Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis
Background: Dexmedetomidine (DEX) is an α2-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 sett...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Brazilian Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001421004206 |
| _version_ | 1797679481821855744 |
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| author | Francisca Jerónimo Fonseca Leonardo Ferreira Ana Lídia Rouxinol-Dias Joana Mourão |
| author_facet | Francisca Jerónimo Fonseca Leonardo Ferreira Ana Lídia Rouxinol-Dias Joana Mourão |
| author_sort | Francisca Jerónimo Fonseca |
| collection | DOAJ |
| description | Background: Dexmedetomidine (DEX) is an α2-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. |
| first_indexed | 2024-03-11T23:15:18Z |
| format | Article |
| id | doaj.art-333a7f1ddd064e2998a754c26abc3651 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-03-11T23:15:18Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-333a7f1ddd064e2998a754c26abc36512023-09-21T04:36:04ZengElsevierBrazilian Journal of Anesthesiology0104-00142023-09-01735641664Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysisFrancisca Jerónimo Fonseca0Leonardo Ferreira1Ana Lídia Rouxinol-Dias2Joana Mourão3Faculty of Medicine of the University of Porto, Porto, PortugalSão João University Hospital Center, Department of Anesthesiology, Porto, Portugal; Corresponding author.São João University Hospital Center, Department of Anesthesiology, Porto, Portugal; Faculty of Medicine of the University of Porto, Department of Community Medicine, Information and Decision in Health, MEDCIDS, Porto, Portugal; Faculty of Medicine of the University of Porto, Center for Health Technology and Services Research, CINTESIS, Porto, PortugalFaculty of Medicine of the University of Porto, Porto, Portugal; São João University Hospital Center, Department of Anesthesiology, Porto, PortugalBackground: Dexmedetomidine (DEX) is an α2-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.http://www.sciencedirect.com/science/article/pii/S0104001421004206AnesthesiologyConscious sedationDexmedetomidineHypnotics and sedativesPatient safety |
| spellingShingle | Francisca Jerónimo Fonseca Leonardo Ferreira Ana Lídia Rouxinol-Dias Joana Mourão Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis Brazilian Journal of Anesthesiology Anesthesiology Conscious sedation Dexmedetomidine Hypnotics and sedatives Patient safety |
| title | Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis |
| title_full | Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis |
| title_fullStr | Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis |
| title_full_unstemmed | Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis |
| title_short | Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis |
| title_sort | effects of dexmedetomidine in non operating room anesthesia in adults a systematic review with meta analysis |
| topic | Anesthesiology Conscious sedation Dexmedetomidine Hypnotics and sedatives Patient safety |
| url | http://www.sciencedirect.com/science/article/pii/S0104001421004206 |
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