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Safety and efficacy of perioperative benzodiazepine administration: study protocol for a systematic review and meta-analysis
  1. Jessica Spence1,
  2. Jack Young2,
  3. Waleed Alhazzani3,
  4. Richard Whitlock4,
  5. Frédérick D'Aragon5,
  6. Kevin Um6,
  7. David Mazer7,
  8. Chris Beaver8,
  9. Eric Jacobsohn9,
  10. Emilie Belley-Cote10
  1. 1 Departments of Anesthesia and Critical Care and Health Research Methods, Evaluation, and Impact (HEI); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  2. 2 Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
  3. 3 Departments of Critical Care, Medicine (Gastroenterology), and Health Research Methods, Evaluation, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
  4. 4 Departments of Surgery (Cardiac Surgery) and Health Research Methods, Evaluation and Impact (HEI); Population Health Research Institute (PHRI), McMaster University, Hamilton, Ontario, Canada
  5. 5 Départment d'anesthésiologie, Faculte de medecine et des sciences de la sante, Université de Sherbrooke, Sherbrooke, Quebec, Canada
  6. 6 Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  7. 7 Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  8. 8 Sheridan College, Oakville, Ontario, Canada
  9. 9 Rady Faculty of Health Sciences and Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  10. 10 Departments of Critical Care and Medicine (Cardiology); Population Health Research Institute (PHRI), McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Jessica Spence; spencej{at}phri.ca

Abstract

Introduction Perioperative benzodiazepines are used because of their anxiolytic, sedative and amnestic effects. Evidence has demonstrated an association of benzodiazepines with adverse neuropsychiatric effects. Nonetheless, because of their potential benefits, perioperative benzodiazepines continue to be used routinely. We seek to evaluate the body of evidence of the risks and benefits of benzodiazepine use during the perioperative period.

Methods and analysis We will search Cochrane CENTRAL, MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Science from inception to March 2019 for randomised controlled trials (RCTs) and observational studies evaluating the administration of benzodiazepine medications as compared with all other medications (or nothing) in patients undergoing cardiac and non-cardiac surgery. We will exclude studies assessing the use of benzodiazepines for procedural sedation or day surgery. We will examine the impact of giving these medications before, during and after surgery. Outcomes of interest include the incidence of delirium, duration of delirium, postprocedure cognitive change, the incidence of intraoperative awareness, patient satisfaction/quality of life/quality of recovery, length-of-stay (LOS) in the intensive care unit (ICU), hospital LOS and in-hospital mortality.

Reviewers will screen references and assess eligibility using predefined criteria independently and in duplicate. Two reviewers will independently collect data using prepiloted forms. We will present results separately for RCTs and observational studies. We will pool data using a random effect model and present results as relative risk with 95% CIs for dichotomous outcomes and mean difference with 95% CI for continuous outcomes. We will pool adjusted ORs for observational studies. We will assess risk of bias for individual studies using the Cochrane Collaboration tool for RCTs. For observational studies, we will use tools designed by the Clinical Advances through Research and Information Translation group. Quality of evidence for each outcome will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Ethics and dissemination This systematic review involves no patient contact and no interaction with healthcare providers or systems. As such, we did not seek ethics board approval. We will disseminate the findings of our systematic review through the presentation at peer-reviewed conferences and by seeking publication in a peer-reviewed journal.

PROSPERO registration number CRD42019128144

  • adult anaesthesia
  • epidemiology
  • adult intensive & critical care
  • neurological injury
  • adult surgery

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @jess_spence13

  • Contributors JS was responsible for the design and conception of this work, development of the search strategy, and the drafting and revision of the final manuscript. JY was responsible for the design and conception of this work, development and execution of the search strategy, and the revision of the final manuscript. WA, RW, FD, KU, DM, CB and EJ were responsible for the design and conception of this work and the revision of the final manuscript. EB-C was responsible for the design and conception of this work, development of the search strategy and the drafting and revision of the final manuscript. All authors approved of the final version submitted for publication and all agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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