| Part one Intraoperative dexmedetomidine infusionis associated with improved recovery profiles undergoing general anesthesia in adult:A meta-analysis with trial sequential analysis of randomized controlled trialsBackground:Emergence agitation is one of the instant complications during recovery from general anesthesia.Dexmedetomidine is a highly selective ?2 adrenoreceptor agonist that provides anxiolysis,sedation,and modest analgesia.Dexmedetomidine is recommended for preventing emergence agitation in children;however,its role in adults remains unclear.This meta-analysis aimed to assess the effect of dexmedetomidine on emergence agitation and recovery profiles in adults.Method:We searched databases for randomized controlled trials that compared dexmedetomidine with placebo in patients over 18 years old.The primary outcome was incidence of emergence agitation.Secondary outcomes included emergence time,time to extubation,time to discharge from postanesthesia care unit,number of patients requiring rescue analgesia,and perioperative adverse events.Random-effects meta-analyses techniques,sensitivity analyses and subgroup analyses were performed to analyze the initial data.Trial sequential analysis was adopted to demonstrate how much information has been accrued.Results:Twenty-one randomized placebo-controlled trials(1297 subjects)were analyzed for the primary outcome.Standard meta-analysis method demonstrated dexmedetomidine significantly reduced the incidence of emergence agitation[RR(95%CI)= 0.41(0.32-0.52),P<0.00001].Patients receiving dexmedetomidine required less analgesia(P = 0.001)in the recovery room.Hypotension(P = 0.01)and bradycardia(P = 0.04)were more common with dexmedetomidine.In addition,no difference was found in the times of emergence,extubation in postanesthesia care unit.Trial sequential analysis demonstrated that,except for the incidence of emergence agitation and analgesic requirements in the recovery room,the standard meta-analysis lacked adequate information size and did not achieve statistical significance for the other outcomes.Conclusions:Dexmedetomidine was proven effective for decreasing emergence agitation and reducing recovery room analgesic requirements.However,the safety of dexmedetomidine remains unclear.Part two Intraoperative dexmedetomidine infusionis is associated with improved recovery profiles undergoing lung surgery in adult:a retrospective cohort studyObjective:In this retrospective cohort study,we investigated the association between intraoperative dexmedetomidine infusion and emergence agitation,and recovery profiles after lung surgery in adult patients.Methods:A single-center chart review was conducted on elective lung surgeries in adults between January and December 2016.The primary outcome was the incidence of emergence agitation in the post-anesthesia care unit;the secondary outcome included sedation therapy,postoperative pain score,rescue analgesia,shivering,residual sedation,time to extubation,duration of PACU stay,length of hospital stay,complications of circulatory and respiratory systems,and intraoperative hemodynamic changes.Univariate and multivariate regression analyses were applied for data analysis.Results:Among 2468 patients,814 received an intraoperative dexmedetomidine infusion.Intraoperative dexmedetomidine administration was associated with incidence of emergence agitation[10.9%vs 15.0%;adjusted adds ratio(OR),0.67;95%confidence interval(CI),0.51-0.87;P = 0.003],sedation therapy(adjusted OR,0.65;95%Cl,0.49-0.87;P = 0.004),postoperative pain score>3(adjusted OR,0.63;95%CI,0.47-0.86;P = 0.003),rescue analgesia(adjusted OR,0.61;95%CI,0.45-0.83;P =0.002),shivering(adjusted OR,0.59;95%Cl,0.39-0.89;P = 0.011),and intraoperative bradycardia(adjusted OR,1.51;95%CI,1.19-1.92;P = 0.001).Conclusion:Intraoperative dexmedetomidine infusion was associated with lower incidence of emergence agitation,alleviated postoperative pain and shivering in adults after lung surgery.Intraoperative bradycardia was the main side effect. |
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