Meta-analysis of the effects of dexmedetomidine vs esmolol for used controlled hypotension during surgery

Abstract

Background: At present ,the anesthetist usally use Controlled hypotension tecnical reduced blood loss and improved surgical field. Dexmedetomidine and esmolol have been proved effective for controlled hypotension. This meta-analysis aimed to evaluate the effects of dexmedetomidine versus esmolol on the controlled hypotension during surgery.Methods: All articles were retrieved from PubMed, Embase, Cochrane Library up to January 2020. JL and HD independently screened, extracted and evaluated the literature that meet the inclusion and exclusion criteria, and used RevMan 5.3 for statistic analysis.Results: Eight randomised trials, including 418 patients were selected in this meta-anaysis. And it’s results showed:1) The dexmedetomidine group was more favorable in reducing blood loss (MD 49.48 with 95% CI [-5.44,104.40], P =0.08）;2）Compared with the esmolol group，HR （MD 3.30 with 95% CI [2.11,4.50], P <0.00001）,requiring of fentany(SMD 5.96 with 95% CI [3.43,8.48], P <0.00001）were considerably lower in the dexmedetomidine group，while emergence time （MD -6.69 with 95% CI [-9.61,-3.76], P <0.0001)was more longer in the dexmedetomidine group . 3）Compared with the esmolol group，duration of surgery（MD -0.12 with 95% CI [-6.24,6.01], P = 0.97），MAP（ MD 2.29 with 95% CI [-2.02,6.60],P =0.30），the recovery period（MD -0.52 with 95% CI [-3.07,2.04], P = 0.69）were not statistically significant differences in the dexmedetomidine group.Conclusion: Two drugs were effective for controlled hypotension, but compared with esmolol, dexmedetomidine is more better in reducing blood loss ,and less requiring of fentanyl.But attention should be paid to the long emegence time and bradycardia.