UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy.
UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy.
J Clin Anesth. 2021 Sep;72:110287. doi: 10.1016/j.jclinane.2021.110287. Epub 2021 Apr 16.
An uncontrolled adrenergic response during tracheal intubation may lead to life-threatening complications. Dexmedetomidine binds to α2-receptors and may attenuate this response. The primary aim of our meta-analysis is to investigate dexmedetomidine efficacy in attenuating sympathetic response to tracheal intubation, compared with placebo or no dexmedetomidine, in terms of heart rate and blood pressure at intubation.
Meta-analysis with meta-regression and trial sequential analysis.
Systematic search from inception until December 1, 2020 in the following databases: Pubmed, Scopus, the Cochrane Central Register of Controlled Trials, EMBASE and Google Scholar.
All randomized controlled trials investigating intravenous dexmedetomidine as premedication in adult patients undergoing tracheal intubation were included in our study. Studies were included without any language or publication date restriction. A trial sequential analysis and a post-hoc meta-regression were performed on the main outcomes.
Hemodynamic parameters and heart rate at tracheal intubation, dose of anesthetic needed for induction of anesthesia, total anesthetic requirement throughout the operative procedure, postoperative pain and percentage of patients requiring analgesics at 24 postoperative hours, postoperative nausea and vomiting, intraoperative and postoperative bradycardia, hypotension, dizziness, shivering and/or respiratory depression.
Ninety-nine included studies randomized 6833 patients. During laryngoscopy, all hemodynamic parameters were significantly greater in the no dexmedetomidine group. In particular, in the dexmedetomidine group, systolic blood pressure differed by -21.8 mm Hg (95% CI -26.6 to -17.1, p-value < 0.001, I 97%), mean arterial pressure by -12.8 mm Hg (95% CI -15.6 to -10.0, p-value < 0.001, I 98%), and heart rate by -16.9 bpm (95% CI -19.8 to -13.9, p-value < 0.001, I 98%).
Patients receiving premedication with dexmedetomidine for tracheal intubation, compared with no dexmedetomidine, have a lower blood pressure and heart rate, however, the risk of bradycardia and hypotension is relevant and its use during daily practice should be cautiously evaluated for each patient.
气管插管过程中不受控制的肾上腺素能反应可能导致危及生命的并发症。右美托咪定与 α2-受体结合，可能减轻这种反应。我们的荟萃分析的主要目的是调查右美托咪定在减轻气管插管时交感神经反应方面的疗效，与安慰剂或无右美托咪定相比，以插管时的心率和血压为指标。
具有荟萃回归和试验序贯分析的荟萃分析。
从成立到 2020 年 12 月 1 日，在以下数据库中进行系统搜索：PubMed、Scopus、Cochrane 对照试验中心注册、EMBASE 和 Google Scholar。
所有研究均纳入静脉注射右美托咪定作为接受气管插管的成年患者的预用药，纳入研究时无语言或出版日期限制。对主要结局进行了试验序贯分析和事后荟萃回归。
气管插管时的血流动力学参数和心率、麻醉诱导所需的麻醉剂剂量、整个手术过程中的总麻醉需求、术后疼痛和术后 24 小时需要镇痛药的患者百分比、术后恶心和呕吐、术中及术后心动过缓、低血压、头晕、颤抖和/或呼吸抑制。
99 项纳入研究随机分配了 6833 名患者。在喉镜检查期间，所有血流动力学参数在无右美托咪定组均显著升高。特别是在右美托咪定组，收缩压降低了-21.8mmHg（95%CI-26.6 至-17.1，p 值<0.001，I 97%），平均动脉压降低了-12.8mmHg（95%CI-15.6 至-10.0，p 值<0.001，I 98%），心率降低了-16.9bpm（95%CI-19.8 至-13.9，p 值<0.001，I 98%）。
与无右美托咪定相比，接受气管插管预用药的患者血压和心率较低，但心动过缓和低血压的风险相关，其在日常实践中的使用应根据每位患者的情况谨慎评估。
