Dexmedetomidine versus remifentanil in nasal surgery: a systematic review and meta-analysis.
Dexmedetomidine
Nasal surgery
Remifentanil
Rhinoplasty
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
30 May 2024
30 May 2024
Historique:
received:
16
01
2024
accepted:
14
05
2024
medline:
31
5
2024
pubmed:
31
5
2024
entrez:
30
5
2024
Statut:
epublish
Résumé
Nasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes. Four electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration's tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17. Out of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects. In summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors.
Sections du résumé
BACKGROUND
BACKGROUND
Nasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes.
METHODS
METHODS
Four electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration's tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17.
RESULTS
RESULTS
Out of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects.
CONCLUSION
CONCLUSIONS
In summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors.
Identifiants
pubmed: 38816731
doi: 10.1186/s12871-024-02563-0
pii: 10.1186/s12871-024-02563-0
doi:
Substances chimiques
Dexmedetomidine
67VB76HONO
Remifentanil
P10582JYYK
Hypnotics and Sedatives
0
Types de publication
Systematic Review
Journal Article
Meta-Analysis
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
194Informations de copyright
© 2024. The Author(s).
Références
Rohrich RJ, Ahmad J. A practical approach to rhinoplasty. Plast Reconstr Surg. 2016;137(4):e725–46.
doi: 10.1097/PRS.0000000000002240
Kazemy S, Najari F, Khalilzadeh M, Safavi H, Najari D. Complications of rhinoplasty in patients: an epidemiological study. Int J Med Toxicol Forensic Med. 2018;8(3):109–12.
Daniel RK. The preservation rhinoplasty: a new rhinoplasty revolution. Oxford University Press US; 2018. pp. 228–9.
Muslu Ü, Demir E. Development of rhinoplasty: yesterday and today. Med Sci. 2019;23(97):294–301.
Ersoy Z, Uslu A, Gökdemir BN, Çekmen N, Jafarov S. Comparison of the effects of remifentanil and dexmedetomidine in patients under general anesthesia for rhinoplasty. Res Opin Anesth Intensive Care. 2023;10(2):175–84.
doi: 10.4103/roaic.roaic_2_23
Jouybar R, Nemati M, Asmarian N. Comparison of the effects of remifentanil and dexmedetomidine on surgeon satisfaction with surgical field visualization and intraoperative bleeding during rhinoplasty. BMC Anesthesiol. 2022;22(1):1–9.
doi: 10.1186/s12871-021-01546-9
Meningaud J-P, Lantieri L, Bertrand J-C. Rhinoplasty: an outcome research. Plast Reconstr Surg. 2008;121(1):251–7.
pubmed: 18176228
doi: 10.1097/01.prs.0000293866.57517.d4
Rettinger G. Risks and complications in rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery. 2007;6.
Kavalci G, Ethemoglu F, Durukan P, Batuman A, Emre C. Comparison of the effects of dexmedetomidine and remiphentanyl on emergence agitation after sevoflurane anesthesia in adults undergoing septoplasty operation: a randomized double-blind trial. Eur Rev Med Pharmacol Sci. 2013;17(22):3019–23.
pubmed: 24302181
Karabayirli S, Ugur KS, Demircioglu RI, Muslu B, Usta B, Sert H, Ark N. Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil. Eur Arch Otorhinolaryngol. 2017;274:239–45.
pubmed: 27470115
doi: 10.1007/s00405-016-4220-1
Zamani F, Naseri N, Farmani F, Kamali A. Comparison of the effect of dexmedetomidine and remifentanil on controlled hypotension during rhinoplasty: a clinical trial study. Int Tinnitus J. 2020;24(2):60–4.
Polat R, Peker K, Baran I, Dönmez A. Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery: a randomized double-blind trial. Anaesthesist. 2015;64(10):740–6.
pubmed: 26329913
doi: 10.1007/s00101-015-0077-8
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
pubmed: 33782057
pmcid: 8005924
doi: 10.1136/bmj.n71
Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. 2008.
Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366.
Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:1–13.
doi: 10.1186/1471-2288-14-135
Gruber RP, Holland M, Rochlin D, Sue G, Moshrefi S. Aesthetic science of Rhinoplasty: three principles. Aesthetic Plast Surg. 2022;46(5):2588–98.
pubmed: 35441238
doi: 10.1007/s00266-022-02856-0
Sklar M, Golant J, Solomon P. Rhinoplasty with intravenous and local anesthesia. Clin Plast Surg. 2013;40(4):627–9.
pubmed: 24093657
doi: 10.1016/j.cps.2013.08.002
Bailey BJ, Johnson JT, Newlands SD, Head. & neck surgery–otolaryngology: Lippincott Williams & Wilkins; 2006.
Servin FS. Remifentanil; from pharmacological properties to clinical practice. Advances in Modelling and Clinical Application of Intravenous Anaesthesia. 2003:245 – 60.
