No abstract

Nowadays, temporomandibular joint (TMJ) arthroscopies are often finished with intraarticular injections. There are a couple of different substances that can be injected into the articular cavity following arthroscopy; however, it is still unclear which one can help to reach the best clinical results. The aim of this systematic review was to compare different substances that can be injected intraarticularly following TMJ arthroscopy to enhance clinical success. A review protocol was registered in PROSPERO (Registration number: CRD42018114833). An electronic search was performed using PubMed, Cochrane Library, PlosOne, and Science Direct databases using a combination of the terms “temporomandibular” and “arthroscopy” to identify clinical trials published from 2009 until 2019. Mean differences of pain levels were evaluated in random-effect meta-analysis. In total, 951 records were screened, of which only 3 fulfilled the inclusion criteria and were included into qualitative data synthesis, and only 2 articles were included into quantitative data analysis. The results showed that subjects who received plasma rich in growth factors intraarticular injections had statistically significantly lower pain levels 18 months postoperatively than patients who received hyaluronic acid injections. The results of the meta-analysis revealed that intraarticular injections followed by TMJ arthroscopy were more effective than arthroscopy alone in pain management (mean difference = −1.00, 95% confidence interval: −4.76 to 2.77, I 2 = 97% with significant heterogeneity). The authors conclude that, although the sample is not extensive (only 3 studies), a tendency towards the superiority of plasma rich in growth factors over other treatments is seen in pain management of TMD.

The objective.The aim is to present the major effects of cancer treatment (chemotherapy, radiotherapy, surgery) that the anaesthesiologist should consider preoperatively, and to review techniques of the analgesic management of the disease.Materials and Methods.To summarize the major challenges that cancer patients present for the anaesthesiologists, a literature review was conducted. Articles presenting evidence or reviewing the possible effects of anaesthetics on cancer cells were also included. Online databases of Science Direct, PubMed, and ELSEVIER, as well as reference lists of included studies were searched. Articles published from 2005 to 2016 were selected.Results.Anaesthesiologists should pay attention to patients receiving chemotherapy and its side effects on organ systems. Bleomycin causes pulmonary damage, anthracyclines are cardiotoxic, and platinum-based chemotherapy agents are nephrotoxic. A lot of chemotherapy agents lead to abnormal liver function, vomiting, diarrhoea, etc. Surgery itself is suspected to be associated with an increased risk of metastasis and recurrence of cancer. Regional anaesthesia and general anaesthesia with propofol should be used and volatile agents should be avoided to prevent cancer patients from perioperative immunosuppression that leads to increased risk of cancer recurrence. Pain management for palliative patients remains a major problem.Conclusions.To provide the best treatment for cancer patients, cooperation of anaesthesiologists with oncologists and surgeons becomes imperative. It has been established that anaesthetic techniques and drugs could minimize the perioperative inflammation. However, further research of the perioperative “onco-anaesthetic” is needed.