Can Dexmedetomidine Influence Recovery Profiles from General Anesthesia in Nasal Surgery?

Abstract

Objectives Dexmedetomidine has sympatholytic, sedative, anesthetic, and analgesic effects, as well as vasoconstrictive effects, which may help prevent hypotension under general anesthesia. This meta-analysis aimed to perform a systematic review of the literature and investigate the effect of dexmedetomidine on perioperative morbidity following nasal surgery and its adverse effects. Data Sources MEDLINE, SCOPUS, and the Cochrane database. Review Methods Two authors independently searched the databases from their inception to March 2017. Studies were selected that compared perioperative dexmedetomidine administration (dexmedetomidine groups) with a placebo or remifentanil (control groups) with regard to intraoperative morbidity, including surgical time, bleeding amount, hypotension, and bradycardia during operation, and postoperative morbidity, such as emergence agitation, nausea and vomiting, and sedation after operation. Results Surgical time, intraoperative blood loss, dose of inhaled anesthetic gas, dose of fentanyl, postoperative pain, and incidence of emergence agitation were significantly lower in the dexmedetomidine group versus the placebo group. In contrast, there were no significant differences in intraoperative hemodynamic stability and postoperative residual sedation and nausea and vomiting between groups. Additionally, compared with remifentanil (a currently widely used agent), dexmedetomidine was superior in view of postoperative pain and intraoperative blood pressure control. Conclusion This meta-analysis shows that the systemic administration of dexmedetomidine can decrease surgical time, intraoperative blood loss, and doses of intraoperative inhaled anesthetic gas and fentanyl as compared with placebo. It can also decrease postoperative pain and incidence of the emergence agitation. Due to the small number of studies, further clinical trials are needed to confirm these results.

Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: A meta‐analysis and systematic review

“…An electronic database search (PubMed, SCOPUS, Google scholar, Embase, and the Cochrane Register of Controlled Trials) using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines was conducted with the goal of identifying all available studies related to an preoperative tranexamic acid from inception of application of tranexamic acid and written in English up to July of 2018 . Two authors independently conducted the literature search using the search terms “endoscopic sinus surgery,” “tranexamic acid,” “general anesthesia,” “operative bleeding,” “surgical field,” “operative time,” “satisfaction,” “nausea and vomiting,” “thromboembolism,” and “hypotension.” We complemented the keyword‐based searches by the combinations of all possible keywords with hand‐screening of references listed in the retrieved articles …”

“…We complemented the keyword-based searches by the combinations of all possible keywords with hand-screening of references listed in the retrieved articles. 13 The full texts of studies that were potentially relevant to the topic were obtained if a decision for inclusion could not be made from the abstract alone. Randomized controlled trials that met the following inclusion criteria were eligible for review: the trials studied adult patients receiving endoscopic sinus surgery with the preoperative (before the start of the operation) or perioperative (during the surgery) administration of intravenous tranexamic acid.…”

Effect of perioperative dexmedetomidine infusion on blood glucose levels in non-diabetic morbid obese patients undergoing laparoscopic bariatric surgery

“…In the current study, perioperative adverse effects % were not significantly different between both groups. And this goes with an investigation done by Lee and his partners [40].…”

Dexmedetomidine for Postoperative Sedation Following Stereotactic Lead Placement

“…Dexmedetomidine has been previously shown to reduce postoperative pain, time to extubation, agitation, nausea, and vomiting. [10][11][12][13][14] Since its initial approval by the Food and Drug Administration (FDA) in 1999 as a short-term sedative and analgesic agent for patients on mechanical ventilation in the intensive care setting, the applications of dexmedetomidine have rapidly expanded. It has become an increasingly popular alternative or adjunctive agent in recent years for pain control and sedation in a variety of contexts in adults, including delirium, extubation, and postoperative analgesia.…”