The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis.

Abstract

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. 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. 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. 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.