Dexmedetomidine in the General Anesthesia: A Meta-analysis of Randomized Controlled Trials_Chinese Journal of Evidence-Based Medicine

Authors：

SUN Jiehao , HAN Ning ,  WU Xiuying

Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, China;

Corresponding author：

WU Xiuying, Email: sun_jiehao@126.com

Keywords：

Dexmedetomidine; General anesthesia; Randomized controlled trials; Meta-analysis

DOI：

10.7507/1672-2531.20080174

Video：

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Objective　 To determine the efficiency and safety of dexmedetomidine in general anesthesia.
Methods　 Trials were located through electronic searches of the PubMed, EBSCO, OVID, Springer, Foreign Journals Integration System, CNKI, CMBdisk (from the date of establishment of the databases to April 2008). Bibliographies of the retrieved articles were also checked.
Result　 A total of 25 trials involving 1 241 patients were included. The Meta-analysis showed: dexmedetomidine reduced peri-operative heart rate and blood pressure, reduced the occurrence of postoperative nausea and vomitting [RR=0.57, 95%CI (0.38, 0.84)], postoperative agitation [RR=0.29, 95%CI (0.17, 0.51)], shivering [RR=0.45, 95%CI (0.29, 0.68)], increase the occurrence of bradycardia [RR=2.16, 95%CI (1.58, 2.95)], hypotension [RR=2.97, 95%CI (1.42, 6.18)]. Dexmedetomidine reduced administration of thiopental, isoflurane and fentanyl, while there was no difference in muscle relaxant. Dexmedetomidine showed no difference in emergency time compared with the control group. As a result of low incidence of adverse reaction, dexmedetomidine showed superior in discharge time [WMD15.17, 95%CI (3.87, 26.46)].
Conclusions　 The limited current evidence shows that dexmedetomidine is better in maintaining the hemodynamic balance; reducing occurrence of nausea, vomiting, agitation and shivering; and reducing doses of anesthetics. In emergency time, dexmedetomidine shows no difference except discharge time.

Citation： SUN Jiehao,HAN Ning,WU Xiuying. Dexmedetomidine in the General Anesthesia: A Meta-analysis of Randomized Controlled Trials. Chinese Journal of Evidence-Based Medicine, 2008, 08(9): 773-780. doi: 10.7507/1672-2531.20080174 Copy

1.	Hayashi Y, Maze M. Alpha-2 adrenoceptor agonists and anaesthesia. Br J Anaesth, 1993, 71(1): 108-118.
2.	Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia, 1999, 54(2): 146-165.
3.	李慧玲, 佘守章, 莫世湟, 等. 右旋美托咪陡对全麻患者脑电双频谱指数及靶控输注异丙酚用量的影响. 广东医学, 2004, 25(12):1394-1396.
4.	Gurbet A, Basagan-Mogol E, Turker G, et al. Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anaesth, 2006, 53(7): 646-652.
5.	Isik B, Arslan M, Tunga AD, et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth, 2006, 16(7): 748-753.
6.	Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and perioperative haemodynamic stability. Anaesthesia, 1997, 52(8): 736-744.
7.	Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth, 2005, 15(9): 762-766.
8.	Unlugenc H, Gunduz M, Guler T, et al. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol, 2005, 22(5): 386-391.
9.	Jaakola ML, Al i-Melkkil? T, Kanto J, et al. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth,1992, 68(6): 570-575.
10.	Jaionen J, Hynynen M, Kuitunen A, et al. Dexmedetomidine as an Anesthetic Adjunct in Coronary Artery Bypass Grafting. Anesthesiology, 1997, 86(2): 331-345.
11.	Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth, 2005, 15(12): 1098-1104.
12.	Yildiz M, Tavlan A, Tuncer S, et al. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: perioperative haemodynamics and anaesthetic requirements. Drugs R D, 2006, 7(1): 43-52.
13.	Durmus M, But AK, Dogan Z, et al. Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol, 2007, 24(5): 447-453.
14.	Talke P, Chen R, Thomas B, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg, 2000, 90(4): 834-839.
15.	Tanskanen PE, Kytt JV, Randell TT, et al. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study. Br J Anaesth, 2006, 97(5): 658-665.
16.	Ozkose Z, Demir FS, Pampal K, et al. Hemodynamic and anesthetic advantages of dexmedetomidine, an alpha 2-agonist, for surgery in prone position. Tohoku J Exp Med, 2006, 210(2): 153-160.
17.	But AK, Ozgul U, Erdil F, et al. The effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Acta Anaesthesiol Scand, 2006, 50(10): 1207-1212.
18.	Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand, 2005, 49(8): 1088-1091.
19.	Taittonen MT, Kirvel OA, Aantaa R, et al. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth, 1997, 78(4): 400-406.
20.	Aho M, Scheinin M, Lehtinen AM, et al. Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg, 1992, 75(6): 932-939.
21.	Aantaa R, Jaakola ML, Kallio A, et al. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology, 1997, 86(5): 1055-1060.
22.	Bicer C, Esmaoglu A, Akin A, et al. Dexmedetomidine and meperidine prevent postanaesthetic shivering. Eur J Anaesthesiol, 2006, 23(2): 149-153.
23.	Mukhtar AM, Obayah EM, Hassona AM. The use of dexmedetomidine in pediatric cardiac surgery. Anesth Analg, 2006, 103(1): 52-56.
24.	Aho M, Erkola O, Kallio A, et al. Dexmedetomidine infusion for maintenance of anesthesia in patients undergoing abdominalhysterectomy. Anesth Analg, 1992, 75(6): 940-946.
25.	Aho M, Lehtinen AM, Erkola O, et al. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology, 1991, 74(6): 997-1002.
26.	Talke P, Li J, Jain U, et al. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. The Study of Perioperative Ischemia Research Group. Anesthesiology, 1995, 82(3): 620-633.
27.	吴新民, 许幸, 王俊科, 等. 静脉注射右美托咪陡辅助全身麻醉的有效性和安全性. 中华麻醉学杂志, 2007, 27(9): 773-776.
28.	Ebert T, Hall JE, Barney JA, et al. The effects of increase plasma concentration of dexmedetomidine in humans. Anesthesiology, 2000, 93(2): 382-394.
29.	Bakhamees HS, El-Halafawy YM, El-Kerdawy HM, et al. Effects of dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass. Middle East J Anesthesiol, 2007, 19(3): 537-551.
30.	Del A, Castellanos O, Munguia M. Dexmedetomidine as preventive postoperative analgesia in inguinal hernioplasty. Gac Med Mex, 2006, 142(1): 9-12.

