Intravenous dexmedetomidine during spinal anaesthesia for caesarean section: A meta-analysis of randomized trials

Bao, Zeqing; Zhou, Chengmao; Wang, Xianxue; Zhu, Yu

doi:10.1177/0300060517708945

Cited by 16 publications

(18 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 29 The reasons for shivering may include suppression of spinal reflex activity, decrease in sympathetic activity, and inhibition of adrenal function. 30 Many studies reported that DEX could effectively reduce the incidence of shivering during neuraxial anesthesia in patients undergoing cesarean section, without any associated respiratory depression as with other antishivering drugs, such as meperidine. 18 – 22 The present meta-analysis showed the same results reported in previous clinical trials.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of intrathecal dexmedetomidine on preventing shivering in cesarean section after spinal anesthesia: a meta-analysis and trial sequential analysis

Miao

Shi

Zou

et al. 2018

DDDT

View full text Add to dashboard Cite

ObjectiveIntrathecal dexmedetomidine (DEX) has been used to prevent shivering in patients undergoing cesarean section. The aim of this meta-analysis was to evaluate whether intrathecal DEX could prevent shivering in cesarean section after spinal anesthesia.MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) comparing intrathecal DEX in cesarean section after spinal anesthesia with placebo and reporting on shivering, postoperative nausea and vomiting (PONV), hypotension, and bradycardia. Trial sequential analysis (TSA) was also carried out for RCTs comparing DEX with placebo. This meta-analysis has been registered on PROSPERO, and the registration number is CRD42017071640.ResultsSix randomized clinical trials comparing 360 patients were included in this study. Compared with placebo, intrathecal DEX significantly reduced the incidence of shivering (risk ratio [RR]=0.40; 95% CI [0.26, 0.62]; P<0.0001). No significant difference was found in the incidence of PONV (RR=1.34; 95% CI [0.82, 2.18]; P=0.24), hypotension (RR=1.09; 95% CI [0.84, 1.42]; P=0.50), or bradycardia (RR=1.55; 95% CI [0.54, 4.42]; P=0.42). However, no firm conclusions can be made based on the results of all outcomes according to the TSA.ConclusionThis meta-analysis found that intrathecal DEX could prevent shivering in cesarean section after spinal anesthesia and did not induce PONV, hypotension, or bradycardia. However, firm conclusions cannot be made until more studies are conducted.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Several studies reported that the usage of DEX could reduce the demand for opioids during cesarean section. 18 , 19 , 30 This means that DEX may not only increase the incidence of PONV but also reduce the incidence of PONV during cesarean section.…”

Section: Discussionmentioning

confidence: 99%

Effect of intrathecal dexmedetomidine on preventing shivering in cesarean section after spinal anesthesia: a meta-analysis and trial sequential analysis

Miao

Shi

Zou

et al. 2018

DDDT

View full text Add to dashboard Cite

show abstract

“…Use of DEX in cesarean section anesthesia has received more and more attention. Studies have shown that DEX can be used as an auxiliary for general anesthesia and intrathecal anesthesia in cesarean section; it can enhance the anesthetic effects, prevent and reduce adverse reactions of anesthetics, and reduce the amount of anesthetic drugs used [14][15][16]. However, when DEX is used in cesarean section to improve anesthesia, there are concerns about whether DEX will adversely affect the fetus.…”

Section: Introductionmentioning

confidence: 99%

Fetal and Maternal Responses to Dexmedetomidine Intrathecal Application During Cesarean Section: A Meta-Analysis

