右美托咪定对老年患者围术期血流动力学稳定性影响的系统评价与Meta分析

doi:10.24920/004088

Abstract

Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia. Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.

Methods PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched for randomized-controlled trials (RCTs) on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September, 2021. The standardized mean differences (SMD) with 95% confidence interval (CI) were employed to analyze the data. The random-effect model was used for the potential clinical inconsistency.

Results A total of 12 RCTs with 833 elderly patients (dexmedetomidine group, 546 patients; control group, 287 patients) were included. There was no significant increase in perioperative heart rate (HR), mean arterial pressure (MAP), and diastolic blood pressure (DBP) in the dexmedetomidine group before and during the operation. In addition, the variations of hemodynamic indexes including HR, MAP, SBP (systolic blood pressure), and DBP were significantly lower in the dexmedetomidine group compared with the control group (HR: SMD = -0.87, 95% CI: -1.13 to -0.62; MAP: SMD = -1.12, 95% CI: -1.60 to -0.63; SBP: SMD = -1.27, 95% CI: -2.26 to -0.27; DBP: SMD = -0.96, 95% CI: -1.33 to -0.59). Subgroup analysis found that with the prolongation of 1.0 μg/kg dexmedetomidine infusion, the patient's heart rate declined in a time-dependent way.

Conclusion Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients. However, further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.

Key words: dexmedetomidine, elderly patient, hemodynamics, perioperative period

Li-Juan Tian, Yun-Tai Yao, Su Yuan, Zheng Dai. Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients: A Systematic Review and Meta-analysis[J].Chinese Medical Sciences Journal, 2023, 38(1): 1-10.

