A systematic review and meta-regression analysis of mivacurium for tracheal intubation

Abstract

SummaryWe systematically reviewed factors associated with intubation conditions in randomised controlled trials of mivacurium, using random-effects meta-regression analysis. We included 29 studies of 1050 healthy participants. Four factors explained 72.9% of the variation in the probability of excellent intubation conditions: mivacurium dose, 24.4%; opioid use, 29.9%; time to intubation and age together, 18.6%. The odds ratio (95% CI) for excellent intubation was 3.14 (1.65-5.73) for doubling the mivacurium dose, 5.99 (2.14-15.18) for adding opioids to the intubation sequence, and 6.55 (6.01-7.74) for increasing the delay between mivacurium injection and airway insertion from 1 to 2 min in subjects aged 25 years and 2.17 (2.01-2.69) for subjects aged 70 years, p < 0.001 for all. We conclude that good conditions for tracheal intubation are more likely by delaying laryngoscopy after injecting a higher dose of mivacurium with an opioid, particularly in older people.

Risk of bias and methodological appraisal practices in systematic reviews published in anaesthetic journals: a meta-epidemiological study

“…Since analysis by quality rather than clinical characteristics is properly termed ‘sensitivity’ analysis rather than ‘subgroup’ analysis, this suggests that the terminology was incorrectly applied by some authors. Twenty reported a change in pooled effect size over a range of clinically relevant outcomes due to the influence of low methodological quality/high risk of bias studies (Table S1). Some showed that low methodological quality/high risk of bias studies decreased the apparent incidence of adverse events such as mortality, infection or requirements for increased blood transfusion .…”

Reviews, systematic reviews and Anaesthesia

“…Such sequential methods can provide information on when firm evidence is reached in a cumulative meta-analysis, and can also provide an early clue to the lack of presence of a clinical effect. Finally, the systematic review can cast light on other aspects of practice; within Anaesthesia we have recently published a systematic review with meta-regression [32], a review of the interaction between ondansetron and tramadol [33], and case reports and series of cranial nerve injuries with supraglottic airways [34]. Manipulation of the existing dataset from a systematic review also helped confirm a recent case of research fraud [35].…”

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

“…Random‐effects meta‐regression analysis demonstrated that, within the age range 0‐12 years, excellent intubation conditions for rocuronium (17 study arms, 326 participants, R 2 = 71.4 and I 2 = 26.8%) were more likely with higher NMBA dose, younger participants and increasing time to intubation (Figure , Table S1).…”

“…Each circle represents a treatment group, the diameter of which is proportional to the number of participants. Some of the treatment groups are not displayed as they are overlapped by others…”

“…I 2 thresholds of 25%, 50%, and 75% indicate mild, moderate, and high degrees of inconsistency, respectively . We explored the causes of clinically important heterogeneity using subgroup analyses and meta‐regression . A sensitivity analysis was done to determine whether the results were sensitive to restrictions on the data included.…”