Sun

Wang

et al. 2020

Med Sci Monit

View full text Add to dashboard Cite

Departmental sources Background: Intrathecal dexmedetomidine (DEX) can improve the blockade of spinal anesthesia, but there is no clear conclusion on whether it has an effect on the fetus during cesarean section. Our meta-analysis evaluated the safety and efficacy of intrathecal DEX in cesarean delivery. Material/Methods: We searched Cochrane, Embase, PubMed, and CBM for eligible studies, and used the Revised Cochrane Risk of Bias Tool (RoB 2.0) to assess the risk of bias of each study. RevMan was used for statistical analyses. We have registered this meta-analysis on PROSPERO (CRD42019120995). Results: The meta-analysis included 10 RCTs, but only 5 were prospectively registered. The results of preregistration studies, including the 1-or 5-min Apgar score (mean difference [MD],-0.03; 95% confidence intervals [CI],-0.16 to 0.10; P=0.64 or MD, 0.00; 95% CI,-0.09 to 0.09; P=1), the umbilical arterial oxygen or carbon dioxide partial pressure (MD, 0.90; 95% CI,-4.92 to 6.72; P=0.76 or MD, 1.20; 95% CI,-2.06 to 4.46; P=0.47), and the cord blood pH (MD,-0.01; 95% CI,-0.05 to 0.03; P=0.72), showed that intrathecal DEX had no significant difference in neonatal outcomes compared with placebo. In maternal outcomes, intrathecal DEX significantly prolonged postoperative pain-free period and reduced the incidence of postoperative shivering, which did not increase spinal anesthesia-associated adverse effects. Conclusions: Intrathecal DEX is safe for the fetus during cesarean section and can improve the blockade effects of spinal anesthesia on puerperae.

show abstract

“…The Food and Drug Administration (FDA) has approved dexmedetomidine for limited use for sedation, mechanical ventilation and monitored anesthesia care in adults (3). There are current reports on the intraoperative use of dexmedetomidine for various indications including Cesarean sections (4)(5)(6)(7)(8). It is crucial to elucidate the possible effects of dexmedetomidine on the uterus and fetal circulation.…”

Section: Introductionmentioning

confidence: 99%

In vitro vasoactive effects of dexmedetomidine on isolated human umbilical arteries

Arun¹,

Taylan²,

Duman³

et al. 2019

BLL

View full text Add to dashboard Cite

OBJECTIVE: We aimed to investigate the vasoactive effects of dexmedetomidine on isolated human umbilical arteries and possible mechanisms involved. METHODS: Human umbilical artery strips were suspended in Krebs-Henseleit solution and dose-response curves were obtained for cumulative dexmedetomidine before and after incubation with different agents; propranolol, atropine, yohimbine, prazosin, indomethacin, verapamil. Effects of calcium on cumulative dexmedetomidineinduced contractions were also studied. RESULTS: Cumulative dexmedetomidine resulted in dose dependent contraction responses. Incubation with propranolol (Emax: 93.3 ± 3.26 %), atropine (Emax: 92.0 ± 6.54 %), or indomethacin (Emax: 94.25 ± 2.62 %), did not attenuate dexmedetomidine-elicited contractions (p > 0.05). There were signifi cant decreases in the contraction responses of cumulative dexmedetomidine with yohimbine (Emax: 12.1 ± 11.9 %), prazosin (Emax: 28.8 ± 4.6 %) and verapamil (Emax: 11.2 ± 13.6 %) (p < 0.05). In Ca +2 free medium contraction responses to cumulative dexmedetomidine was insignifi cant (Emax: 5.20 ± 3.42 %). Addition of cumulative calcium to the Ca +2 free medium resulted in concentration dependent increase in contractions (Emax: 64.83 ± 37.7 %) (p < 0.05). CONCLUSION: Dexmedetomidine induces vasoconstriction in endothelial-free umbilical arteries via both, α 1and α 2-adrenergic receptors and also extracellular Ca +2 concentrations play a major role. β-adrenergic receptors, muscarinic cholinergic receptors, and inhibition of cyclooxygenase enzyme are not involved in this vasoconstriction

show abstract

Intravenous dexmedetomidine during spinal anaesthesia for caesarean section: A meta-analysis of randomized trials

Cited by 16 publications

References 15 publications

Effect of intrathecal dexmedetomidine on preventing shivering in cesarean section after spinal anesthesia: a meta-analysis and trial sequential analysis

Effect of intrathecal dexmedetomidine on preventing shivering in cesarean section after spinal anesthesia: a meta-analysis and trial sequential analysis

Fetal and Maternal Responses to Dexmedetomidine Intrathecal Application During Cesarean Section: A Meta-Analysis

In vitro vasoactive effects of dexmedetomidine on isolated human umbilical arteries

Contact Info

Product

Resources

About