Effect of Transcutaneous Electrical Acupoint Stimulation on Extubation-Related Stress Response in Noncardiac Surgery Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

PurposeStress response is a common complication during extubation, mainly manifested by dramatic hemodynamic fluctuations. Transcutaneous electrical acupoint stimulation (TEAS) is widely applied in perioperative period. We performed this meta-analysis to evaluate whether the TEAS could relieve stress response during extubation in non-cardiac surgery patients. DesignA systematic review and meta-analysis of randomized controlled trials (RCTs). MethodsWe searched six databases (PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, CNKI and Wan Fang) for relevant literature. Risk of bias assessment was executed based on the Cochrane Criteria. We applied RevMan5.4.1 software to analyze data. When the chi-square test did not show heterogeneity, we adopted the fixed-effect model. Otherwise, the random-effect model was utilized. Findingsln total, twelve RCTs with 1347 participants were enrolled in this meta-analysis. Meta-analysis showed the heart rate and mean arterial pressure of the intervention group were significantly lower than the control group at immediately,5 min and 10 min after extubation. And the occurrence rate of emergency agitation (RR 0.39, 95% CI [0.26,0.60]) and postoperative delirium (RR 0.40, 95% CI [0.22, 0.72] were lower in TEAS group. The consumptions of propofol (SMD-0.47, 95% CI [-0.77, -0.18]) and remifentanil (SMD-1.49, 95%CI [-2.01, -0.96]) of the intervention group were also significantly reduced compared with the control group. ConclusionsTEAS was beneficial for improving stress response during extubation, emergence agitation, postoperative delirium and reduced the consumption of intraoperative propofol and remifentanil, but it was necessary to note the limitations of the current evidence.