Figures/Tables 7

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References 38

[1]	Chattopadhyay U, Mallik S, Ghosh S, et al. Comparison between propofol and dexmedetomidine on depth of anaesthesia: A prospective randomized trial. J Anaesthesiol Clin Pharmacol 2014 ;30(4):550-4. doi: 10.4103/0970-9185.142857. doi: 10.4103/0970-9185.142857
[2]	Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care 2000 ;4(5):302-8. doi:10.1186/cc712. doi: 10.1186/cc712
[3]	Hwang W, Lee J, Park J, et al. Dexmedetomidine versus remifentanil in postoperative pain control after spinal surgery:a randomized controlled study. BMC Anaesthesiol 2015; 15:21. doi:10.1186/s12871-015-0004-1. doi: 10.1186/s12871-015-0004-1
[4]	Talke P, Chen R, Thomas B, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg 2000; 90(4):834-9. doi:10.1097/00000539-200004000-00011. doi: 10.1097/00000539-200004000-00011 pmid: 10735784
[5]	Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth 2011 ;55(4):352-7. doi:10.4103/0019-5049.84846. doi: 10.4103/0019-5049.84846
[6]	Virtanen R, Savola JM, Saano V, et al. Characterisation of selectivity, specificity and potency of medetomidine as an α2-receptor agonist. Eur J Pharmacol 1988; 150(1-2):9-14. doi:10.1016/0014-2999(88)90744-3. doi: 10.1016/0014-2999(88)90744-3 pmid: 2900154
[7]	Hall JE, Uhrich TD, Barney JA, et al. Sedative, amnestic, and analgesic properties of small-dose Dexmedetomidine infusions. Anesth Analg 2000; 90:699-705. doi:10.1097/00000539-200003000-00035. doi: 10.1097/00000539-200003000-00035 pmid: 10702460
[8]	Yang L, Gong Y, Tan Y, et al. Dexmedetomidine exhibits antiarrhythmic effects on human-induced pluripotent stem cell-derived cardiomyocytes through a Na/Ca channel-mediated mechanism. Ann Transl Med 2021; 9(5):399. doi:10.21037/atm-20-5898. doi: 10.21037/atm-20-5898 pmid: 33842620
[9]	Shribman AJ. Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anesth 1987 ;59(3):295-9. doi:10.1093/bja/59.3.295. doi: 10.1093/bja/59.3.295
[10]	Tsujikawa S, Ikeshita K. Low-dose dexmedetomidine provides hemodynamics stabilization during emergence and recovery from general anesthesia in patients undergoing carotid endarterectomy: a randomized double-blind, placebo-controlled trial. J Anesth 2019 ;33(2):266-72. doi:10.1007/s00540-019-02612-w. doi: 10.1007/s00540-019-02612-w
[11]	Andres TM, McGrane T, McEvoy MD, et al. Geriatric Pharmacology: An Update. Anesthesiol Clin 2019; 37(3):475-92. doi:10.1016/j.anclin.2019.04.007. doi: S1932-2275(19)30037-0 pmid: 31337479
[12]	Bloor BC, Ward DS, Belleville JP, et al. Effects of intravenous dexmedetomidine in humans, Ⅱ: hemodynamic changes. Anesthesiology 2000; 77(3): 1134-42. doi:10.1097/00000542-199212000-00014. doi: 10.1097/00000542-199212000-00014
[13]	Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.1. (updated September 2020). Cochrane 2020. Available from www.training.cochrane. org/handbook.
[14]	Moher D, Shamseer L, Clarke M, et al. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4(1):1. doi:10.1186/2046-4053-4-1. doi: 10.1186/2046-4053-4-1
[15]	Borenstein M, Hedges LV, Higgins JP, et al. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 2010 ;1(2):97-111. doi:10.1002/jrsm.12. doi: 10.1002/jrsm.12
[16]	Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health 2014 ;72(1): 39. doi:10.1186/2049-3258-72-39. doi: 10.1186/2049-3258-72-39
[17]	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315(7109):629-34. doi:10.1136/bmj.315.7109.629. doi: 10.1136/bmj.315.7109.629 pmid: 9310563
[18]	Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000 ;56(2):455-63. doi:10.1111/j.0006-341x.2000.00455.x. doi: 10.1111/j.0006-341x.2000.00455.x
[19]	Qiao KK, Li X. Effects of dexmedetomidine on anesthesia and cognitive function in elderly patients undergoing laparoscopic cholecystectomy. Chin J Pharmacovigilance 2020; 17(2):81-6.
[20]	Li SM, Dong TL. The observation on the anesthetic effect of dexmedetomidine for the elder ERCP. Chin J Geriatr Care 2015; 13(2):68-70.
[21]	Song TX, Hu WS. Cardiovascular effects of pre prescribed dexmedetomidine on elderly patients undergoing tracheal intubation under general anesthesia. Chin Med Pharm 2017; 7(17):180-2,198.
[22]	Chen SY, Li XL, Zhou DX, et al. Effects of different doses of dexmedetomidine on the extubation reaction of elderly patients after general anesthesia colorectal cancer surgery. Chin Anti-tumor Pharmacy 2019; 9(3):451-5.
[23]	Lin YB, Shu HH, Ye F, et al. The effects of dexmedetomidine of two different dose infusion on myocardial oxygen supply and hemodynamics in patients with radical resection of esophageal carcinoma under thoracoscopy surgery. Chin Progress in Modern Biomedicine 2017; 17(4):692-5.
[24]	Su XJ, Li P, Guo ZG, et al. Clinical observation of continuous infusion of dexmedetomidine in elderly patients undergoing spinal surgery. Chin J Med Res 2014; 43(4):108-11.
[25]	Zhang XH, Tian XT, Zhou Z. Effect of dexmedetomidine on recovery period of elderly patients under intravenous inhalation combined with general anesthesia. Chin J Laboratory Diagn 2018; 22(6):946-9.
[26]	Cao BF, Hu HZ, Zhang SJ, et al. The effect of dexmedetomidine on cardiovascular response during extubation in older patients undergoing laparoscopic radical resection of colorectal cancer. Chin J Colorect Anal Surg 2018; 24(1):77-80.
[27]	Guan ZY, Wang CM, Tang S, et al. Comparison of effects of different doses dexmedetomidine on inhibiting tracheal intubation-evoked haemodynamic response in the elderly patients. J Clin Diagn Res 2015; 9(9):UC10-3. doi:10.7860/JCDR/2015/14624.6455. doi: 10.7860/JCDR/2015/14624.6455
[28]	Lee CW, Kim MW. Effects of preanesthetic dexmedetomidine on hemodynamic responses to endotracheal intubation in elderly patients undergoing treatment for hypertension: a randomized, double-blinded trial. Korean J Anesthesiol 2017; 70(1):39-45. doi:10.4097/kjae.2017.70.1.39. doi: 10.4097/kjae.2017.70.1.39 pmid: 28184265
[29]	Ko KH, Jun IJ, Lee SS, et al. Effective dose of dexmedetomidine to induce adequate sedation in elderly patients under spinal anesthesia. Korean J Anesthesiol 2015; 68(6):575-80. doi:10.4097/kjae.2015.68.6.575. doi: 10.4097/kjae.2015.68.6.575
[30]	Du XX, Song F, Zhang XQ, et al. Protective efficacy of combined use of parecoxib and dexmedetomidine on postoperative hyperalgesia and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients. Acta Cir Bras 2019; 34(9): e201900905. doi:10.1590/s0102-865020190090000005. doi: 10.1590/s0102-865020190090000005
[31]	Yun SH, Park JC, Kim SR, et al. Effects of dexmedetomidine on serum interleukin-6, hemodynamic stability, and postoperative pain relief in elderly patients under spinal anesthesia. Acta Med Okayama 2016; 70(1):37-43. doi:10.18926/AMO/54002. doi: 10.18926/AMO/54002 pmid: 26899608
[32]	Chang YF, Chao A, Shih PY, et al. Comparison of dexmedetomidine versus propofol on hemodynamics in surgical critically ill patients. J Surg Res 2018; 228:194-200. doi:10.1016/j.jss.2018.03.040. doi: 10.1016/j.jss.2018.03.040
[33]	Yu J, Park JY, Kim DH, et al. Dexmedetomidine attenuates the increase of ultrasonographic optic nerve sheath diameter as a surrogate for intracranial pressure in patients undergoing robot-assisted laparoscopic prostatectomy: A randomized double-blind controlled trial. Medicine (Baltimore) 2019; 98(33):e16772. doi:10.1097/MD.0000000000016772. doi: 10.1097/MD.0000000000016772
[34]	Bekker AY, Basile J, Gold M, et al. Dexmedetomidine for awake carotid endarterectomy: efficacy, hemodynamic profile, and side effects. J Neurosurg Anesthesiol 2004; 16(2):126-35. doi:10.1097/00008506-200404000-00004. doi: 10.1097/00008506-200404000-00004
[35]	Inatomi O, Imai T, Fujimoto T, et al. Dexmedetomidine is safe and reduces the additional dose of midazolam for sedation during endoscopic retrograde cholangiopancreatography in very elderly patients. BMC Gastroenterol 2018; 18(1):166. doi:10.1186/s12876-018-0897-5. doi: 10.1186/s12876-018-0897-5 pmid: 30400828
[36]	Ueki M, Kawasaki T, Habe K, et al. The effects of dexmedetomidine on inflammatory mediators after cardiopulmonary bypass. Anaesthesia 2014; 69:693-700. doi:10.1111/anae.12636. doi: 10.1111/anae.12636 pmid: 24773263
[37]	Wang C, Zhang H, Fu Q, et al. Effective dose of dexmedetomidine as an adjuvant sedative to peripheral nerve blockade in elderly patients. Acta Anaesthesiol Scand 2018; 62(6):848-56. doi:10.1111/aas.13087. doi: 10.1111/aas.13087 pmid: 29424059
[38]	Zhong Q, Kumar A, Deshmukh A, et al. Dexmedetomidine Reduces Incidences of Ventricular Arrhythmias in Adult Patients: A Meta-Analysis. Cardiol Res Pract 2022; 2022:5158362. doi:10.1155/2022/5158362. doi: 10.1155/2022/5158362

