Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

Fonseca, Francisca Jerónimo; Ferreira, Leonardo; Rouxinol-Dias, Ana Lídia; Mourão, Joana

doi:10.1016/j.bjane.2021.12.002

Cited by 4 publications

(3 citation statements)

References 100 publications

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“…Continuation of dexmedetomidine postoperatively did not prevent delirium in the trial by Turan et al. but did cause hypotension, as was reported by a meta‐analysis [22, 36]. The combination of our results with those of Turan et al.…”

Section: Discussionsupporting

confidence: 85%

A randomised controlled trial of dexmedetomidine for delirium in adults undergoing heart valve surgery

Jia

Zhang

et al. 2023

Anaesthesia

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Dexmedetomidine might reduce delirium after cardiac surgery. We allocated 326 participants to an infusion of dexmedetomidine at a rate of 0.6 lg kg À1 for 10 min and then at 0.4 lg.kg À1 .h À1 until the end of surgery; 326 control participants received comparable volumes of saline. We detected delirium in 98/652 (15%) participants during the first seven postoperative days: 47/326 after dexmedetomidine vs. 51/326 after placebo, p = 0.62, adjusted relative risk (95%CI) 0.86 (0.56-1.33), p = 0.51. Postoperative renal impairment (Kidney Disease Improving Global Outcomes stages 1, 2 and 3) was detected in 46, 9 and 2 participants after dexmedetomidine and 25, 7 and 4 control participants, p = 0.040. Intra-operative dexmedetomidine infusion did not reduce the incidence of delirium after cardiac valve surgery but might impair renal function.

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Section: Discussionsupporting

confidence: 85%

A randomised controlled trial of dexmedetomidine for delirium in adults undergoing heart valve surgery

Jia

Zhang

et al. 2023

Anaesthesia

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“…Dexmedetomidine has a mechanism of action similar to clonidine, but its affinity for the α2 receptor is eight times greater (Canpolat et al, 2012). Hypotension and bradycardia caused by dexmedetomidine were obvious in the previous study (Fonseca et al, 2021); these effects are also dosedependent. Poorzamany Nejat Kermany et al (2016) reported that dexmedetomidine provides sufficient analgesia at a bolus dose of 0.5 μg kg −1 , and its hemodynamic side effects can be alleviated in this approach.…”

Section: Discussionmentioning

confidence: 78%

Efficacy of dexmedetomidine versus midazolam when combined with butorphanol for sedation and analgesia during burn dressing changes: A randomized clinical trial

Xian-chao

Cui

et al. 2022

Front. Pharmacol.

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Objective: The aim of this study was to compare dexmedetomidine-butorphanol (DB) and midazolam-butorphanol (MB) combinations for sedation, and analgesia in burn patients undergoing dressing changes.Methods: A total of 56 ASA I–II burn patients were included in this single-center randomized clinical trial. The ages of these patients were between 20 and 60 years. TBSA ranged from 10% to 50%. They were randomized to group DB and group MB during dressing change. In the DB group, each patient received a bolus dose of dexmedetomidine (0.5 μg kg−1) and intermittent boluses of butorphanol (20 μg kg−1). In the MB group, each patient received a bolus dose of midazolam (0.05 mg kg−1) and intermittent boluses of butorphanol (20 μg kg−1). The primary outcomes were sedation scores and pain scores. The second outcomes were vital signs, side effects, and butorphanol consumption.Results: The sedation scores of these two groups did not differ significantly (p > 0.05), and the pain scores of these groups were not significantly different (p > 0.05). More patients had hypotension in the DB group than in the MB group (6 versus 0, p = 0.01), but the number of patients who had respiratory depression was higher in the MB group compared with the DB group (4 versus 0, p = 0.038). Butorphanol consumption in the MB group was higher than in the DB group (p = 0.025).Conclusion: Dexmedetomidine is comparable to midazolam when combined with butorphanol in burn patients during dressing change. Compared with midazolam, it has the advantage of opioid-sparing effect.Clinical Trial Registration: [http://www.chictr.org.cn/showproj.aspx&proj=130622], identifier [ChiCTR2100049325].

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“…Despite its benefits, dexmedetomidine is still not widely used for NORA, primarily due to its adverse hemodynamic effects. In a recent meta-analysis of over 6000 NORA patients, dexmedetomidine sedation resulted in less desaturation events but a longer time to recovery and more hemodynamic instability (hypotension and bradycardia) [16 ▪▪ ]. It is recommended that patients receiving dexmedetomidine should undergo hemodynamic monitoring after termination of administration due to the prolonged duration of effect [17].…”

Section: Sedatives and Analgesics For Nonoperating Room Anesthesiamentioning

confidence: 99%

Sedation-analgesia techniques for nonoperating room anesthesia: an update

Khorsand¹,

Karamchandani²,

Joshi³

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThere has been a substantial increase in nonoperating room anesthesia procedures over the years along with an increase in the complexity and severity of cases. These procedures pose unique challenges for anesthesia providers requiring meticulous planning and attention to detail. Advancements in the delivery of sedation and analgesia in this setting will help anesthesia providers navigate these challenges and improve patient safety and outcomes. Recent findingsThere has been a renewed interest in the development of newer sedative and analgesic drugs and delivery systems that can safely provide anesthesia care in challenging situations and circumstances. SummaryDelivery of anesthesia care in nonoperating room locations is associated with significant challenges. The advent of sedative and analgesic drugs that can be safely used in situations where monitoring capabilities are limited in conjunction with delivery systems, that can incorporate unique patient characteristics and ensure the safe delivery of these drugs, has the potential to improve patient safety and outcomes. Further research is needed in these areas to develop newer drugs and delivery systems.

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Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

Cited by 4 publications

References 100 publications

A randomised controlled trial of dexmedetomidine for delirium in adults undergoing heart valve surgery

A randomised controlled trial of dexmedetomidine for delirium in adults undergoing heart valve surgery

Efficacy of dexmedetomidine versus midazolam when combined with butorphanol for sedation and analgesia during burn dressing changes: A randomized clinical trial

Sedation-analgesia techniques for nonoperating room anesthesia: an update

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