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BackgroundErector spinae plane block (ESPB), as a regional anesthesia modality, is gaining interest and has been used in abdominal, thoracic and breast surgeries. The evidence on the efficacy of this block in spinal surgeries is equivocal. Recently published reviews on this issue have concerning limitations in methodology.MethodsA systematic search was conducted using the PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) that were done in patients undergoing spinal surgery and had compared outcomes of interest among those that received ESPB and those with no block/placebo were considered for inclusion. Statistical analysis was performed using STATA software. GRADE assessment was done for the quality of pooled evidence.ResultsA total of 13 studies were included. Patients receiving ESPB had significantly reduced total opioid use (Standardized mean difference, SMD −2.76, 95% CI: −3.69, −1.82), need for rescue analgesia (Relative risk, RR 0.38, 95% CI: 0.22, 0.66) and amount of rescue analgesia (SMD −5.08, 95% CI: −7.95, −2.21). Patients receiving ESPB reported comparatively lesser pain score at 1 h (WMD −1.62, 95% CI: −2.55, −0.69), 6 h (WMD −1.10, 95% CI: −1.45, −0.75), 12 h (WMD −0.78, 95% CI: −1.23, −0.32) and 24 h (WMD −0.54, 95% CI: −0.83, −0.25) post-operatively. The risk of postoperative nausea and vomiting (PONV) (RR 0.32, 95% CI: 0.19, 0.54) was lower in those receiving ESPB. There were no differences in the duration of surgery, intra-operative blood loss and length of hospital stay between the two groups. The quality of pooled findings was judged to be low to moderate.ConclusionsESPB may be effective in patients with spinal surgery in reducing post-operative pain as well as need for rescue analgesic and total opioid use. In view of the low to moderate quality of evidence, more trials are needed to confirm these findings.Systematic Review Registration:http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021278133.

Background Stroke volume variation (SVV) and pulse pressure variation (PPV) are based on the interaction between the heart and lungs during mechanical ventilation. However, debate continues as to whether SVV and PPV can accurately predict fluid responsiveness during the one-lung ventilation (OLV). We therefore undertook a systematic review and meta-analysis of clinical trials that investigated the diagnostic value of SVV and PPV in predicting fluid responsiveness undergoing OLV during thoracic surgery. Methods The MEDLINE, EMBASE, WANFANG, and CENTRAL databases were systematically searched for studies on the use of SVV and/or PPV in patients undergoing OLV from 2010 to 2021. Heterogeneity was assessed using I 2 statistics. The funnel diagram analysis was used to test publication bias. A fixed-effects model was used to calculate the pooled values of sensitivity, specificity, the diagnostic odds ratio (DOR), and the relevant 95% confidence intervals (95% CIs). The summary receiver operating characteristic (SROC) curves were estimated, and the areas under the SROC curve were calculated. Results In total nine studies, comprising 452 patients were ultimately included in this meta-analysis, including 217 (48%) responders and 235 (52%) nonresponders. After combining the correlation coefficients, a slight heterogeneity was found between SVV and PPV in these selected studies (I 2 SVV =19.7%, I 2 PPV =15.3%), and the funnel diagram also showed that the P values of SVV and PPV were 0.33 and 0.26. After the pooled analysis, the respective sensitivity of SVV and PPV in predicting fluid responsiveness was 0.66 and 0.61, the specificity was 0.62 and 0.53, the positive likelihood ratios were 1.7 and 1.3, the negative likelihood ratios were 0.55 and 0.74, and the DORs were 3 and 2. The areas under the SROC curve of SVV and PPV were 0.68 and 0.60, respectively, according to STATA SE16 software, and the combined areas under the receiver operating characteristic (ROC) curve of SVV and PPV were 0.681 and 0.604, respectively, according to MedCalc19.0.4 software. Conclusions Current evidence suggests that SVV and PPV are not suitable for guiding intraoperative fluid therapy due to their poor ability to predict fluid responsiveness in patients undergoing OLV, and we need a better indicator instead.

Background : Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed. Methods: Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators included overall intubation success rates, the success rates of the first intubation, insertion time, ventilation efficiency rates, SpO2 rise time, the blood gas index and adverse events. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software. Results: We included 31 human studies. Compared to endotracheal intubation, the application of laryngeal mask for pre-hospital emergencies enhanced the ventilation efficiency rates [RR=1.20, 95% CI (1.06, 1.35), P<0.001], improved the success of first intubation [RR=1.29, 95% CI (1.18, 1.40), P<0.001] and the patients’ blood gas index, shortened the insertion and SpO2 rise times [SMD=-3.48, 95% CI (-4.17, -2.80), P < 0.001; -2.19, 95% CI (-3.06, -1.32), P < 0.001] and reduced the incidence of adverse events [RR=0.41, 95% CI (0.30, 0.57, P<0.001]. All results were stable and statistically significant. Conclusions: Laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application.

Background Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed.Methods Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators were overall intubation success rates, success rates of the initial intubation, insertion time, ventilation efficiency rates, SpO2 rise time and blood gas index. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software.Results We included 9 randomized manikin studies and 31 human studies. Meta-analysis of the manikin studies showed that the overall intubation success rates of the laryngeal mask group [RR=1.10, 95% CI (1.02, 1.18), P<0.05] and the success rates of first intubation [RR=1.25, 95% CI (1.01, 1.55), P <0.05] were significantly higher than the endotracheal intubation group. The insertion time of the laryngeal mask group was also significantly shorter [SMD = -1.53, 95% CI (-1.88, -1.17), P <0.05]. In human studies, excluding the success rates of first intubation and insertion time, the laryngeal mask was superior to endotracheal intubation and improved the patients’ blood gas index and shortened the SpO2 rise time. All the results were statistically significant.Conclusions Compared to endotracheal intubation, laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application .