Effect of dexmedetomidine on hemodynamic responses to tracheal intubation: A meta-analysis with meta-regression and trial sequential analysis.

Cassai, Alessandro De; Boscolo, Annalisa; Geraldini, Federico; Zarantonello, Francesco; Pettenuzzo, Tommaso; Pasin, Laura; Iuzzolino, Margherita; Rossini, Nicolò; Pesenti, Elisa; Zecchino, Giovanni; Sella, Nicolò; Munari, Marina; Navalesi, Paolo

doi:10.1016/j.jclinane.2021.110287

Cited by 29 publications

(30 citation statements)

References 95 publications

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“…Our meta-analysis suggests that the administration of dexmedetomidine before endotracheal intubation compared to no dexmedetomidine or placebo may be associated with a lower HR and BP. These findings confirm the results of a previous meta-analysis, which showed that dexmedetomidine use was associated with a reduction in the adrenergic response at induction, surgical incision, and extubation [ 6 ].…”

Section: Discussionsupporting

confidence: 91%

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Preoperative dexmedetomidine and intraoperative bradycardia in laparoscopic cholecystectomy: a meta-analysis with trial sequential analysis

Cassai¹,

Sella²,

Geraldini³

et al. 2022

Korean J Anesthesiol

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Background: Laparoscopic surgical procedures have various advantages over traditional open techniques, however, the artificial pneumoperitoneum is associated with severe bradycardia and also with cardiac arrest. Dexmedetomidine is an imidazole derivative that highly selectively binds to α2-receptors. It has sedative and analgesic properties, however it could cause hypotension and bradycardia. Our primary aim was to assess the association of dexmedetomidine use with intraoperative bradycardia during laparoscopic cholecystectomy. Methods:We performed a systematic review with meta-analysis and trial sequential analysis of the medical literature using the following PICOS: adult patients undergoing endotracheal intubation for laparoscopic cholecystectomy (P); intravenous dexmedetomidine before tracheal intubation (I); no intervention or any placebo administration (C); intraoperative bradycardia (primary outcome), intraoperative hypotension, SBP at intubation, MAP at intubation, HR at intubation, dose of anesthetic needed for induction of anesthesia, total anesthetics (both ipnotics and opioids) requirement throughout the operative procedure, percentage of patients requiring postoperative analgesics, PONV and postoperative shivering occurrence (O); randomized controlled trials (S).Results: Fifteen studies were included in the meta-analysis (980 patients). Patients receiving dexmedetomidine compared to patients not receiving it had a higher risk of developing intraoperative bradycardia )) and hypotension (RR 1.66 (0.92 -2.98)), however they need lower dose of intraoperative anesthetics and had a lower incidence of PONV. In the TSA for bradycardia, the cumulative z-score crossed the monitoring boundary for harm at the tenth trial.Conclusions: Patients undergoing laparoscopic cholecystectomy receiving dexmedetomidine at tracheal intubation are more likely to develop intraoperative bradycardia and hypotension.

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Section: Discussionsupporting

confidence: 91%

“…It has been shown that compared with no dexmedetomidine or placebo, the use of dexmedetomidine for tracheal intubation is associated with an increased risk for intraoperative bradycardia in the general surgical population [ 6 ]. However, no information on patients undergoing laparoscopic procedures has been reported.…”

Section: Introductionmentioning

confidence: 99%

Preoperative dexmedetomidine and intraoperative bradycardia in laparoscopic cholecystectomy: a meta-analysis with trial sequential analysis

Cassai¹,

Sella²,

Geraldini³

et al. 2022

Korean J Anesthesiol

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“…The reason may be due to the efficacy of a higher dose of DEX in USG-DSAPB in attenuating the sympathetic response to surgical stimulation. However, according to De Cassai et al (46), the risk of bradycardia and hypotension should not be ignored, and vasoactive agents should be used cautiously. The time to first rescue analgesia was significantly longer and the requirement for rescue analgesia was significantly higher in the RD2 group.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Ultrasound Guided-Deep Serratus Anterior Plane Blockade With Different Doses of Dexmedetomidine for Women Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial

Chen

Zhu

et al. 2022

Front. Med.

