficial in prevention and treatment of PONV, the evidence justifies future high-quality studies.
Source : PLOS One
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Essential Oils for Complementary Treatment of Surgical Patients: State of the Art
Susanna Stea,1 Alina Beraudi,1,2 and Dalila De Pasquale1,2
1Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
2Prometeo Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
Aromatherapy is the controlled use of plant essences for therapeutic purposes. Its applications are numerous (i.e., wellbeing, labour, infections, dementia, and anxiety treatment) but often they have not been scientifically validated. The aim of the present study is to review the available literature to determine if there is evidence for effectiveness of aromatherapy in surgical patients to treat anxiety and insomnia, to control pain and nausea, and to dress wound. Efficacy studies of lavender or orange and peppermint essential oils, to treat anxiety and nausea, respectively, have shown positive results. For other aspects, such as pain control, essential oils therapy has shown uncertain results. Finally, there are encouraging data for the treatment of infections, especially for tea tree oil, although current results are still inconclusive. It should also be considered that although they are, allergic reactions and toxicity can occur after oral ingestion. Therefore, while rigorous studies are being carried out, it is important that the therapeutic use of essential oils be performed in compliance with clinical safety standards.
Source : Evidence Based Complementary and Alternative Medicine
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