Attenuation of the increase in intraocular pressure with dexmedetomidine: Systematic review with meta-analysis and trial sequential analysis

Abstract

Study objectiveWhether dexmedetomidine effectively attenuates the increase in intraocular pressure (IOP) remains inconclusive. We aim to evaluate the effects of dexmedetomidine on IOP in adult patients undergoing surgery which requires general anesthesia and endotracheal intubation. DesignSystematic review and meta-analysis. InterventionsIntravenous administration of dexmedetomidine during surgery. MeasurementsIntraocular pressure. MethodsWe searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, Google Scholar, Wanfang Data, and China National Knowledge Infrastructure from the inception through April 14, 2020. Randomized control trials which involved adult patients undergoing surgery that required general anesthesia and endotracheal intubation, which compared intravenous administration of dexmedetomidine with placebo regarding the IOP levels, which also provided sufficient information for meta-analysis were considered eligible. Main resultsTwenty-nine randomized control trials were included. The IOP levels are significantly lower in patients receiving dexmedetomidine after the administration of dexmedetomidine [mean difference (MD), −2.04 mmHg; 95% confidence interval (CI), −2.40 mmHg to −1.67 mmHg], after the injection of succinylcholine (MD, −3.84 mmHg; 95% CI, −4.80 mmHg to −2.88 mmHg), after endotracheal intubation (MD, −3.64 mmHg; 95% CI, −4.46 mmHg to −2.82 mmHg), after pneumoperitoneum (MD, −3.12 mmHg; 95% CI, −3.93 mmHg to −2.30 mmHg), and after the patients being placed in a steep Trendelenburg position (MD, −4.12 mmHg; 95% CI, −5.39 mmHg to −2.85 mmHg). Trial sequential analyses for these outcomes are conclusive. ConclusionsDexmedetomidine effectively attenuates the increase in IOP levels, and should be considered especially for at-risk patients.