Background: Lymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD) could prevent or manage limb edema in women after breast-cancer surgery. Methods: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro), SCOPUS, and Cochrane Central Register of Controlled Trials electronic databases were searched for articles on MLD published before December 2012, with no language restrictions. The primary outcome for prevention was the incidence of postoperative lymphedema. The outcome for management of lymphedema was a reduction in edema volume. Results: In total, 10 RCTs with 566 patients were identified. Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI) of 0.14 to 2.82. Seven studies assessed the reduction in arm volume, and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI, −9.34 to 159.58). Conclusions: The current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema.

Postoperative sore throat and other airway morbidities are common and troublesome after endotracheal tube intubation general anesthesia (ETGA). We propose lidocaine as endotracheal tube (ETT) cuff inflation media to reduce the postintubation-related emergence phenomenon. We searched PubMed, EMBASE, and Cochrane databases systematically for randomized controlled trials (RCTs) that have investigated the outcome of intracuff lidocaine versus air or saline in patients receiving ETGA. Using a random-effects model, we conducted a meta-analysis to assess the relative risks (RRs) and mean difference (MD) of the incidence and intensity of relevant adverse outcomes. We reviewed nineteen trials, which comprised 1566 patients. The incidence of early- and late-phase postoperative sore throat (POST), coughing, agitation, hoarseness, and dysphonia decreased significantly in lidocaine groups, with RRs of 0.46 (95% confidence interval [CI]: 0.31 to 0.68), 0.41 (95% CI: 0.25 to 0.66), 0.43 (95% CI: 0.31 to 0.62), 0.37 (95% CI: 0.25 to 0.55), 0.43 (95% CI: 0.29 to 0.63), and 0.19 (95% CI: 0.08 to 0.5), respectively, when compared with the control groups. The severity of POST also reduced significantly (mean difference [MD] -16.43 mm, 95% CI: -21.48 to -11.38) at 1 h and (MD -10.22 mm, 95% CI: -13.5 to -6.94) at 24 h. Both alkalinized and non-alkalinized lidocaine in the subgroup analyses showed significant benefits in emergence phenomena prevention compared with the control. Our results indicate that both alkalinized and non-alkalinized intracuff lidocaine may prevent and alleviate POST and postintubation-related emergence phenomena.

Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic review and meta-analysis of recovery outcomes in morbidly obese patients who had undergone general anesthesia. We systematically searched the PubMed, EMBASE™, Cochrane, and Scopus™ databases for randomized controlled trials that evaluated the outcome of anesthesia with desflurane, sevoflurane, isoflurane, or propofol in morbidly obese patients. Using a random effects model, we conducted meta-analyses to assess recovery times (eye opening, hand squeezing, tracheal extubation, and stating name or birth date), time to discharge from the postanesthesia care unit (PACU), and the incidence and severity of postoperative nausea and vomiting (PONV). We reviewed results for 11 trials and found that patients given desflurane took less time: to respond to commands to open their eyes (weighted mean difference [WMD] −3.10 min; 95% confidence interval (CI): −5.13 to −1.08), to squeeze the investigator’s hand (WMD −7.83 min; 95% CI: −8.81 to −6.84), to be prepared for tracheal extubation (WMD −3.88 min; 95% CI: −7.42 to −0.34), and to state their name (WMD −7.15 min; 95% CI: −11.00 to −3.30). We did not find significant differences in PACU discharge times, PONV, or the PACU analgesic requirement. Postoperative recovery was significantly faster after desflurane than after sevoflurane, isoflurane, or propofol anesthesia in obese patients. No clinically relevant differences were observed regarding PACU discharge time, incidence of PONV, or postoperative pain scores. The systematic review was registered with PROSPERO (CRD42014009480). Les patients obèses constituent un défi pour une anesthésie générale sécuritaire en raison d’une physiologie cardiopulmonaire altérée et de risques accrus d’aspiration et d’obstruction aiguë des voies aériennes hautes. Considérant que l’on manque d’études sur la récupération des effets postopératoires de l’anesthésie générale chez des patients présentant une obésité morbide, nous avons effectué une revue systématique et une méta-analyse des critères de jugement de la récupération chez ces patients ayant une obésité morbide et ayant subi une anesthésie générale. Nous avons effectué une recherche systématique dans les bases de données PubMed, MEDLINE™, Cochrane et Scopus™ pour identifier des études randomisées et contrôlées qui avaient évalué les aboutissements de l’anesthésie par desflurane, sévoflurane, isoflurane ou propofol chez des patients ayant une obésité morbide. Au moyen d’un modèle d’effets aléatoires, nous avons réalisé des méta-analyses pour évaluer les temps de récupération (ouverture des yeux, serrement de main, extubation trachéale, indication du nom ou de la date de naissance), le temps écoulé jusqu’au congé de l’unité de soins post anesthésie (salle de réveil) et l’incidence et la sévérité des nausées et vomissements postopératoires. Nous avons analysé les résultats de 11 études et avons constaté que les patients ayant reçu du desflurane prenaient moins de temps à: répondre à l’ordre d’ouvrir les yeux (différence moyenne pondérée [DMP] −3,10 min; intervalle de confiance [IC] à 95 %: −5,13 à −1,08), à serrer la main de l’investigateur (DMP −7,83 min; IC à 95 %: −8,81 à −6,84), à être prêt pour l’extubation trachéale (DMP −3,88 min; IC à 95 %: −7,42 à −0,34) et à donner leur nom (DMP −7,15 min; IC à 95 %: −11,00 à −3,30). Nous n’avons pas trouvé de différences significatives dans les délais de congé de la salle de réveil, ni sur les plans des nausées et vomissements post opératoires ou des besoins en analgésiques en salle de réveil. La récupération postopératoire a été significativement plus rapide après desflurane qu’après une anesthésie par sévoflurane, isoflurane ou propofol chez des patients obèses. Aucune différence cliniquement pertinente n’a été observée concernant les délais de congé de la salle de réveil, l’incidence des nausées et vomissements postopératoires, ou des scores de douleur postopératoire. La revue systématique a été enregistrée dans PROSPERO (CRD42014009480).

Background: Breast cancer is rare in men and managed by extrapolating from breast cancer in women. The clinicopathological features of male breast cancer, however, differ from those of female breast cancer. Because clinical trials are rare, the synthesis of real-world data is one method of integrating sufficient evidence on the optimal treatment for this patient population. Methods: PubMed, Embase, and Cochrane Library databases were searched. Clinical studies were included if they evaluated the treatments of interest in male breast cancer; these evaluations included breast-conserving surgery (BCS) versus mastectomy, postmastectomy radiation therapy versus no radiation, the accuracy of sentinel lymph node biopsy (SLNB), and a comparison of various endocrine therapies. Results: Forty studies were retrieved. The pooled estimate of overall survival (OS) revealed no difference between BCS and mastectomy groups. Postmastectomy radiation to the chest wall significantly increased OS relative to no postmastectomy radiation (hazard ratio (HR) 0.67, 95 per cent confidence interval 0.54 to 0.84). The pooled estimates of identification and false-negative rates of SLNB were 97.4 and 7.4 per cent respectively. Tamoxifen treatment was associated with significantly increased OS compared with no tamoxifen intake (HR 0.62, 0.41 to 0.95). Conclusion: Identification and false-negative rates for SLNB were comparable to those in female breast cancer. Breast-conserving surgery can be effective and safe; postmastectomy radiation to the chest wall and 5-year tamoxifen treatment improves survival.