The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis

Abstract

Objectives. A systematic review of the literature was conducted to evaluate hypotensive agents in terms of their adverse effects and associations with perioperative morbidity in patients undergoing nasal surgery. Methods. Two authors independently searched databases (Medline, Scopus, and Cochrane databases) up to February 2020 for randomized controlled trials comparing the perioperative administration of a hypotensive agent with a placebo or other agent. The outcomes of interest for this analysis were intraoperative morbidity, operative time, intraoperative bleeding, hypotension, postoperative nausea/vomiting, and postoperative pain. Both a standard pairwise meta-analysis and network meta-analysis were conducted. Results. Our analysis was based on 37 trials. Treatment networks consisting of six interventions (placebo, clonidine, dexmedetomidine, beta-blockers, opioids, and nitroglycerine) were defined for the network meta-analysis. Dexmedetomidine resulted in the greatest differences in intraoperative bleeding (−0.971; 95% confidence interval [CI], −1.161 to −0.781), intraoperative fentanyl administration (−3.683; 95% CI, −4.848 to −2.518), and postoperative pain (−2.065; 95% CI, −3.170 to −0.960) compared with placebo. The greatest difference in operative time compared with placebo was achieved with clonidine (−0.699; 95% CI, −0.977 to −0.421). All other agents also had beneficial effects on the measured outcomes. Dexmedetomidine was less likely than other agents to cause adverse effects. Conclusion. This study demonstrated the superiority of the systemic use of dexmedetomidine as a perioperative hypotensive agent compared with the other five tested agents. However, the other agents were also superior to placebo in improving operative time, intraoperative bleeding, and postoperative pain.

Effectiveness of the Endoscopic Prelacrimal Recess Approach for Maxillary Sinus Inverted Papilloma Removal: A Systematic Review and Meta-Analysis

“…The data from the included studies were extracted using standardized forms. 8,9 The primary outcomes of the meta-analysis were the odds ratios (ORs; comparison of outcomes between two groups) for the recurrence of inverted papilloma, facial or gingival numbness, nasal bleeding, and periorbital swelling during follow-up (prelacrimal recess approach vs. conventional surgery [EMM, endoscopic surgery, and/or the Caldwell-Luc operation]). 1,3,[10][11][12][13][14] Additionally, the incidence rates of recurrence and postoperative morbidities (postoperative facial or gingival numbness and alar collapse) after prelacrimal recess approach were assessed as secondary outcomes.…”

The effectiveness of the Ambu® AuraGain™ laryngeal mask on hemodynamic and respiratory parameters in patients undergoing septoplasty: A randomized prospective clinical study

“…Even a small bleeding in the operation area in the ear, nose, or throat affects the appearance of the operation area [17]. Although epinephrine is used to reduce pre-surgical bleeding, increases in arterial pressure can cause increase surgical bleeding [18].…”

Comparison of hypotensive properties of dexmedetomidine versus clonidine for induced hypotension during functional endoscopic sinus surgery: A randomised, double-blind interventional study

“…[ 18 ] compared dexmedetomidine and magnesium sulphate and found that better operating condition was provided by dexmedetomidine but with more hypotension and bradycardia like our study. Kim et al .,[ 19 ] in a meta-analysis of randomised controlled trials comparing the perioperative administration of hypotensive agents, found dexmedetomidine to be a superior agent. They also concluded that systemic use of dexmedetomidine reduces intraoperative bleeding and operating time, provides relatively stable haemodynamics by alleviating stress response and reduces the fentanyl requirement significantly.…”