Effect of Dexmedetomidine on Intraoperative Hemodynamics and Blood Loss in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis.
Chin Med Sci J
; 39(1): 54-68, 2024 Mar.
Article
em En
| MEDLINE
| ID: mdl-38426411
ABSTRACT
Objective Dexmedetomidine (Dex) is a highly selective α2 adrenoceptor agonist that reduces blood pressure and heart rate. However, its ability to provide stable hemodynamics and a clinically significant reduction in blood loss in spine surgery is still a matter of debate. This study aimed to investigate the effects of Dex on intraoperative hemodynamics and blood loss in patients undergoing spine surgery.Methods The Web of Science, MEDLINE, EMBASE, and the Cochrane Library were searched up to February 2023 for randomized controlled trials (RCTs) including patients undergoing spine surgeries under general anaesthesia and comparing Dex and saline. A fixed- or random-effect model was used depending on heterogeneity.Results Twenty-one RCTs, including 1388 patients, were identified. Dex added the overall risk of intraoperative hypotension (odds ratio [OR] 2.11; 95% confidence interval [CI] 1.24 - 3.58; P=0.006) and bradycardia (OR 2.48; 95%CI 1.57 - 3.93; P=0.0001). The use of a loading dose of Dex led to significantly increased risks of intraoperative hypotension (OR 2.00; 95%CI 1.06 - 3.79; P=0.03) and bradycardia (OR 2.28; 95%CI 1.42 - 3.66; P=0.0007). For patients receiving total intravenous anesthesia, there was an increased risk of hypotension (OR 2.90; 95%CI 1.24 - 6.82; P=0.01) and bradycardia (OR 2.66; 95%CI 1.53 - 4.61; P=0. 0005). For patients in the inhalation anesthesia group, only an increased risk of bradycardia (OR 4.95; 95%CI 1.41 - 17.37; P=0.01) was observed. No significant increase in the risk of hypotension and bradycardia was found in the combined intravenous-inhalation anesthesia group. The incidence of severe hypotension (OR 2.57; 95%CI 1.05 - 6.32; P=0.04), but not mild hypotension, was increased. Both mild (OR 2.55; 95%CI 1.06 - 6.15; P=0.04) and severe (OR 2.45; 95%CI 1.43 - 4.20; P=0.001) bradycardia were associated with a higher risk. The overall analyses did not reveal significant reduction in intraoperative blood loss. However, a significant decrease in blood loss was observed in total inhalation anesthesia subgroup (mean difference [MD] -82.97; 95%CI -109.04 - -56.90; P<0.001).Conclusions Dex increases the risks of intraoperative hypotension and bradycardia in major spine surgery. The administration of a loading dose of Dex and the utilization of various anesthesia maintenance methods may potentially impact hemodynamic stability and intraoperative blood loss.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Dexmedetomidina
/
Hipotensão
Limite:
Humans
Idioma:
En
Revista:
Chin Med Sci J
Assunto da revista:
TERAPIAS COMPLEMENTARES
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
China