Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis
Efeitos da dexmedetomidina na anestesia fora da sala cirúrgica em adultos: uma revisão sistemática com meta-análise
Francisca Jerónimo Fonseca, Leonardo Ferreira, Ana Lídia Rouxinol-Dias, Joana Mourão
Abstract
Background: Dexmedetomidine (DEX) is an a2-adrenergic receptor agonist used for its sedative, analgesic, and anxiolytic effects. Non-Operating Room Anesthesia (NORA) is a modality of anesthesia that can be done under general anesthesia or procedural sedation or/and analgesia. In this particular setting, a level-2 sedation, such as the one provided by DEX, is beneficial. We aimed to study the effects and safety of DEX in the different NORA settings in the adult population.
Methods: A systematic review with meta-analysis of randomized controlled trials was conducted. Interventions using DEX only or DEX associated with other sedative agents, in adults (18 years old or more), were included. Procedures outside the NORA setting and/or without a control group without DEX were excluded. MEDLINE, ClinicalTrials.gov, Scopus, LILACS, and SciELO were searched. The primary outcome was time until full recovery. Secondary outcomes included hemodynamic and respiratory complications and other adverse events, among others.
Results: A total of 97 studies were included with a total of 6,706 participants. The meta-analysis demonstrated that DEX had a higher time until full recovery (95% CI = [0.34, 3.13] minutes, a higher incidence of hypotension (OR = 1.95 [1.25, 3.05], p = 0.003, I2 = 39%) and bradycardia (OR = 3.60 [2.29, 5.67], p < 0.00001, I2 = 0%), and a lower incidence of desaturation (OR = 0.40 [0.25, 0.66], p = 0.0003, I2 = 60%).
Conclusion: DEX in NORA procedures in adults was associated with a lower incidence of amnesia and respiratory effects but had a long time to recovery and more hemodynamic complications.
Keywords
Resumo
Introdução
A dexmedetomidina (DEX) é um agonista do receptor α2-adrenérgico usado por seus efeitos sedativos, analgésicos e ansiolíticos. Anestesia fora da sala cirúrgica (NORA) é uma modalidade de anestesia que pode ser realizada sob anestesia geral ou sedação processual e/ou analgesia. Neste cenário específico, uma sedação de nível 2, como a fornecida pela DEX, é benéfica. Nosso objetivo foi estudar os efeitos e a segurança da DEX nas diferentes configurações de NORA na população adulta.
Métodos
Foi realizada uma revisão sistemática com meta-análise de ensaios clínicos randomizados. Foram incluídas intervenções utilizando DEX apenas ou DEX associada a outros sedativos, em adultos (18 anos ou mais). Foram excluídos procedimentos fora do ambiente NORA e/ou sem grupo controle sem DEX. MEDLINE, ClinicalTrials.gov, Scopus, LILACS e SciELO foram pesquisados. O desfecho primário foi o tempo até a recuperação total. Os desfechos secundários incluíram complicações hemodinâmicas e respiratórias e outros eventos adversos, entre outros.
Resultados
Um total de 97 estudos foram incluídos com um total de 6.706 participantes. A meta-análise demonstrou que DEX teve um tempo maior até a recuperação completa (IC 95% = [0,34, 3,13] minutos, uma maior incidência de hipotensão (OR = 1,95 [1,25, 3,05], p = 0,003, I2 = 39%) e bradicardia (OR = 3,60 [2,29; 5,67], p < 0,00001, I2 = 0%) e menor incidência de dessaturação (OR = 0,40 [0,25; 0,66], p = 0,0003, I² = 60%).
Conclusão
A DEX em procedimentos NORA em adultos foi associada a uma menor incidência de amnésia e efeitos respiratórios, mas teve um longo tempo de recuperação e mais complicações hemodinâmicas.
Palavras-chave
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Submitted date:
04/07/2021
Accepted date:
12/05/2021
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