Sharon R Lewis

A systematic review of information format and timing before scheduled adult surgery for peri-operative anxiety

We included 34 trials with 3742 participants, identified through 6 database and supplementary searches (to May 2017): 29 were randomised; 4 were quasi‐randomised and 1 was cluster‐randomised. Disparate measurements and outcomes precluded meta‐analyses. Blinding was attempted in only 6 out of 34 (18%) trials. A multimedia format, alone or in combination with text or verbal formats, was studied in 20/34 (59%) trials: pre‐operative anxiety was unaffected in 10 out of 14 trials and reduced by the multimedia format in three; postoperative anxiety was unaffected in four out of five trials in which formats were compared. Multimedia formats increased knowledge more than text, which in turn increased knowledge more than verbal formats. Other outcomes were unaffected by information format. The timing of information did not affect pre‐operative anxiety, postoperative pain or length of stay. In conclusion, the effects of pre‐operative information on peri‐operative anxiety and other outcomes were affected little by format or timing.

Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly surgical patients

This is the protocol for a review and there is no abstract. The objectives are as follows: To compare maintenance of general anaesthesia for elderly surgical patients using total intravenous anaesthesia (TIVA) or inhalational anaesthesia on postoperative cognitive function, mortality, risk of hypotension, length of stay in the postanaesthetic care unit (PACU), and hospital stay.

Automated monitoring for the early detection of sepsis in critically ill patients

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate whether automated systems for the early detection of sepsis can reduce the time to appropriate treatment and improve clinical outcomes in critically ill patients in the ICU.

Nitrous oxide‐based vs. nitrous oxide‐free general anaesthesia and accidental awareness in surgical patients: an abridged Cochrane systematic review

Accidental awareness during general anaesthesia can arise from a failure to deliver sufficient anaesthetic agent, or from a patients resistance to an expected sufficient dose of such an agent. Awareness is ‘explicit’ if the patient is subsequently able to recall the event. We conducted a systematic review into the effect of nitrous oxide used as part of a general anaesthetic on the risk of accidental awareness in people over the age of five years undergoing general anaesthesia for surgery. We included 15 randomised controlled trials, 14 of which, representing a total of 3439 participants, were included in our primary analysis of the frequency of accidental awareness events. The awareness incidence rate was rare within these studies, and all were considered underpowered with respect to this outcome. The risk of bias across all studies was judged to be high, and 76% of studies failed adequately to conceal participant allocation. We considered the available evidence to be of very poor quality. There were a total of three accidental awareness events reported in two studies, one of which reported that the awareness was the result of a kink in a propofol intravenous line. There were insufficient data to conduct a meta‐ or sub‐group analysis and there was insufficient evidence to draw outcome‐related conclusions. We can, however, recommend that future studies focus on potentially high‐risk groups such as obstetric or cardiac surgery patients, or those receiving neuromuscular blocking drugs or total intravenous anaesthesia.

Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Our main objective is to assess the effectiveness of follow-up services for ICU survivors that aim to identify and address unmet health needs related to the ICU period. We aim to assess the effectiveness in relation to health-related quality of life, mortality, depression and anxiety, post-traumatic stress disorder, physical function, cognitive function, ability to return to work or education and adverse events. Our secondary objectives are, in general, to examine both the various ways that follow-up services are provided and any major influencing factors. Specifically, we aim to explore: the effectiveness of service organisation (physician versus nurse led, face to face versus remote, timing of follow-up service); possible differences in services related to country (developed versus developing country); and whether participants had delirium within the ICU setting.