1. Hayashi Y, Maze M. Alpha-2 adrenoceptor agonists and anaesthesia. Br J Anaesth, 1993, 71(1): 108-118.
2. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia, 1999, 54(2): 146-165.
3. 李慧玲, 佘守章, 莫世湟, 等. 右旋美托咪陡对全麻患者脑电双频谱指数及靶控输注异丙酚用量的影响. 广东医学, 2004, 25(12):1394-1396.
4. Gurbet A, Basagan-Mogol E, Turker G, et al. Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anaesth, 2006, 53(7): 646-652.
5. Isik B, Arslan M, Tunga AD, et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth, 2006, 16(7): 748-753.
6. Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and perioperative haemodynamic stability. Anaesthesia, 1997, 52(8): 736-744.
7. Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth, 2005, 15(9): 762-766.
8. Unlugenc H, Gunduz M, Guler T, et al. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol, 2005, 22(5): 386-391.
9. Jaakola ML, Al i-Melkkil? T, Kanto J, et al. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth,1992, 68(6): 570-575.
10. Jaionen J, Hynynen M, Kuitunen A, et al. Dexmedetomidine as an Anesthetic Adjunct in Coronary Artery Bypass Grafting. Anesthesiology, 1997, 86(2): 331-345.
11. Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth, 2005, 15(12): 1098-1104.
12. Yildiz M, Tavlan A, Tuncer S, et al. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: perioperative haemodynamics and anaesthetic requirements. Drugs R D, 2006, 7(1): 43-52.
13. Durmus M, But AK, Dogan Z, et al. Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol, 2007, 24(5): 447-453.
14. Talke P, Chen R, Thomas B, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg, 2000, 90(4): 834-839.
15. Tanskanen PE, Kytt JV, Randell TT, et al. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study. Br J Anaesth, 2006, 97(5): 658-665.
16. Ozkose Z, Demir FS, Pampal K, et al. Hemodynamic and anesthetic advantages of dexmedetomidine, an alpha 2-agonist, for surgery in prone position. Tohoku J Exp Med, 2006, 210(2): 153-160.
17. But AK, Ozgul U, Erdil F, et al. The effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Acta Anaesthesiol Scand, 2006, 50(10): 1207-1212.
18. Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand, 2005, 49(8): 1088-1091.
19. Taittonen MT, Kirvel OA, Aantaa R, et al. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth, 1997, 78(4): 400-406.
20. Aho M, Scheinin M, Lehtinen AM, et al. Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg, 1992, 75(6): 932-939.
21. Aantaa R, Jaakola ML, Kallio A, et al. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology, 1997, 86(5): 1055-1060.
22. Bicer C, Esmaoglu A, Akin A, et al. Dexmedetomidine and meperidine prevent postanaesthetic shivering. Eur J Anaesthesiol, 2006, 23(2): 149-153.
23. Mukhtar AM, Obayah EM, Hassona AM. The use of dexmedetomidine in pediatric cardiac surgery. Anesth Analg, 2006, 103(1): 52-56.
24. Aho M, Erkola O, Kallio A, et al. Dexmedetomidine infusion for maintenance of anesthesia in patients undergoing abdominalhysterectomy. Anesth Analg, 1992, 75(6): 940-946.
25. Aho M, Lehtinen AM, Erkola O, et al. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology, 1991, 74(6): 997-1002.
26. Talke P, Li J, Jain U, et al. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. The Study of Perioperative Ischemia Research Group. Anesthesiology, 1995, 82(3): 620-633.
27. 吴新民, 许幸, 王俊科, 等. 静脉注射右美托咪陡辅助全身麻醉的有效性和安全性. 中华麻醉学杂志, 2007, 27(9): 773-776.
28. Ebert T, Hall JE, Barney JA, et al. The effects of increase plasma concentration of dexmedetomidine in humans. Anesthesiology, 2000, 93(2): 382-394.
29. Bakhamees HS, El-Halafawy YM, El-Kerdawy HM, et al. Effects of dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass. Middle East J Anesthesiol, 2007, 19(3): 537-551.
30. Del A, Castellanos O, Munguia M. Dexmedetomidine as preventive postoperative analgesia in inguinal hernioplasty. Gac Med Mex, 2006, 142(1): 9-12.

Chinese Journal of Evidence-Based Medicine

Dexmedetomidine in the General Anesthesia: A Meta-analysis of Randomized Controlled Trials

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