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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 October;81(10):1105-17
Efficacy of intraoperative dexmedetomidine compared with placebo for surgery in adults: a meta-analysis of published studies
Le Bot A. 1, 2, Michelet D. 1, 2, Hilly J. 1, 2, Maesani M. 1, 2, Dilly M. P. 2, 3, Brasher C. 2, 3, Mantz J. 2-4, Dahmani S. 1, 2, 4 ✉
1 Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France;
2 Paris Diderot University, Paris, France;
3 Department of Anesthesia and Intensive Care, Hospitals Paris Nord Val de Seine, Paris, France;
4 DHU Protect, INSERM U1141, Robert Debré University Hospital, Paris, France
Dexmedetomidine (Dex) demonstrates sedative and analgesic effects. We investigated the intraoperative and postoperative effects of intraoperative Dex administration during surgery in adult patients.
A search for randomized placebo-controlled trials was conducted in Pubmed and Embase databases to identify randomized controlled clinical trials using intraoperative Dex for surgery in adult population. Outcome assessed were: intraoperative and postoperative opioid consumption, time of recovery from anesthesia, postoperative pain, and postoperative nausea or vomiting (PONV) in the first 24 hours. Data from each trial were combined to calculate pooled odds ratios (OR), mean difference (MD) or standardized mean difference (SMD) and 95% confidence interval (95 % CI). Heterogeneity was measured using I² statistics.
Eighteen randomized controlled trials were analyzed. Dex was administered to 815 patients and 410 received placebo. Overall, Dex significantly decreased intraoperative opioid consumption (SMD=-1.58 [-2.98, -0.19], I²=95 %, P<0.00001), but did not decrease time of recovery from anesthesia (SMD=-0.13 [-1.60, 1.34] minutes, I²=95 %, P<0.00001). Dex significantly reduced postoperative opioid consumption (SMD=-1.58 [-2.98, -0.19], I²=95 %, P<0.00001), postoperative pain intensity (SMD=-0.73 [-1.19, -0.27], I²=62 %, P=0.03), and the prevalence of PONV (OR=0.43 [0.27, 0.69], I²=0 %, P=0.46).
This meta-analysis shows that intraoperative Dex administration in adult patients reduces intra and postoperative opioid consumption, postoperative pain and PONV. Time of recovery is not affected.