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Cochrane Database of Systematic Reviews

Anestesia intravenosa total versus anestesia inhalatoria para pacientes adultos sometidos a cirugía laparoscópica transabdominal asistida por robot

Información

DOI:
https://doi.org/10.1002/14651858.CD011387.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 04 abril 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Anestesia

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Suzanne Forsyth Herling

    Correspondencia a: Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark

    [email protected]

    [email protected]

  • Bjørn Dreijer

    Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark

  • Gitte Wrist Lam

    Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark

  • Thordis Thomsen

    Department of Nursing Research, Rigshospitalet, The Abdominal Centre, Copenhagen, Denmark

  • Ann Merete Møller

    The Cochrane Anaesthesia, Critical and Emergency Care Group, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark

Contributions of authors

Suzanne F Herling (SH), Bjørn Dreijer (BD), Gitte Wrist Lam (GL) Thordis Thomsen (TT), Ann Merete Møller (AM).

Conceiving of the review: SH, BD, TT and AM.

Co‐ordinating the review: SH.

Undertaking manual searches: SH and BD/Karen Hovhannisyan/Torben Jørgensen.

Screening search results: SH and BD.

Organizing retrieval of papers: SH.

Screening retrieved papers against inclusion criteria: SH and BD.

Appraising the quality of papers: SH, BD and AM.

Abstracting data from papers: SH and BD.

Writing to authors of papers for additional information: SH and BD.

Providing additional data about papers: SH and BD.

Obtaining and screening data on unpublished studies: SH and BD.

Managing data for the review: SH.

Entering data into Review Manager (RevMan 5.3): SH.

Analysing RevMan statistical data: SH.

Performing other statistical analysis not using RevMan: N/A.

Interpreting data: SH, BD, TT, GL and AM.

Making statistical inferences: N/A.

Writing the review: SH, BD, TT, GL and AM.

Securing funding for the review: AM.

Performing previous work that was the foundation of the present study: none of the authors of this review.

Serving as guarantor for the review (one author): AM.

Taking responsibility for reading and checking the review before submission: SH, BD, TT, GL and AM.

Sources of support

Internal sources

  • Department of Anaesthesiology, Copenhagen University Hospital, Herlev, Denmark.

External sources

  • None, Other.

Declarations of interest

Suzanne F Herling: none known.

Bjørn Dreijer: none known.

Thordis Thomsen: none known.

Gitte W Lam: none known.

Ann Merete Møller: none known.

Acknowledgements

We would like to thank Rodrigo Cavallazzi (Content Editor); Nathan Pace (Statistical Editor); and Daniel M Gainsburg, Hamdy Awad and André Börgers (Peer Reviewers) for their help and editorial advice during preparation of the protocol for this systematic review (Herling 2014), and Karen Hovhannisyan, Torben Jørgensen and Janne Vendt for assisting in the literature search for the review.

Further, we would like to thank Rodrigo Cavallazzi (Content Editor); Nathan Pace (Statistical Editor); Hamdy Awad and Daniel M Gainsburg (Peer Reviewers) and Janet Wale (Consumer Editor) for their help and editorial advice during preparation of this systematic review.

Version history

Published

Title

Stage

Authors

Version

2017 Apr 04

Total intravenous anaesthesia versus inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery

Review

Suzanne Forsyth Herling, Bjørn Dreijer, Gitte Wrist Lam, Thordis Thomsen, Ann Merete Møller

https://doi.org/10.1002/14651858.CD011387.pub2

2014 Dec 02

Total intravenous anaesthesia versus inhalational anaesthesia for transabdominal robotic assisted laparoscopic surgery

Protocol

Suzanne F Herling, Bjørn Dreijer, Thordis Thomsen, Ann Merete Møller

https://doi.org/10.1002/14651858.CD011387

Differences between protocol and review

We made the following changes to the published protocol (Herling 2014).