Author, year	Sample size		Dexmedetomidine dose/administration	Control group	Surgery
Author, year	Dex	Con	Dexmedetomidine dose/administration	Control group	Surgery
Qiao, 2020^[19]	50	50	0.40 μg/kg loading	Blank	Undergoing laparoscopic cholecystectomy
Li, 2015^[20]	20	20	1.00 μg/kg loading	Blank	ERCP
Song, 2017^[21]	30	30	1.00 μg/kg loading	Blank	Undergoing tracheal intubation under general anesthesia
Chen, 2019^[22]	90	30	0.20, 0.40, 0.60 μg/kg/h infusion	Saline	Colorectal cancer surgery
Lin, 2017^[23]	44	22	0.50, 1.00 μg/kg loading; 0.50 μg/kg/h infusion	Blank	Radical resection of esophageal carcinoma under thoracoscopy surgery
Su, 2014^[24]	25	25	0.50 μg/kg loading; 0.40 μg/kg/h infusion	Saline	Thoracolumbar surgery
Zhang, 2018^[25]	30	30	0.50 μg/kg loading	Saline	Abdominal operation
Cao, 2018^[26]	90	0	0.30, 0.50, 0.70 μg/kg loading	Blank	Radical resection of colorectal cancer
Guan, 2015^[27]	60	20	0.25, 0.50, 1.00 μg/kg loading; constant speed infusion in 10mins	Saline	Abdominal surgery
Lee, 2017^[28]	20	20	0.50 μg/kg loading; constant speed infusion in 10 min	Saline	Hypertension patients with noncardiac surgery
Ko, 2015^[29]	47	0	0.10, 0.30, 0.50, 0.70, 1.00 μg/kg loading	Blank	Orthopedic or urologic surgery
Du, 2019^[30]	40	40	0.60 μg/kg/h infusion	Saline	Laparoscopic cholecystectomy surgery

