Hung Tsung-Yu, Lin Ying-Chun, Wang Yeou-Lih, Lin Mei-Chi
Department of Anesthesia, MacKay Memorial Hospital, Taiwan.
Department of Anesthesia, MacKay Memorial Hospital, Taiwan; Mackay Medical College, Taiwan; Mackay Medicine, Nursing and Management College, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
Taiwan J Obstet Gynecol. 2023 Mar;62(2):239-251. doi: 10.1016/j.tjog.2022.11.010.
This study investigated the efficacy and safety of intravenous dexmedetomidine as an adjuvant to general anesthesia in patients undergoing gynecological surgery. We systemically searched for randomized controlled trials (RCTs), and performed a meta-analysis on studies that met the inclusion criteria. The primary outcomes were postoperative nausea and vomiting (PONV), bradycardia, hypotension, and 24 h opioid consumption. The secondary outcomes include postoperative shivering, postoperative pain score, intraoperative anesthetic consumption, extubation time, postoperative sedation, and the time to first flatus. Twenty-five RCTs were included in this study. Meta-analysis showed that intravenous dexmedetomidine significantly reduced the risk of PONV (RR, 0.57 [0.47, 0.68]) and postoperative shivering (RR: 0.31 [0.22, 0.42]), 24 h opioid consumption (Mean Difference: - 4.85 mg [-8.60, -1.11]) and postoperative pain score within 24 h. However, these benefits were at the cost of increased bradycardia (RR, 3.21 [2.41, 4.28]) and hypotension (RR, 2.17 [1.50, 3.14]). Notably, no serious adverse effects were reported in any of the included studies. Thus, our study showed that intravenous dexmedetomidine provided significant antiemetic and anti-shivering effects and moderate analgesic effects in patients that underwent gynecological surgery. However, its benefits should be weighed against the significantly increased risk of bradycardia and hypotension.
本研究调查了静脉注射右美托咪定作为妇科手术患者全身麻醉辅助药物的有效性和安全性。我们系统检索了随机对照试验（RCT），并对符合纳入标准的研究进行了荟萃分析。主要结局指标为术后恶心呕吐（PONV）、心动过缓、低血压和24小时阿片类药物消耗量。次要结局指标包括术后寒战、术后疼痛评分、术中麻醉药物消耗量、拔管时间、术后镇静情况以及首次排气时间。本研究纳入了25项随机对照试验。荟萃分析表明，静脉注射右美托咪定显著降低了PONV风险（风险比[RR]，0.57[0.47，0.68]）、术后寒战风险（RR：0.31[0.22，0.42]）、24小时阿片类药物消耗量（平均差：-4.85mg[-8.60，-1.11]）以及24小时内的术后疼痛评分。然而，这些益处是以心动过缓（RR，3.21[2.41，4.28]）和低血压（RR，2.17[1.50，3.14]）风险增加为代价的。值得注意的是，纳入的任何研究均未报告严重不良反应。因此，我们的研究表明，静脉注射右美托咪定在接受妇科手术的患者中具有显著的止吐和抗寒战作用以及中度镇痛作用。然而，其益处应与心动过缓和低血压风险显著增加相权衡。