  1. Gitte W Lam is an additional author for this review.

  2. "For adults" was added to the title to clarify study participants.

  3. We planned to report event rates with 95% confidence intervals (CIs) and risk ratios (RRs) for adverse events, mortality and complications; however, the included studies did not produce data other than absolute numbers with standard deviations and percentages.

  4. The unit of analysis consisted of participants included and randomly assigned; this was not stated in the protocol.

  5. We planned to conduct intention‐to‐treat (ITT) analysis for all outcomes, as far as possible. For studies with more dropouts than estimated, we planned to contact trialists to request additional data on participants lost to follow‐up. We planned to perform a sensitivity analysis of best case versus worst case scenarios. However, we did not encounter reports of missing data and so noted the level of attrition in included studies.

  6. We planned to assess heterogeneity between studies by visually inspecting forest plots. We planned to assess statistical heterogeneity of effect sizes by using the I2 statistic and the Chi2 test. The I2 statistic describes the percentage of variability in effect estimates that is due to heterogeneity rather than to sampling error (Higgins 2011). We planned to conduct a meta‐analysis if we visually (forest plot), statistically (I2 statistic) and clinically found heterogeneity acceptable (low enough). We planned to proceed with a meta‐analysis if populations, interventions, comparisons, measurements, time frames and settings were reasonably similar; if we identified three or more studies; and if the direction of effect of an intervention was consistent. All review authors will discuss and agree about when to conduct a meta‐analysis (Higgins 2011). We were not able to calculate effect size from the data needed to perform tests for statistical heterogeneity (seesummary of findings Table for the main comparison). As we have included only three studies, the investigation of heterogeneity is of questionable value (Higgins 2011).

  7. Subgroup analysis were not relevant, as the included studies were rather heterogenic in terms of participants ‐ all were male and were from urology.

  8. "Change in intraocular pressure" has been added to the outcome post hoc: Adverse effects such as changes in intraocular pressure could lead to ocular complications.

  9. As we found an insufficient number of studies, we were unable to perform a sensitivity analysis by comparing results with inclusion and with exclusion of RCTs classified to have 'low risk of bias' to decide whether our conclusions are robust (Higgins 2011).

  10. As other bias, we added "baseline imbalances", as we noted these in one study.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Aged; Humans; Male; Middle Aged;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Summary of findings for the main comparison. Inhalational anaesthesia compared with intravenous anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery

Inhalational anaesthesia compared with intravenous anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery

Patient or population: adults undergoing transabdominal robotic assisted laparoscopic surgery
Setting: Training and Research Hospital in Turkey and Univerity Hospital in South Korea
Intervention: inhalational anaesthesia
Comparison: intravenous anaesthesia

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with intravenous anaesthesia

Risk with inhalational anaesthesia

Pain in the PACU (VAS)

Mean pain in the PACU (VAS) was 42.9

MD 1 lower
(9.82 lower to 7.82 higher)

‐

62
(1 RCT)

⊕⊕⊝⊝
LOWa

VAS 0 to 100, with higher score indicating greater pain

Pain at 1 to 6 hours (VAS)

Mean pain from 1 to 6 hours (VAS) was 42.5

MD 2.2 lower
(10.62 lower to 6.22 higher)

‐

62
(1 RCT)

⊕⊕⊝⊝
LOWa

VAS 0 to 100, with higher score indicating greater pain

Pain at 6 to 24 hours (VAS)

Mean pain from 6 to 24 hours (VAS) was 34.5

MD 1 lower
(7.51 lower to 5.51 higher)

‐

62
(1 RCT)

⊕⊕⊝⊝
LOWa

VAS 0 to 100, with higher score indicating greater pain

Presence of nausea

Study population

RR 0.39
(0.19 to 0.80)

62
(1 RCT)

⊕⊕⊝⊝
LOWa

581 per 1000

226 per 1000
(110 to 465)