Indexes	No. of studies	Sample size	SMD (95% CI)	Heterogeneity
Indexes	No. of studies	Sample size	SMD (95% CI)	I² (%)	P value
Comparison between before and after operation
MAP	8	450	0.12 (-0.54, 0.79)	93.1	<0.001
HR	10	550	0.13 (-0.44, 0.70)	91.7	<0.001
SBP	4	200	1.38 (0.11, 2.64)	93.5	<0.001
DBP	4	200	1.11 (-0.25, 2.46)	94.5	<0.001
Comparison between dexmedetomidine and control
MAP	8	440	-1.12 (-1.60, -0.63)	81.6	<0.001
HR	10	540	-0.87 (-1.13, -0.62)	50.8	0.032
SBP	4	200	-1.27 (-2.26, -0.27)	90.0	<0.001
DBP	4	200	-0.96 (-1.33, -0.59)	34.9	0.203
Time effect of SBP and HR with 0.5 μg/kg and 1.0 μg/kg dexmedetomidine, respectively
SBP_{(0.5, 0)}	3	112	-1.17 (-3.36, 1.02)	96.0	<0.001
SBP_{(0.5, 10)}	3	112	-0.07 (-0.43, 0.28)	0.0	0.686
SBP_{(0.5, 20)}	2	62	-0.59 (-1.10, -0.08)	0.0	0.320
SBP_{(1, 0)}	2	64	-0.24 (-0.73, 0.25)	0.0	0.889
SBP_{(1, 10)}	2	64	-0.86 (-1.95, 0.22)	74.5	0.048
SBP_{(1, 20)}	2	64	-0.24 (-0.73, 0.25)	0.0	0.889
HR_{(0.5, 0)}	5	212	-0.41 (-0.95, 0.13)	72.4	0.006
HR_{(0.5, 10)}	5	212	-0.73 (-1.51, 0.04)	85.7	<0.001
HR_{(0.5, 20)}	3	102	-1.48 (-2.30, -0.66)	68.5	0.042
HR_{(1, 0)}	2	64	-0.14 (-0.63, 0.35)	0.0	0.340
HR_{(1, 10)}	2	64	-1.53 (-2.09, -0.97)	0.0	0.709
HR_{(1, 20)}	2	64	-1.96 (-2.56, -1.36)	0.0	0.944

Index	Egger's regression		Duval and Tweedie's trim and fill
Index	Intercept	P value	Original OR	Studies trimmed	Adjusted OR
Comparison between before and after operation
MAP	9.392	0.334	0.12 (-0.54, 0.79)	2	-0.18 (-0.84, 0.49)
HR	18.491	0.067	0.13 (-0.44, 0.71)	3	-0.21 (-0.78, 0.36)
Comparison between dexmedetomidine and control (blank or saline)
MAP	-2.395	0.669	-1.12 (-1.61, -0.63)	0	-1.12 (-1.61, -0.63)
HR	2.967	0.408	-0.87 (-1.13, -0.62)	0	-0.87 (-1.13, -0.62)

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