Dexmedetomidine as an anesthetic adjuvant for intracranial procedures: Meta-analysis of randomized controlled trials

Peng, Ke; Wu, Shao-ru; Liu, Huayue; Ji, Fuhai

doi:10.1016/j.jocn.2014.02.023

Cited by 39 publications

(39 citation statements)

References 35 publications

(51 reference statements)

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“…6,10 However, a recent study showed that DEX may not increase the risk of postoperative bradycardia. 37 In this meta-analysis, 10 trials including 595 patients showed that DEX group had a significantly lower heart rate than the control group. In addition, TSA indicated that firm conclusion can be drawn because Z curve crossed both the conventional boundary and the TSA boundary.…”

Section: Discussionmentioning

confidence: 94%

“…Postoperative hypotension is another common adverse event during DEX treatment, which increases the risk of cerebral ischemia because regulation of cerebral blood perfusion is often impaired near surgically traumatized areas. 38 Peng et al 37 found that there was no significant difference in the incidence of treatment for postoperative hypotension between DEX and placebo. Thus, doctors should pay attention to the hypotension when DEX was adopted.…”

Section: Discussionmentioning

confidence: 99%

“…No significance was observed between 2 groups about extubation time, which was consistent with previous study. 37 However, heterogeneity was observed, and sensitivity analyses showed that DEX group had a longer extubation time than control group after omitting “Bakhamees 2007.” The TSA indicated that Z curve crossed the conventional boundary only. Thus, more studies are needed in future before drawing a firm conclusion.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Dexmedetomidine in Preventing Postoperative Side Effects for Laparoscopic Surgery

et al. 2016

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of Dexmedetomidine in Preventing Postoperative Side Effects for Laparoscopic Surgery

et al. 2016

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“…The perioperative pain management of patients undergoing neurosurgery has drawn more attention recently, and an increasing number of studies have reported that most patients experience moderate-to-severe pain after neurosurgery (Gottschalk et al, 2007; Flexman et al, 2010; Blaudszun et al, 2012; Schnabel et al, 2013). Although it is generally known that poorly controlled pain after surgery could translate into chronic pain which might influence long-term quality of life, neurosurgeons are still generally reluctant to treat it adequately because of concerns about respiratory and cerebral depression (Peng et al, 2014). Morphine is the most commonly used opioid for postoperative pain as it is economical and easy to manage.…”

Section: Discussionmentioning

confidence: 99%

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

Su¹,

Ren

Zhang

et al. 2016

Front. Pharmacol.

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Background: Approximately 60% of patients experience moderate-to-severe pain after neurosurgery, which primarily occurs in the first 24–72 h. Despite this, improved postoperative analgesia solutions after neurosurgery have not yet been devised. This retrospective study was conducted to evaluate the effect of intra- and post-operative infusions of dexmedetomidine (DEX) plus sufentanil on the quality of postoperative analgesia in patients undergoing neurosurgery.Methods: One hundred and sixty-three post-neurosurgery patients were divided into two groups: Group D (DEX infusion at 0.5 μg·kg−1 for 10 min, then adjusted to 0.3 μg·kg−1·h−1 until incision suturing) and Group ND (no DEX infusion during surgery). Patient-controlled analgesia was administered for 72 h after surgery (Group D: sufentanil 0.02 μg·kg−1·h−1 plus DEX 0.02 μg·kg−1·h−1, Group ND: sufentanil 0.02 μg·kg−1·h−1) in this retrospective study. The primary outcome measure was postoperative sufentanil consumption. Hemodynamics, requirement of narcotic, and vasoactive drugs, recovery time and the incidence of concerning adverse effects were recorded. Pain intensity [Visual Analogue Scale (VAS)], Ramsay sedation scale (RSS) and Bruggemann comfort scale (BCS) were also evaluated at 1, 4, 8, 12, 24, 48, and 72 h after surgery.Results: Postoperative sufentanil consumption was significantly lower in Group D during the first 72 h after surgery (P < 0.05). Compared with Group ND, heart rate (HR) in Group D was significantly decreased from intubation to 20 min after arriving at post anesthesia care unit (PACU), while mean arterial pressure (MAP) in Group D was significantly decreased from intubation to 5 min after arriving at PACU (P < 0.05). The intraoperative requirements for sevoflurane, remifentanil, and fentanyl were approximately 35% less in Group D compared with Group ND. VAS at rest at 1, 4, and 8 h and with cough at 12, 24, 48, and 72 h after surgery were significantly lower in Group D (P < 0.05). Compared with Group ND, patients in Group D showed lower levels of overall incidence of tachycardia, hypertension, nausea, and vomiting (P < 0.05). There were no significant differences between the two groups in terms of baseline clinical characteristics, recovery time, RSS, and BCS (P > 0.05).Conclusions: DEX (0.02 μg·kg−1·h−1) plus sufentanil (0.02 μg·kg−1·h−1) could reduce postoperative opioid consumption and concerning adverse adverse effects, while improving pain scores. However, it did not influence RSS and BCS during the first 72 h after neurosurgery.

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“…The uses of dexmedetomidine have been extended to include general anaesthesia, where it is used as an adjuvant drug for pre-medication and co-induction in total intravenous anaesthesia (TIVA). Studies showed that dexmedetomidine was associated with better perioperative haemodynamic control, less intra-operative opioid consumption, fewer requests for postoperative antiemetics, reduced total propofol dose requirements and smooth emergence (3)(4)(5).…”

Section: Methodsmentioning

confidence: 99%

Comparison of the Effects of Dexmedetomidine on the Induction of Anaesthesia Using Marsh and Schnider Pharmacokinetic Models of Propofol Target-Controlled Infusion

Hassan

2018

MJMS

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Background: The study aimed to determine the effects of dexmedetomidine on the induction of anaesthesia using different models (Marsh and Schnider) of propofol targetcontrolled infusion (TCI).Methods: Sixty-four patients aged 18-60 years, American Society of Anaesthesiologists (ASA) class I-II who underwent elective surgery were randomised to a Marsh group (n = 32) or Schnider group (n = 32). All the patients received a 1 µg/kg loading dose of dexmedetomidine, followed by TCI anaesthesia with remifentanil at 2 ng/mL. After the effect-site concentration (Ce) of remifentanil reached 2 ng/mL, propofol TCI induction was started. Anaesthesia induction commenced in the Marsh group at a target plasma concentration (Cpt) of 2 µg/mL, whereas it started in the Schnider group at a target effect-site concentration (Cet) of 2 µg/mL. If induction was delayed after 3 min, the target concentration (Ct) was gradually increased to 0.5 µg/mL every 30 sec until successful induction. The Ct at successful induction, induction time, Ce at successful induction and haemodynamic parameters were recorded.Results

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Dexmedetomidine as an anesthetic adjuvant for intracranial procedures: Meta-analysis of randomized controlled trials

Cited by 39 publications

References 35 publications

Effect of Dexmedetomidine in Preventing Postoperative Side Effects for Laparoscopic Surgery

Effect of Dexmedetomidine in Preventing Postoperative Side Effects for Laparoscopic Surgery

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

Comparison of the Effects of Dexmedetomidine on the Induction of Anaesthesia Using Marsh and Schnider Pharmacokinetic Models of Propofol Target-Controlled Infusion

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