Introduction
Methods
Search strategy
Inclusion and exclusion criteria
Quality assessment
Data extraction and outcomes
Statistical analysis
Results
Study selection
Study characteristics
Study | County | Design | No. of patients | Mean age years | Male % | Anesthesia regimen | Type of surgery | Protocols of RIPC | Control | Diagnosis of outcomes |
---|---|---|---|---|---|---|---|---|---|---|
Hudetz 2015 | USA | R, DB | 30 | 65.5 | 100 | Midazolam, fentanyl, rocuronium, etomidate, isoflurane; | On-pump heart surgery | UL, 200mmHg, 5min × 4, after anesthesia induction and before CPB | Uninflated cuff | 1-SD |
Gasparovic 2019 | USA | R, DB | 66 | 62 | 82 | Midazolam, sufentanil, rocuronium, sevoflurane; | On-pump CABG | UL, 200mmHg, 5min × 3, after anesthesia induction and before CPB | Uninflated cuff | MoCA |
Meybohm 2018 | Germany | R, DB | 273 | NR | NR | Intravenous anesthesia with no volatile anesthetic agents | On-pump heart surgery | UL, 200mmHg, 5min × 4, after anaesthesia induction and before CPB | Uninflated cuff | 1-SD and Z score |
Meybohm 2013 | Germany | R, DB | 180 | 69 | 81.2 | Propofol, rocuronium, sufentanil; | On-pump heart surgery | UL, 200mmHg, 5min × 4, after anesthesia induction and before CPB | Uninflated cuff | 1-SD |
Joung 2013 | Korea | R, DB | 70 | 60 | 81.4 | Etomidate, propofol, rocuronium, remifentanil; | Off-pump CABG | UL, 200mmHg, 5min × 4, before coronary artery anastomosis | Uninflated cuff | 1-SD |
He 2017 | China | R, DB | 90 | 68 | 13.3 | Midazolam, etomidate, sufentanil, cisatracurium, remifentanil, sevoflurane | Colon surgery | UL, 200mmHg, 5min × 3, before anesthesia induction | Uninflated cuff | MoCA |
Zou 2013 | China | R | 68 | 49.7 | 53 | Intravenous anesthesia with no volatile anesthetic agents | Cardiopulmonary bypass heart surgery | UL, 200mmHg, 5min × 3, after anesthesia induction and after CPB | Uninflated cuff | MMSE |
Wang 2021 | China | R | 60 | 46 | 53.3 | Etomidate, sufentanil, cisatracurium, remifentanil, desflurane | Moyamoya disease vascularization | LL, 200mmHg, 5min × 4, after anesthesia induction | Uninflated cuff | MoCA |
Jing 2011 | China | R, DB | 40 | 49.5 | 37.5 | Midazolam, etomidate, fentanyl, sevoflurane, Vecuronium bromide | On-pump valvular surgery | UL, 35kPa,5min× 4, after anesthesia induction | Uninflated cuff | MMSE and MoCA |
Zhou 2018 | China | R | 60 | 69.5 | 56.6 | Intravenous anesthesia with no volatile anesthetic agents | Liver cancer surgery | LL, 5min × 3, after anesthesia induction, arterial blood flow cannot be detected by ultrasound | Uninflated cuff | MMSE |
Su 2009 | China | R | 36 | 55.5 | 41.6 | Intravenous anesthesia with no volatile anesthetic agents | CPB heart surgery | UL, 200mmHg, 5min × 3, after anesthesia induction | Uninflated cuff | MMSE |
Tao 2014 | China | R | 80 | 67.5 | 57.5 | Intravenous anesthesia with no volatile anesthetic agents | radical resection of rectal carcmoma | LL, 200mmHg, 5min × 3, after anesthesia induction | Uninflated cuff | MMSE |
Zhang 2020 | China | R | 69 | 67 | 49.2 | Intravenous anesthesia with no volatile anesthetic agents | Surgical operation | UL, 50mmHg higher than basal systolic blood pressure (up to 200mmHg), 3min × 3, after anesthesia induction | Uninflated cuff | Z score |
The effect of RIPC on the POCD incidence
Study excluded | OR/MD (95% CI) | I2 (%) | P for Cochrane’s Q test | P for overall effect |
---|---|---|---|---|
Influence of RIPC on POCD | ||||
Gasparovic 2019 | 0.49 [0.29,0.84] | 54 | 0.03 | 0.009 |
Hudetz 2015 | 0.59 [0.38,0.91] | 36 | 0.13 | 0.02 |
Jing 2011 | 0.53 [0.32,0.89] | 50 | 0.04 | 0.02 |
Joung 2013 | 0.44 [0.26,0.76] | 51 | 0.04 | 0.003 |
Meybohm 2013 | 0.43 [0.23,0.77] | 51 | 0.04 | 0.005 |
Meybohm 2018 | 0.42 [0.23,0.79] | 52 | 0.04 | 0.007 |
Su 2009 | 0.57 [0.35,0.91] | 43 | 0.08 | 0.02 |
Tao 2014 | 0.45 [0.26,0.78] | 53 | 0.03 | 0.004 |
Zhang 2020 | 0.56 [0.34,0.91] | 46 | 0.07 | 0.02 |
Zhou 2018 | 0.52 [0.30,0.89] | 51 | 0.04 | 0.02 |
Influence of RIPC on surgery time | ||||
He 2017 | −0.99 [−8.5,6.52] | 54 | 0.04 | 0.8 |
Hudetz 2015 | −2.43 [−7.68,2.82] | 61 | 0.02 | 0.36 |
Jing 2011 | −1.96 [−8.15,4.23] | 60 | 0.02 | 0.53 |
Joung 2013 | −3.18 [−8.18,1.82] | 56 | 0.03 | 0.21 |
Wang 2021 | −4.74 [−9.01, −0.47] | 39 | 0.13 | 0.03 |
Zhang 2020 | −2.79 [−7.95,2.38] | 59 | 0.02 | 0.29 |
Zhou 2018 | −1.8 [−5.09,1,49] | 0 | 0.5 | 0.28 |
Zou 2013 | −3.06 [−8.17,2.06] | 57 | 0.03 | 0.24 |