Influence of dexmedetomidine on cardiac complications in non-cardiac surgery: a meta-analysis of randomized trials

Abstract

Background The cardiac protection of dexmedetomidine (Dex) in peri-operative period of patients with non-cardiac surgery is still controversial. Aim of the Review We aimed to evaluate the influence of Dex on cardiac complications in peri-operative period of non-cardiac surgery by using a meta-analysis. Methods PubMed, Embase, the Cochrane library and Springer databases were searched for relevant studies. Patients in the eligible studies were divided into Dex group and placebo group. Relative risk (RR) and the 95 % confidence interval (CI) were calculated to evaluate the outcomes including all-cause mortality, myocardial infarction, myocardial ischaemia, hypotension and bradycardia. Subgroup analysis was performed based on the dosage of Dex. Publication bias was assessed by Egger's test. Results Twenty double-blind randomized controlled trials containing 1157 patients were included in this meta-analysis. The pooled results showed no significant difference between Dex group and placebo group in peri-operative myocardial infarction, myocardial ischaemia and all-cause mortality. However, Dex group showed higher risk of hypotension (RR = 1.46, 95 % CI 1.07, 2.01) and bradycardia (RR = 1.98, 95 % CI 1.33, 2.95) than that of placebo group. In addition, significant publication bias was found among studies involving hypotension and bradycardia. In subgroup analysis, the risk of bradycardia was significantly higher in 1.0 μg/kg Dex group than that in placebo group. Besides, a higher risk of hypotension in 0.5 μg/kg Dex group than that in placebo group was found. Conclusions Dex supplement might not reduce the risk of cardiac complications but increases the risk of hypotension and bradycardia in peri-operative period of patients who underwent non-cardiac surgeries.

Effects of Perioperative Dexmedetomidine on Postoperative Mortality and Morbidity: A Systematic Review and Meta-analysis

“…Due to . In contrast, another study suggested that perioperative DEX use in noncardiac surgery did not decrease the risk for cardiac complications or mortality and may increase the risk for hypotension and bradycardia [61]. The inconsistency between the results in cardiac and noncardiac surgery may have been the result of a higher potential for postoperative complications and mortality in cardiac surgery, where DEX was reported to provide protective effects by attenuating excessive inflammation.…”

Dexmedetomidine and clinical outcomes of non-cardiac surgery

“…Although in a different setting of cardiac surgery with a higher incidence of adverse events, a previous study reported that dexmedetomidine reduced 1-year postoperative mortality, and overall complication rates [2]. For non-cardiac surgery, a recent meta-analysis reported no significant difference in postoperative all-cause mortality, myocardial ischemia or infarction [3]. However, in this meta-analysis, only four small randomized trials were included for these outcomes.…”

A Response Surface Analysis of the Combination of Dexmedetomidine and Sufentanil for Attenuating the Haemodynamic Response to Endotracheal Intubation

“…High doses of dexmedetomidine may lead to cardiovascular side effects, including bradycardia, hypotension or even cardiac arrest. 17 , 18 The common dose of dexmedetomidine used in anaesthesia induction should be no more than 1.0 μg/kg. 19 , 20 Based on clinical practice, .5 μg/kg sufentanil is generally sufficient to completely inhibit the stress response during anaesthesia induction.…”