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BackgroundUltrasound guided-deep serratus anterior plane block (USG-DSAPB) has been used for pain management of patients undergoing modified radical mastectomy (MRM), but evidence supporting their adjuvant analgesic benefits is limited. We explored the efficacy and safety of preemptive use of ropivacaine combined with different doses of dexmedetomidine (DEX) in USG-DSAPB for patients undergoing MRM.MethodsNinety-five female patients undergoing unilateral MRM were allocated randomly to two groups. Group RD1 had 20 mL of 0.5% ropivacaine with 5 mg of dexamethasone and 0.5 μg·kg−1 DEX in USG-DSAPB. Group RD2 had 20 mL of 0.5% ropivacaine with 5 mg of dexamethasone and 1 μg·kg−1 DEX in USG-DSAPB. The primary outcome was sufentanil consumption 72 h after USG-DSAPB. Secondary outcomes were: postoperative pain scores and level of sedation; intraoperative hemodynamics; duration of post-anesthesia care unit (PACU) stay; prevalence of moderate-to-severe pain; one-time puncture success; procedure time of blockade; time to first rescue analgesia; requirement of rescue analgesia; satisfaction scores of patients and surgeons; duration of hospital stay; adverse events; prevalence of chronic pain; quality of postoperative functional recovery.ResultsCompared with the RD1 group, the visual analog scale score for coughing was significantly lower at 4, 8, 12 h and sufentanil consumption was significantly lower at 4, 8, 12, 24, and 48 h after surgery in the RD2 group (P < 0.05). The time to first rescue analgesia was significantly longer in the RD2 group (P < 0.05). The requirement for rescue analgesia was significantly higher in the RD1 group (P < 0.05). The prevalence of moderate-to-severe pain, number of patients using vasoactive agents, duration of PACU stay, as well as consumption of propofol, remifentanil, and DEX were significantly lower in the RD2 group (P < 0.05). There were no significant differences between the two groups with respect to one-time puncture success, procedure time of blockade, total dermatomal spread, satisfaction scores of patients and surgeons, postoperative complications, duration of hospital stay, 40-item Quality of Recovery questionnaire (QoR-40) score, or prevalence of chronic pain (P > 0.05).ConclusionsWe discovered that 1 μg·kg−1 (not 0.5 μg·kg−1) DEX combined with 20 mL of 0.5% ropivacaine and 5 mg of dexamethasone in USG-DSAPB could provide superior postoperative analgesia for patients undergoing MRM. However, the quality of postoperative functional recovery and prevalence of chronic pain were similar.Clinical Trial Registration:http://www.chictr.org.cn/showproj.aspx?proj=54929, identifier: ChiCTR2000033685.

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“…Trial sequential analysis (TSA) is a recently described cumulative frequentist MA method [2] used to weigh type I and II errors and to estimate when the effect is large enough to be unlikely affected by further studies [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Trial sequential analysis (TSA) is a recently described cumulative frequentist meta-analysis method [ 2 ] used to weigh type I and II errors and to estimate when the effect is large enough to unlikely be affected by further studies [ 3 , 4 ]. While TSA is based on frequentist thinking as it is founded on P value and type I and type II error methods, it incorporates elements of Bayesian thinking.…”

Section: Introductionmentioning

confidence: 99%

Explanation of trial sequential analysis: using a post-hoc analysis of meta-analyses published in Korean Journal of Anesthesiology

Cassai

Tassone

Geraldini

et al. 2021

Korean J Anesthesiol

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Background: Trial sequential analysis (TSA) is a recently described cumulative meta-analysis method used to weigh I and II errors and to estimate when the effect is large enough to be unlikely to be affected by further studies. The aim of this paper is to illustrate possible TSA scenarios and their significance using the meta-analyses published in the Korean Journal of Anesthesiology as a reference.Methods: We performed a systematic research of medical literature searching for meta-analysis published in the Korean Journal of Anesthesiology. TSA was performed on each main outcome estimating the required sample size on the calculated effect size for the intervention, considering a type I error of 5% and a power of both 90% and 99%, respectively.Results: Six meta-analyses with a total of ten main outcomes were included in the analysis. Seven TSA confirmed the meta-analysis results. However, only three of them reached the required sample size. In two TSA the cumulative z-line lies were not statistically significant. In one TSA boundary for effect was reached with the 90% analysis but not with the 99% analysis. Discussion:In TSA the meta-analysis pooled effect may be established assessing if the cumulative sample size is large enough. TSA can be used to add strength to meta-analysis conclusions, however, pre-registration of TSA protocol is of paramount importance. Conclusions:This paper could be useful to better understand the use of TSA as an additional statistical tool to improve meta-analysis quality.

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Effect of dexmedetomidine on hemodynamic responses to tracheal intubation: A meta-analysis with meta-regression and trial sequential analysis.

Cited by 29 publications

References 95 publications

Preoperative dexmedetomidine and intraoperative bradycardia in laparoscopic cholecystectomy: a meta-analysis with trial sequential analysis

Preoperative dexmedetomidine and intraoperative bradycardia in laparoscopic cholecystectomy: a meta-analysis with trial sequential analysis

Efficacy and Safety of Ultrasound Guided-Deep Serratus Anterior Plane Blockade With Different Doses of Dexmedetomidine for Women Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial

Explanation of trial sequential analysis: using a post-hoc analysis of meta-analyses published in Korean Journal of Anesthesiology

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