Twersky RS, Jamerson B, Warner DS, Fleisher LA, Hogue S. Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients. J Clin Anesth. 2001;13(6):407–16.
pubmed: 11578883
doi: 10.1016/S0952-8180(01)00292-6
Motazedian G, Sohrabpour M, Jahromi MSS, Ghaedi M. Bleeding management in rhinoplasty surgery: a systematic review study on clinical trial studies conducted in Iran. Int J Med Invest. 2021;10(4):32–40.
Kaur H, Tiwari RL, Bhargava J, Kasliwal N. Effect of dexmedetomidine on consumption of anesthetic agents, duration of surgery, time to extubation and post-operative emergence during endoscopic nasal surgeries: a pilot study. Scholars J Appl Med Sci. 2016;4(6E):2180–6.
doi: 10.21276/sjams.2016.4.6.64
Cai M, Liu J, Lei XF, Li YL, Yu J. Remifentanil at a relatively elevated dose in active phase is safe and more suitable than fixed Lower Dose for Intravenous Labor Analgesia. J Pain Res. 2023;16:2543–52.
pubmed: 37521009
pmcid: 10378612
doi: 10.2147/JPR.S419076
Obstetricians, ACo. Gynecologists. ACOG practice bulletin 209: obstetric analgesia and anesthesia. Obstet Gynecol. 2019;133(3):e208–25.
doi: 10.1097/AOG.0000000000003132
Min JJ, Kim G, Lee J-H, Hong KY, Kim WS, Lee Y-T. Does the type of anesthetic technique affect in-hospital and one-year outcomes after off-pump coronary arterial bypass surgery? PLoS ONE. 2016;11(4):e0152060.
pubmed: 27054364
pmcid: 4824512
doi: 10.1371/journal.pone.0152060
Kosucu M, Ömür S, Besir A, Uraloglu M, Topbas M, Livaoglu M. Effects of perioperative remifentanil with controlled hypotension on intraoperative bleeding and postoperative edema and ecchymosis in open rhinoplasty. J Craniofac Surg. 2014;25(2):471–5.
pubmed: 24531244
doi: 10.1097/SCS.0000000000000603
Reel B, Maani CV. Dexmedetomidine. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK513303/ .
Gupta P, Choudhary R, Ojha T, Jethava D. Dexmedetomidine as an adjuvant for hypotensive anaesthesia during functional endoscopic sinus surgery (FESS). IOSR J Dent Med Sci. 2016;15(8):143–6.
doi: 10.9790/0853-150802143146
Ayoglu H, Yapakci O, Ugur MB, Uzun L, Altunkaya H, Ozer Y, et al. Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations. J Clin Anesth. 2008;20(6):437–41.
pubmed: 18929284
doi: 10.1016/j.jclinane.2008.04.008
Durmus M, But A, Dogan Z, Yucel A, Miman M, Ersoy M. Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol. 2007;24(5):447–53.
pubmed: 17241505
doi: 10.1017/S0265021506002122
Dogan R, Erbek S, Gonencer HH, Erbek HS, Isbilen C, Arslan G. Comparison of local anaesthesia with dexmedetomidine sedation and general anaesthesia during septoplasty. Eur J Anaesthesiology| EJA. 2010;27(11):560–964.
doi: 10.1097/EJA.0b013e32833a45c4
Rokhtabnak F, Motlagh SD, Ghodraty M, Pournajafian A, Delarestaghi MM, Banihashemi AT, Araghi Z. Controlled hypotension during rhinoplasty: a comparison of dexmedetomidine with magnesium sulfate. Anesthesiology pain Med. 2017;7(6).
Berenjian S, Hassani V, Farhadi M, Zaman B, Alimian M. Comparing the effect of tranexamic acid and dexmedetomidine on bleeding during rhinoplasty. Anesthesiology Pain. 2017;7(4):36–43.
Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, et al. Relationship between Intraoperative Mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119(3):507–15.
pubmed: 23835589
doi: 10.1097/ALN.0b013e3182a10e26
Mohammad Shehata I, Elhassan A, Alejandro Munoz D, Okereke B, Cornett EM, Varrassi G, et al. Intraoperative hypotension increased risk in the Oncological patient. Anesth Pain Med. 2021;11(1):e112830.
pubmed: 34221948
pmcid: 8241822
doi: 10.5812/aapm.112830
Wijnberge M, Schenk J, Bulle E, Vlaar AP, Maheshwari K, Hollmann MW, et al. Association of intraoperative hypotension with postoperative morbidity and mortality: systematic review and meta-analysis. BJS Open. 2021;5(1):zraa018.
pubmed: 33609377
pmcid: 7893468
doi: 10.1093/bjsopen/zraa018
Christensen AL, Jacobs E, Maheshwari K, Xing F, Zhao X, Simon SE et al. Development and evaluation of a risk-adjusted measure of intraoperative hypotension in patients having nonemergent, noncardiac surgery. Anesth Analgesia. 2021;133(2).
