Introduction Various strategies have been proposed for postoperative pain control. Among those, intravenous lidocaine infusion (IVLI) has gained in interest. However, its clinical benefit remains unclear. This systematic review is an evaluation of the analgesic efficacy and safety of IVLI during general anesthesia. Methods A systematic search was performed using MED-LINE, EMBASE, Cochrane, and SCOPUS databases, likewise, grey literature. The review included all randomized controlled trials that used a placebo or any comparator and evaluated IVLI during general anesthesia for any type of surgery. Primary outcomes were pain control and opioid requirement. Secondary outcomes were mortality, length of stay, ileus recovery time, nausea/vomiting, and adverse events. Random effects models were used and heterogeneity was assessed using the I 2 index. to -5.56), time to first flatus (WMD -7.62 hr, 95% CI -10.78 to -4.45), time to first feces (WMD -10.71 hr, 95% CI -16.14 to -5.28), nausea/vomiting (risk ratios = 0.71, 95% CI 0.57-0.90), and hospital length of stay (WMD -0.17 days, 95% CI -0.41 to 0.07). Abdominal surgery was strongly associated with benefit. For the 12 studies that systematically screened adverse events, the Results 123Can J Anesth/J Can Anesth (2011) 58:22-37 DOI 10.1007/s12630-010-9407-0 incidence of cardiac and neurologic adverse events was comparable. Eight studies observed toxic plasma levels. Discussion Perioperative IVLI reduced postoperative pain and opioid requirement, as well as ileus recovery time, hospital length of stay, and nausea/vomiting. Intravenous lidocaine infusion was effective mainly in abdominal surgery populations. Considering that toxic levels were detected and that adverse events were not systematically screened for in most studies, dose and safety of IVLI should be established before recommending its use. RésuméIntroduction Plusieurs strate´gies ont e´te´propose´es pour le contrôle de la douleur postope´ratoire. Parmi ces strate´gies, la lidocaı¨ne par voie intraveineuse suscite un inte´reˆt croissant. Toutefois, ses avantages cliniques demeurent peu clairs. Cette revue me´thodique est une e´valuation de l'efficaciteá nalge´sique et de l'innocuite´de la lidocaı¨ne par voie intraveineuse pendant l'anesthe´sie ge´ne´rale. Méthode Une recherche me´thodique a e´te´re´alise´e dans les bases de donne´es MEDLINE, EMBASE, Cochrane et SCOPUS ainsi que dans la litte´rature grise. Cette revue a tenu compte de toutes les e´tudes randomise´es contrôle´es ayant utilise´un placebo ou un traitement de re´fe´rence et e´value´la lidocaı¨ne par voie intraveineuse pendant l'anesthe´sie ge´ne´rale, quel que soit le type de chirurgie. Les principaux crite`res d'e´valuation e´taient le contrôle de la douleur et le besoin en opioı¨des. Les crite`res d'e´valuation secondaires e´taient la mortalite´, la dure´e d'hospitalisation, le temps de re´cupe´ration du transit intestinal, les nause´es et vomissements et les e´ve´nements inde´sirables. Des mode`les a`effets ale´atoires ont e´teú tilise´s e...

Objective To evaluate the risk of postoperative bleeding and reintervention with the use of systemic steroids in patients undergoing tonsillectomy.Design Systematic review and meta-analysis of randomised controlled trials.Data sources Medline, Embase, Cochrane Library, Scopus, Web of Science, Intute, Biosis, OpenSIGLE, National Technical Information Service, and Google Scholar were searched. References from reviews identified in the search and from included studies were scanned.Review methods Randomised controlled trials comparing the administration of systemic steroids during tonsillectomy with any other comparator were eligible. Primary outcome was postoperative bleeding. Secondary outcomes were the rate of admission for a bleeding episode, reintervention for a bleeding episode, blood transfusion, and mortality.Results Of 1387 citations identified, 29 randomised controlled trials (n=2674) met all eligibility criteria. Seven studies presented a low risk of bias, but none was specifically designed to systematically identify postoperative bleeding. Administration of systemic steroids did not significantly increase the incidence of post-tonsillectomy bleeding (29 studies, n=2674 patients, odds ratio 0.96 (95% confidence interval 0.66 to 1.40), I²=0%). We observed a significant increase in the incidence of operative reinterventions for bleeding episodes in patients who received systemic steroids (12, n=1178, 2.27 (1.03 to 4.99), I²=0%). No deaths were reported. Sensitivity analyses were consistent with the findings. ConclusionsAlthough systemic steroids do not appear to increase bleeding events after tonsillectomy, their use is associated with a raised incidence of operative reinterventions for bleeding episodes, which may be related to increased severity of bleeding events. Systemic steroids should be used with caution, and the risks and benefits weighed, for the prevention of postoperative nausea and vomiting after tonsillectomy before further research is performed to clarify their condition of use.

Purpose Lung deflation during one-lung ventilation (OLV) is thought to be faster using a double-lumen endotracheal tube (DL-ETT) than with a bronchial blocker, especially when the non-ventilated lumen is opened to allow egress of air from the operative lung. Nevertheless, ambient air can also be entrained into the non-ventilated lumen before pleural opening and subsequently delay deflation. We therefore hypothesized that occluding the non-ventilated DL-ETT lumen during OLV before pleural opening would prevent air entrainment and consequently enhance operative lung deflation during video-assisted thoracoscopic surgery (VATS). Methods Thirty patients undergoing VATS using DL-ETT to allow OLV were randomized to having the lumen of the operative lung either open (control group) or occluded (intervention group) to ambient air. The primary outcome was the time to lung collapse evaluated intraoperatively by the surgeons. The T 50 , an index of rate of deflation, was also determined from a probabilistic model derived from intraoperative video clips presented in random order to three observers. ResultsThe median [interquartile range] time to lung deflation occurred faster in the intervention group than in the control group (24 [20-37] min vs 54 min,