Respiratory outcomes of adrenergic beta-antagonists in
patients undergoing tracheal extubation: a systematic
review and meta-analysis of randomized controlled
trials

Lucas Cael Azevedo Ramos Bendaham; Altair Pereira de Melo Neto; Hilária Saugo Faria; André Richard da Silva Oliveira Filho; Carlos Henrique de Oliveira Ferreira; Marcela da Silva Kazitani Cunha; Victor Gonçalves Soares; Ocílio Ribeiro Gonçalves; Milene Vitória Sampaio Sobral; Mohamed Doma; Denis Maltz Grutcki; Fabrício Tavares Mendonça

doi:10.1016/j.bjane.2025.844659

Revisão Sistemática

Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials

Desfechos respiratórios de beta-antagonistas adrenérgicos em pacientes submetidos à extubação traqueal: uma revisão sistemática e meta-análise de ensaios clínicos randomizados

Lucas Cael Azevedo Ramos Bendaham, Altair Pereira de Melo Neto, Hilária Saugo Faria, André Richard da Silva Oliveira Filho, Carlos Henrique de Oliveira Ferreira, Marcela da Silva Kazitani Cunha, Victor Gonçalves Soares, Ocílio Ribeiro Gonçalves, Milene Vitória Sampaio Sobral, Mohamed Doma, Denis Maltz Grutcki, Fabrício Tavares Mendonça

http://dx.doi.org/10.1016/j.bjane.2025.844659 Braz J Anesthesiol, vol.75, n6, 844659, 2025

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Abstract

Background

Tracheal extubation after general anesthesia may cause hemodynamic and respiratory complications, with no established strategies to prevent them. We conducted a meta-analysis to evaluate the safety and efﬁcacy of beta-blockers in patients undergoing tracheal extubation.

Methods

We searched the MEDLINE, EMBASE and CENTRAL databases for randomized controlled trials up to 2024 comparing beta-blockers to placebo in patients undergoing tracheal extubation. Primary outcome: cough intensity; secondary: bronchospasm, bucking, hypertension. Risk Ratios (RR) with 95% Conﬁdence Intervals (95% CI) were computed. Leave-one-out sensitivity and meta-regression analyses were performed for outcomes with high heterogeneity.

Results

We included 31 randomized studies, comprising 1,803 patients, of whom 965 received beta-blockers. The risk of moderate/severe cough (RR = 0.21; 95% CI 0.13 to 0.34; p < 0.001; I² = 0%) and hypertension (RR = 0.28; 95% CI 0.13 to 0.58; p < 0.001; I² = 45%) was signiﬁcantly lower in the beta-blockers group compared with the placebo group. There were no statistically signiﬁcant differences between groups in the risk of bronchospasm (RR = 0.58; 95% CI 0.17 to 1.94; p = 0.375; I² = 0%) or bucking (RR = 0.47; 95% CI 0.20 to 1.13; p = 0.093; I² = 72%). Sensitivity analysis identiﬁed Mendonça (2023) as the main heterogeneity source in bucking.

Conclusion

Our study demonstrates that beta-blockers reduced moderate/severe cough and hypertension in patients undergoing tracheal extubation compared with placebo with no signiﬁcant difference in the risk of bronchospasm and bucking. These ﬁndings suggest beta-blockers may be a valuable strategy for preventing peri-extubation hemodynamic instability and airway hyperresponsiveness.

Prospero register
CRD42024542103.

Keywords

Adrenergic betaantagonists; Airway extubation; Complications; Meta-analysis; Randomized controlled trials

Resumo

Introdução

A extubação traqueal após anestesia geral pode causar complicações hemodinâmicas e respiratórias, sem estratégias estabelecidas para preveni-las. Realizamos uma meta-análise para avaliar a segurança e a eficácia dos betabloqueadores em pacientes submetidos à extubação traqueal.

Métodos

Foram pesquisadas as bases de dados MEDLINE, EMBASE e CENTRAL por ensaios clínicos randomizados até 2024 que comparassem betabloquadores ao placebo em pacientes submetidos à extubação traqueal. Desfecho primário: intensidade da tosse; secundários: broncoespasmo, esforço de tosse (bucking), hipertensão. Calculamos Risco Relativo (RR) com intervalos de confiança de 95% (IC 95%). Foram realizadas análises de sensibilidade leave-one-out e meta-regressão para desfechos com alta heterogeneidade.

Resultados

Foram incluídos 31 estudos randomizados, totalizando 1.803 pacientes, dos quais 965 receberam betabloqueadores. O risco de tosse moderada/grave (RR = 0,21; IC 95% 0,13–0,34; p < 0,001; I² = 0%) e de hipertensão (RR = 0,28; IC 95% 0,13–0,58; p < 0,001; I² = 45%) foi significativamente menor no grupo betabloqueadores em comparação ao grupo placebo. Não houve diferenças estatisticamente significativas entre os grupos quanto ao risco de broncoespasmo (RR = 0,58; IC 95% 0,17–1,94; p = 0,375; I² = 0%) ou de bucking (RR = 0,47; IC 95% 0,20–1,13; p = 0,093; I² = 72%). A análise de sensibilidade identificou Mendonça (2023) como a principal fonte de heterogeneidade em bucking.

Conclusão

Nosso estudo demonstra que os betabloqueadores reduziram a tosse moderada/grave e a hipertensão em pacientes submetidos à extubação traqueal, em comparação ao placebo, sem diferença significativa no risco de broncoespasmo e bucking. Esses achados sugerem que os betabloqueadores podem ser uma estratégia valiosa para prevenir instabilidade hemodinâmica e hiper-responsividade das vias aéreas no período periextubação.

Registro Prospero
CRD42024542103.

Palavras-chave

Beta-antagonistas adrenérgicos; Extubação das vias aéreas; Complicações; Meta-análise; Ensaios clínicos randomizados

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Submetido em:
20/12/2024

Aceito em:
30/06/2025