Effectiveness of dexmedetomidine for intraoperative wake-up test during spinal surgery: a meta-analysis of randomized placebo-controlled clinical trials

Abstract

Objective To explore the safety and effectiveness of dexmedetomidine in intraoperative wake-up during spinal surgery. Methods We searched PubMed, EMbase, Web of Science, Chinese biomedical database (CBM) and China national knowledge infrastructure (CNKI) for clinical randomized controlled trials about the effects of dexmedetomidine on intraoperative wake-up during spinal surgery. RevMan 5.3 software was used for Meta analysis of the included studies. Results Fourteen randomized controlled trials involving 696 patients were included in the Meta-analysis study. The patients were divided into two groups: a dexmedetomidine group (n=348) and a control group (n=348). Results showed that no significant difference in wake-up time was found between two groups [mean deviation (MD)=0.18, 95%CI:-0.27-0.36, P=0.44]. However, compared with the control group, the dexmedetomidine group presented substantially improvement in wake-up quality [relative risk (RR)=2.02, 95%CI: 1.58-2.68, P<0.001. RR=1.69, 95%CI: 1.30-2.21, P<0.001], and lower MAP and HR levels at wake-up time (MD=-13.39, 95%CI: -18.20-8.58, P<0.01. MD=-14.53, 95%CI: -17.44-11.61, P<0.01]. Conclusions Dexmedetomidine can not prolong wake-up time and may contribute to improvement in wake-up quality and maintain hemodynamic stability during wake-up period in spinal surgery. However, due to the existence of various biases, more high quality studies are needed to confirm the results. Key words: Dexmedetomidine; Spinal surgery; Wake-up; Meta-analysis