RESUMEN
BACKGROUND: Current evidence on the effect of dexmedetomidine in early postoperative recovery is limited. We conducted a systematic review to evaluate the effect of dexmedetomidine on the length of stay (LOS) and recovery profile in postanesthesia care unit (PACU) patients. METHODS: The study protocol is registered on International Prospective Register of Systematic Reviews (PROSPERO; CRD42021240559). No specific funding or support was received. We conducted searches in MEDLINE, Embase, PubMed, and Cochrane Library to March 31, 2021 for peer-reviewed randomized controlled studies comparing adult patients who received intravenous dexmedetomidine and placebo undergoing noncardiac, nonneurosurgical procedures under general anesthesia. All studies reporting statistics relating to the duration of stay in the recovery ward or PACU, the primary outcome, were included. We performed individual random-effect meta-analysis on the primary and secondary outcomes (time to extubation, emergence agitation, cough, pain, postoperative nausea and vomiting, shivering, residual sedation, bradycardia, and hypotension) using Stata version 17.0. Evidence was synthesized as mean difference (MD) and risk ratio (RR) for continuous and dichotomous variables, respectively. The quality of evidence was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Thirty-three studies including 2676 patients were eligible for analysis. All studies had low risk or some concerns of overall bias and provided low-to-high certainty evidence for all studied outcomes. Dexmedetomidine was not associated with a significantly increased PACU LOS (MD, 0.69 minute; 95% confidence interval [CI], -1.42 to 2.81 minutes). It was associated with a statistically but not clinically significant prolonged time to extubation (MD, 1 minute; 95% CI, 0.32-1.68 minutes). Dexmedetomidine was associated with significantly reduced incidence of emergence agitation (RR, 0.38; 95% CI, 0.29-0.52), cough (RR, 0.69; 95% CI, 0.61-0.79), pain (RR, 0.50; 95% CI, 0.32-0.80), postoperative nausea and vomiting (RR, 0.54; 95% CI, 0.33-0.86), and shivering (RR, 0.24; 95% CI, 0.12-0.49) in PACU. There was an increased incidence of hypotension (RR, 5.39; 95% CI, 1.12-5.89) but not residual sedation (RR, 1.23; 95% CI, 0.20-7.56) or bradycardia (RR, 5.13; 95% CI, 0.96-27.47) in the dexmedetomidine group. CONCLUSIONS: The use of dexmedetomidine did not increase the duration of PACU LOS but was associated with reduced emergence agitation, cough, pain, postoperative nausea and vomiting, and shivering in PACU. There was an increased incidence of hypotension but not residual sedation or bradycardia in PACU.
Asunto(s)
Dexmedetomidina , Delirio del Despertar , Hipotensión , Adulto , Anestesia General , Bradicardia , Tos , Humanos , Hipotensión/tratamiento farmacológico , Dolor/tratamiento farmacológico , Alta del Paciente , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Náusea y Vómito Posoperatorios/epidemiologíaAsunto(s)
Varicela/complicaciones , Neumonía Bacteriana/etiología , Choque Séptico/etiología , Infecciones Estreptocócicas/etiología , Streptococcus pyogenes , Adulto , Resultado Fatal , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/terapia , Radiografía , Choque Séptico/diagnóstico , Choque Séptico/terapia , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/terapia , Enfisema Subcutáneo/diagnóstico por imagen , Enfisema Subcutáneo/etiologíaRESUMEN
STUDY OBJECTIVE: To determine whether residual gas volume reduces more quickly after insufflation with humidified CO(2) compared with dry CO(2). DESIGN: Animal study (Canadian Task Force classification I). SETTING: University. INTERVENTION: Piglets were randomly divided into two groups of five and underwent abdominal insufflation with either cold, dry CO(2) or warm, humidified CO(2). MEASUREMENTS AND MAIN RESULTS: Following insufflation, anteroposterior and lateral gas-bubble radiographic images were obtained at 5, 15, 30, 45, and 60 minutes, and the area of each gas-bubble profile calculated. Blood samples were obtained at 0, 2, 4, and 5 hours, and they were analyzed for IL-1beta and TNFalpha. Peritoneal tissue samples were obtained on euthanasia at 5 hours for histological analysis. The results indicate that following pneumoperitoneum, residual CO(2) dissipates more rapidly when the gas is heated and humidified compared with when it is cool and dry. This is associated with a reduction in the duration of the inflammatory response as measured by TNF alpha production, although no histologic differences in the peritoneal tissue were observed. CONCLUSION: Heating and humidifying CO(2) leads to faster dissipation of residual gas associated with a reduced duration of inflammation, which may contribute toward a reduction in postlaparoscopic pain.