Beta-Blocking Agents for Surgery: Influence on Mortality and Major Outcomes. A Meta-Analysis

Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery

“…Epidural analgesia provides better analgesia than parenteral opioids regardless of the analgesic agent, location of catheter placement, and type and time of pain assessment (Block 2003;Guay 2006). The superior analgesia o ers improved postoperative coughing and breathing, and improved pulmonary mechanics thus potentially reducing pulmonary complications (Guay 2014a). The sympathetic blockade provided by epidural anaesthesia and analgesia and the sparing of the total opioid doses required improve bowel motility (Jorgensen 2000).…”

In Reply to Professor Bolsin and Colleagues

“…This retracted study was not included in our meta-analysis. 2 We, however, included 1 study from Poldermans that can still be downloaded from the journal website where it was published. 3 We feel it is not up to individual physicians to determine whether scientific misconduct has occurred.…”

“…3 Data from this study were included in the following analysis: Death at 0 to 30 days and myocardial infarction at 0 to 30 days. 2,3 Excluding any data from Poldermans, and using random-effects models, the risk ratio (RR) for the 0-to-30 day mortality would be 1.17 (95% confidence interval [CI] 0.85, 1.62; I-square 7%) and the RR for myocardial infarction at 0-to-30 days would be 0.68 (95%CI 0.57, 0.83; I-square 0%). Therefore, as one can see, adding or excluding the data from Poldermans does not modify our conclusions.…”

“…5,6 For our outcome death at 1 year, as clearly stipulated in the methods section of our meta-analysis, we included all deaths from any cause occurring from the start of the study up to 1 year (cumulative). 2…”

The Assessment and Reduction of Cardiac Events Risk in Noncardiac Operations: Is There a Need for Review of Recommendations?

“…Соответственно, если в мета-анализы включать недостоверные результаты исследований DECREASE [22,23], то можно прийти к заключению, что БАБ существенно не влияют на смертность, что позволяет фокусироваться на снижении числа нефатальных инфарктов миокарда как суррогатной конечной точки. Неудивительно, что назначение БАБ отнесено к рекомендациям I/IIa класса [4][5][6][7], несмотря на то, что в отдельных исследованиях они увеличивали смертность [19].…”