神经丛麻醉与全身麻醉对颈动脉内膜切除术贴片血管成形术患者的影响:随机临床试验的荟萃分析和试验序贯分析的系统评价方案

M.S. Marsman , J. Wetterslev , F. Keus , D. van Aalst , F.G. van Rooij , J.M.M. Heyligers , F.L. Moll , A.Kh. Jahrome , P.W.H.E Vriens , G.G. Koning
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引用次数: 1

摘要

传统的颈动脉内膜切除术被认为是预防症状性颈动脉狭窄患者新发卒中的标准技术。到目前为止,传统颈动脉内膜切除术中使用神经丛麻醉或全身麻醉并没有明确证明孰优孰弊。对于症状性颈动脉狭窄的患者,传统的颈动脉内膜切除术,神经丛麻醉和全身麻醉哪一种更有效,需要进行系统的评价来评估利弊。方法和结果本综述将按照《Cochrane系统综述手册》的建议按照本方案进行,并按照系统综述和荟萃分析的首选报告项目进行报告。将包括比较传统颈动脉内膜切除术中神经丛麻醉与全身麻醉的随机临床试验。主要结局是术后死亡和/或中风(30天)和严重不良事件。次要结局是非严重不良事件。我们的结论将主要基于总体偏倚风险较低的试验的荟萃分析。我们将使用试验序列分析来协助评估推荐评估、开发和评估分级的不精确性。然而,如果所有试验的合并点估计值与总体低偏倚风险试验的合并点估计值相似,并且总体高偏倚风险试验和总体低偏倚风险试验的估计值之间缺乏统计学上显著的相互作用,我们将考虑将所有试验中获得的估计值的试验序列分析调整置信区间精度作为meta分析的结果。伦理和传播建议的系统评价将收集和分析已经进行的研究的次要数据,因此不需要伦理批准。系统审查的结果将在同行评议期刊上发表,并提交给相关会议。
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Plexus anesthesia versus general anesthesia in patients for carotid endarterectomy with patch angioplasty: Protocol for a systematic review with meta-analyses and Trial Sequential Analysis of randomized clinical trials

Introduction

Traditional carotid endarterectomy is considered to be the standard technique for prevention of a new stroke in patients with a symptomatic carotid stenosis. Use of plexus anesthesia or general anesthesia in traditional carotid endarterectomy is, to date, not unequivocally proven to be superior to one other. A systematic review is needed for evaluation of benefits and harms to determine which technique, plexus anesthesia or general anesthesia is more effective for traditional carotid endarterectomy in patients with symptomatic carotid stenosis.

Methods and outcomes

The review will be conducted according to this protocol following the recommendations of the ‘Cochrane Handbook for Systematic Reviews’ and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Randomized Clinical Trials comparing plexus anesthesia versus general anesthesia in traditional carotid endarterectomy will be included. Primary outcomes will be postoperative death and/ or stroke (<30 days) and serious adverse events. Secondary outcomes will be non-serious adverse events.

We will primarily base our conclusions on meta-analyses of trials with overall low risk of bias. We will use Trial Sequential Analysis to assist the evaluation of imprecision in Grading of Recommendations Assessment, Development and Evaluation. However, if pooled point-estimates of all trials are similar to pooled point-estimates of trials with overall low risk of bias and there is lack of a statistical significant interaction between estimates from trials with overall high risk of bias and trials with overall low risk of bias we will consider the Trial Sequential Analysis adjusted confidence interval precision of the estimate achieved in all trials as the result of our meta-analyses.

Ethics and dissemination

The proposed systematic review will collect and analyze secondary data from already performed studies therefore ethical approval is not required. The results of the systematic review will be disseminated by publication in a peer-review journal and submitted for presentation at relevant conferences.

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期刊介绍: IJS Protocols is the first peer-reviewed, international, open access journal seeking to publish research protocols across across the full breadth of the surgical field. We are aim to provide rapid submission to decision times whilst maintaining a high quality peer-review process.
期刊最新文献
The association of breast surgery ASPIRE: breast pain pathway rapid evaluation project - study protocol. The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: protocol for a prospective, multicentre cohort study. Artificial intelligence-enabled ophthalmoscopy for papilledema: a systematic review protocol. Protocol to evaluate the efficacy and safety of tolvaptan in patients with refractory ascites after liver resection: an open-label, single-arm phase I/II study A new minimally invasive, nonexcisional, surgical browlift technique with minimal scarring: a protocol for a prospective observational study
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