Tung Alan, Fergusson Nicholas A, Ng Nicole, Hu Vivien, Dormuth Colin, Griesdale Donald E G
Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Br J Anaesth. 2020 Apr;124(4):480-495. doi: 10.1016/j.bja.2019.12.041. Epub 2020 Feb 22.
Emergence coughing can harm the patient following completion of surgery, but it is unclear which medication is most effective at reducing this event. We conducted a systematic review and network meta-analysis of RCTs to determine the medications' relative efficacies on decreasing moderate to severe emergence coughing after general anaesthesia. Medications studied were lidocaine (i.v., intracuff, topical, or tracheal application), dexmedetomidine, remifentanil, and fentanyl.
We searched eight different medical literature databases, conference abstracts, and article references. After screening, included citations were evaluated for bias and had their data extracted. Pooled odds ratios and 95% confidence intervals for each treatment comparison were calculated. A surface under the cumulative ranking curve analysis (SUCRA) determined the relative rank of each intervention to decrease moderate to severe emergence coughing. Subgroup analyses included severe coughing only, extubation times, type of maintenance anaesthetic, and dosages.
The network meta-analysis included 70 studies and 5286 patients. All study medications had favourable odds in reducing moderate and severe peri-extubation coughing compared with either no medication or placebo. No single medication was favoured over another. Dexmedetomidine had the highest SUCRA rank, followed in order by remifentanil, fentanyl, and lidocaine via intracuff, tracheal/topical, and i.v. routes. Remifentanil was ranked highest for decreasing severe coughing only. Intracuff lidocaine had higher odds of prolonging extubation times compared with placebo, dexmedetomidine, fentanyl, and remifentanil.
All study medications were better than placebo or no medication in reducing moderate to severe emergence cough, with dexmedetomidine ranked the most effective.
PROSPERO registration number: CRD42018102870.
术后苏醒期咳嗽会对患者造成伤害，但目前尚不清楚哪种药物在减少这一情况方面最为有效。我们对随机对照试验进行了系统评价和网状Meta分析，以确定这些药物在降低全身麻醉后中重度苏醒期咳嗽方面的相对疗效。研究的药物包括利多卡因（静脉注射、套囊内注射、局部应用或气管内应用）、右美托咪定、瑞芬太尼和芬太尼。
我们检索了八个不同的医学文献数据库、会议摘要和文章参考文献。筛选后，对纳入的文献进行偏倚评估并提取数据。计算每种治疗比较的合并比值比和95%置信区间。累积排序曲线下面积分析（SUCRA）确定了每种干预措施在减少中重度苏醒期咳嗽方面的相对排名。亚组分析包括仅重度咳嗽、拔管时间、维持麻醉类型和剂量。
网状Meta分析纳入了70项研究和5286例患者。与未用药或安慰剂相比，所有研究药物在减少中重度拔管期咳嗽方面均具有良好的优势比。没有一种药物比另一种更具优势。右美托咪定的SUCRA排名最高，其次依次为瑞芬太尼、芬太尼以及套囊内注射、气管内/局部应用和静脉注射途径的利多卡因。瑞芬太尼在仅减少重度咳嗽方面排名最高。与安慰剂、右美托咪定、芬太尼和瑞芬太尼相比，套囊内注射利多卡因延长拔管时间的几率更高。
在减少中重度苏醒期咳嗽方面，所有研究药物均优于安慰剂或未用药，其中右美托咪定最为有效。
PROSPERO注册号：CRD42018102870。