Nausea intensity (VNRS) in PACU

Mean nausea intensity (VNRS) in PACU was 0.2

MD 0.7 lower
(1.35 lower to 0.05 lower)

‐

62
(1 RCT)

⊕⊕⊝⊝
LOWa

VNRS 0 to 10: 1 to 3 = mild, 4 to 6 = moderate, 7 to 10 = severe, or with retching and vomition

Nausea intensity (VNRS) at 1 to 6 hours

Mean nausea intensity (VNRS) at 1 to 6 hours was 0.4

MD 1.7 lower
(2.59 lower to 0.81 lower)

‐

62
(1 RCT)

⊕⊕⊝⊝
LOWa

VNRS 0 to 10: 1 to 3 = mild, 4 to 6 = moderate, 7 to 10 = severe, or with retching and vomition

Nausea‐vomiting rate at 1 hour

Study population

RR 23.00
(1.44 to 366.71)

42
(1 RCT)

⊕⊝⊝⊝
VERY LOWa,b,c

0 per 1000

0 per 1000
(0 to 0)

Nausea‐vomiting rate at 3 hours

Study population

RR 2.00
(0.20 to 20.41)

42
(1 RCT)

⊕⊝⊝⊝
VERY LOWa,b,c

48 per 1000

95 per 1000
(10 to 972)

Adverse effects: increase in IOP during maintenance of anaesthesia

Mean Increase in IOP during maintenance of anaesthesia was 2.1

MD 3.9 lower
(6.34 lower to 1.46 lower)

‐

66
(1 RCT)

⊕⊕⊝⊝
LOWa,d

No participants experienced ocular complications

No included study reported other adverse events of interest

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI).

CI: confidence interval; IOP: intraocular pressure; MD: mean difference; OR: odds ratio; RR: risk ratio; VAS: visual analogue scale; VNRS: verbal numerical rating scale.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to the estimate of effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aFew participants.

bUnclear allocation concealment and blinding.

cPower calculation for the study performed on mean difference in pH between groups and minimal relevant difference not stated; primary outcomes: heart rate, mean atrial pressure and values for oxygen and carbon dioxide.

dAddresses a restricted version of the review question.

Figuras y tablas -
Summary of findings for the main comparison. Inhalational anaesthesia compared with intravenous anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery
Ir a la tabla de la revisión
Table 1. Effect estimates for single studies

Outcome

Study/Participant

Statistical method

Effect estimate [95% CI]

P value

Pain in the PACU (VAS)

1/n = 62

MD

‐1.00 [‐9.82 to 7.82]

0.82

Pain at 1 to 6 hours (VAS)

1/n = 62

MD

‐2.20 [‐10.62 to 6.22]

0.61

Pain at 6 to 24 hours (VAS)

1/n = 62

MD

‐1.00 [‐7.51 to 5.51]

0.76

Presence of nausea

1/n = 62

RR

0.39 [0.19 to 0.80]

0.01

Nausea intensity in PACU (VNRS)

1/n = 62

MD

‐0.70 [‐1.35 to ‐0.05]

0.03

Nausea intensity at 1 to 6 hours (VNRS)

1/n = 62

MD

‐1.70 [‐2.59 to ‐0.81]

0.0002

Nausea‐vomiting rate at 1 hour

1/n = 42

RR

23.00 [1.44 to 366.71]

0.03

Nausea‐vomiting rate at 3 hours

1/n = 42

RR

2.00 [0.20 to 20.41]

0.56

Adverse events: increase in IOP during maintenance of anaesthesia

1/n = 66

MD

‐3.90 [‐6.34 to ‐1.46]

0.002

CI: confidence interval; IOP: intraocular pressure; MD: mean difference; PACU: post‐anaesthesia care unit; RR: risk ratio; VAS: visual analogue scale; VNRS: verbal numerical rating scale.

Figuras y tablas -
Table 1. Effect estimates for single studies
Ir a la tabla de la revisión