Dexmedetomidine reduces postoperative cognitive and behavioral dysfunction in adults submitted to general anesthesia for non-cardiac surgery: meta-analysis of randomized clinical trials
Dexmedetomidina reduz alterações cognitivo-comportamentais pósoperatórias de adultos submetidos à anestesia geral para cirurgias não-cardíacas: metanálise de ensaios clínicos randomizados
Catia Sousa Govêia, Denismar Borges de Miranda, Lucas Valente de Brito Oliveira, Felícia Benevides Praxedes, Larissa Govêia Moreira, Gabriel Magalhães Nunes Guimarães
Abstract
Introduction and objectives Dexmedetomidine (DEX) have been associated with a decrease in postoperative cognitive and behavioral dysfunction in patients submitted to general anesthesia, whether inhalation or total intravenous anesthesia. Consequently, the DEX effects on postoperative agitation and delirium in patients submitted to general anesthesia for non-cardiac surgery have been investigated.
Method
We performed a meta-analysis of randomized and double-blind clinical trials assessing adults submitted to elective procedures under general anesthesia that received DEX or placebo. We searched articles published in English in the Pubmed and Web of Science databases using keywords such as dexmedetomidine, delirium, and agitation. We excluded duplicate publications, studies involving cardiac surgery or that used active control (other than saline solution). A random effects model was adopted using the DerSimonian-Laird method and estimate of Odds Ratio (OR) for dichotomous variables, and weighted mean difference for continuous variables, with their respective 95% Confidence Intervals (95% CI).
Results
Of the 484 articles identified, 15 were selected comprising 2,183 patients (1,079 and 1,104 patients in the DEX and control group, respectively). The administration of DEX was considered a protective factor for postoperative cognitive and behavioral dysfunction (OR = 0.36; 95% CI 0.23–0.57 and p < 0.001), regardless of the anesthesia technique used.
Conclusion
Dexmedetomidine administration reduced by at least 43% the likelihood of postoperative cognitive and behavioral dysfunction in adult patients submitted to general anesthesia for non-cardiac surgery.
Keywords
Resumo
Justificativa e objetivos: A dexmedetomidina (DEX) tem sido associada à diminuição de transtornos cognitivo-comportamentais pós-operatórios de pacientes submetidos à anestesia geral, tanto inalatória, quanto venosa total. Assim, foram avaliados os efeitos da DEX sobre a agitação e delirium pós-operatórios em pacientes submetidos à anestesia geral para cirurgias não-cardíacas. Método: Metanálise de ensaios clínicos randomizados e duplamente encobertos, em adultos submetidos a procedimentos eletivos sob anestesia geral que usaram DEX ou placebo. Buscaram-se artigos em língua inglesa na base de dados Pubmed e Web of Science com termos como dexmedetomidina, delirium e agitação. Artigos duplicados, com cirurgias cardíacas ou estudos que usaram controle ativo (diferente de solução salina) foram excluídos. Adotou-se modelo de efeitos aleatórios com testes de DerSimonian-Laird e cálculo de odds ratio (OR) para variáveis dicotômicas e diferença de média ponderada para variáveis contínuas, com seus respectivos intervalos de 95% de confiança (IC 95%). Resultados: Dos 484 estudos identificados, 15 foram selecionados, com 2.183 pacientes (1.079 no grupo DEX e 1.104 controles). O uso da DEX foi considerado fator de proteção para alterações cognitivo-comportamentais pós-operatórias (OR=0,36; IC 95% 0,23-0,57 e p<0,001), independentemente da técnica anestésica utilizada. Conclusão: O uso da dexmedetomidina reduziu em pelo menos 43% a chance da ocorrência de alterações cognitivo-comportamentais no pós-operatório de pacientes adultos submetidos à anestesia geral para cirurgias não-cardíacas.
Palavras-chave
References
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