Adjunctive Dexmedetomidine in Alcohol Withdrawal Syndrome: A Systematic Review and Meta-analysis of Retrospective Cohort Studies and Randomized Controlled Trials.

OBJECTIVE: To investigate whether dexmedetomidine (DEX), as adjunctive therapy to benzodiazepine (BZD), is superior to BZD alone in critically ill patients with alcohol withdrawal syndrome (AWS). DATA SOURCES: PubMed Central, Cochrane CENTRAL, ClinicalTrials.gov and Google Scholar were used as search databases. Specific keywords and MeSH terms were "dexmedetomidine," "benzodiazepine," and "alcohol withdrawal syndrome." The last search was on September 16, 2022. STUDY SELECTION AND DATA EXTRACTION: Randomized controlled trials (RCTs) and nonrandomized/cohort studies exploring the use of DEX in the management of AWS were included. A total of 12 studies were included in the systematic review and 7 in the meta-analysis. DATA SYNTHESIS: The intensive care unit length of stay (ICU LOS) was found to have a mean difference (MD) of 48.06 [37.48, 58.64], P = <0.001 for the cohort subgroup, significantly favoring the DEX arm, but, in contrast, pooled RCT data showed a result of -20.07 [-36.86, -3.28], P = 0.02, a shorter ICU LOS for the DEX arm. Bradycardia and hypotension incidence significantly favored the BZD arm in both subgroups. This study compares the effectiveness of adjunctive DEX in clinical practice and aims to help providers in critical decision-making by compiling and analyzing the best current available evidence of its use in AWS. CONCLUSIONS: Based on low to very low level of evidence, adjunctive DEX showed no significant difference for ICU LOS when compared with BZD alone. Pooled randomized trials potentially show a benefit but are similarly limited by their low quality of evidence.

Postoperative Drain Site Seeding to the Abdominal Wall of Sigmoid Adenocarcinoma: A Case Report and Literature Review.

Colorectal carcinoma (CRC) is a very common cancer found worldwide. When metastasizing, it would often seed the liver via traveling through the portal circulation; however, locoregional metastasis is also possible. Abdominal wall seeding postoperatively has been described to happen rarely in those who underwent definitive surgery for CRC. Currently, five case reports are in publication describing this phenomenon. Here, we present a case of a drain site abdominal wall tumor recurrence after definitive surgery with curative intent of a sigmoid adenocarcinoma. Those with higher tumor-node-metastasis (TNM) staging and a primary site at the sigmoid colon were found to be at a higher risk for recurrence. Despite this, abdominal wall recurrence of CRC is exceptionally rare, with less than 1% of those with locoregional recurrence presenting at the incision site or trocar site placement. Because of the rarity of this complication, few studies are available that detail the management of abdominal wall recurrence of CRC. Further studies on this subject are currently warranted.