Dexmedetomidine as an anesthetic adjuvant for intracranial procedures: meta-analysis of randomized controlled trials

Abstract

This meta-analysis aimed to systematically collect the current evidence regarding the efficacy and safety of dexmedetomidine (DEX) as an anesthetic adjuvant for patients undergoing intracranial surgery. A systematic literature search of randomized controlled trials (RCT) was conducted to compare DEX with placebo or opioids in patients undergoing intracranial procedures. Hemodynamic data, opioid consumption, and recovery parameters were pooled. Eight RCT were included. Results showed that patients treated with DEX required less intraoperative treatment for hypertension and hypotension (risk ratio [RR]=0.48, 95% confidence interval [CI] 0.31-0.75, p=0.001; and RR=0.66, 95% CI 0.43-1.01, p=0.05, respectively) and less postoperative treatment for hypertension and tachycardia (RR=0.37, 95% CI 0.17-0.79, p=0.01; and RR=0.14, 95% CI 0.03-0.59, p=0.007, respectively) compared with placebo. Patients also had lower mean arterial pressure and heart rate when extubated (mean difference [MD]=-9.74 mm Hg, 95% CI -12.35 to -7.12, p<0.00001; and MD=-16.35 beats/minute, 95% CI -20.00 to -12.70, p<0.00001, respectively), a lower intraoperative additional fentanyl consumption (MD=-0.78 μg/kg, 95% CI -1.51 to -0.05, p=0.04), and lower postoperative antiemetic requests (RR=0.51, 95% CI 0.33-0.80, p=0.003). DEX may not increase extubation time, postoperative PaCO2, or the risk of perioperative bradycardia. Only a small number of RCT are available, but meta-analysis shows evidence that DEX as an anesthetic adjuvant during intracranial procedures leads to better perioperative hemodynamic control, less intraoperative opioid consumption, and fewer postoperative antiemetic requests.

Keywords: Craniotomy; Dexmedetomidine; General anesthesia; Intracranial surgery; Neurosurgical procedures.