Correction to. Drugs that may cause or exacerbate heart failure: a Scientific Statement from the American Heart Association. Circulation. 2016;134(12):e261.
Yanaral TU, Karaaslan P, Gungor H, Atalay YO, Tobias JD. Rhinorrhea due to infusion of Dexmedetomidine during Rhinoplasty: a Case Report and current literature review. Med Bull Haseki/Haseki Tip Bulteni. 2022;60(3).
Djalali Motlagh S, Rokhtabnak F, Ghodraty MR, Maleki Delarestaghi M, Saadat S, Araghi Z. Effect of different loading doses of Dexmedetomidine on controlled hypotension and the incidence of Bradycardia during Rhinoplasty: a clinical trial. Anesth Pain Med. 2021;11(4):e118857.
pubmed: 34692447
pmcid: 8520684
doi: 10.5812/aapm.118857
Rashad MN, Akl DAk, Ammar MA, ElGharabawy WS. Comparative study between opioid-free General Anesthesia by Dexmedetomidine and Opioid-Based General Anesthesia in Rhinoplasty surgeries. QJM: Int J Med. 2021;114(Supplement1):hcab08669.
Irwin MG, Wong GTC. Remifentanil and opioid-induced cardioprotection. J Cardiothorac Vasc Anesth. 2015;29:S23–6.
pubmed: 26025042
doi: 10.1053/j.jvca.2015.01.021
Riksen NP, Smits P, Rongen GA. Ischaemic preconditioning: from molecular characterisation to clinical application-part I. Neth J Med. 2004;62(10):353–63.
pubmed: 15683090
Yi S, Cao H, Zheng W, Wang Y, Li P, Wang S, Zhou Z. Targeting the opioid remifentanil: protective effects and molecular mechanisms against organ ischemia-reperfusion injury. Biomed Pharmacother. 2023;167:115472.
pubmed: 37716122
doi: 10.1016/j.biopha.2023.115472
Ahmetovic-Djug J, Hasukic S, Djug H, Hasukic B, Jahic A. Impact of preoperative anxiety in patients on hemodynamic changes and a dose of Anesthetic during induction of Anesthesia. Med Arch. 2017;71(5):330–3.
pubmed: 29284900
pmcid: 5723172
doi: 10.5455/medarh.2017.71.330-333
Ragab A, El Shamaa H, Ibrahim M. Dexmedetomidine, morphine, propofol vs midazolam, morphine, propofol for conscious sedation in rhinoplasty under local anesthesia. A prospective, randomized study. Egypt J Anaesth. 2013;29(3):181–7.
doi: 10.1016/j.egja.2013.01.003
Dehghanpisheh L, Sahmeddini MA, Kaboodkhani R, Samadi K, Khademi S, Rafati Z, et al. Efficacy of isoflurane-remifentanil versus propofol-remifentanil on controlled hypotension and surgeon satisfaction in Rhinoplasty: a single-blind clinical trial study. Iranian Journal of Medical Sciences; 2023.
Jouybar R, Nemati M, Asmarian N. Comparison of the effects of remifentanil and dexmedetomidine on surgeon satisfaction with surgical field visualization and intraoperative bleeding during rhinoplasty. BMC Anesthesiol. 2022;22(1):24.
pubmed: 35031005
pmcid: 8759207
doi: 10.1186/s12871-021-01546-9
Elyassi H, Mousavinasab M, Rambod M, Hashemian MR, Dabbagh A. The effects of anesthesia method on throat pain after elective rhinoplasty. Int J Prev Med. 2011;2(4):275–9.
pubmed: 22174969
pmcid: 3237272
Unruh AM. Gender variations in clinical pain experience. Pain. 1996;65(2):123–67.
pubmed: 8826503
doi: 10.1016/0304-3959(95)00214-6
Gadkaree SK, Shaye DA, Occhiogrosso J, Lee LN. Association between Pain and patient satisfaction after Rhinoplasty. JAMA Facial Plast Surg. 2019;21(6):475–9.
pubmed: 31536105
pmcid: 6753502
doi: 10.1001/jamafacial.2019.0808
Dildine TC, Necka EA, Atlas LY. Confidence in subjective pain is predicted by reaction time during decision making. Sci Rep. 2020;10(1):21373.
pubmed: 33288781
pmcid: 7721875
doi: 10.1038/s41598-020-77864-8
Aydemir L, Çelik M, Şen C, Çayönü M, Çomoglu Ş. Assessment of Acute and Chronic Pain after open technique Septorhinoplasty: should we really be concerned about this topic? Allergy. 2020;3(3):55–8.
Khansa I, Khansa L, Pearson GD. Patient satisfaction after Rhinoplasty: a social media analysis. Aesthet Surg J. 2016;36(1):Np1–5.
pubmed: 26063834
doi: 10.1093/asj/sjv095
İnan S, Yığman F. The Effect of Acceptance of Cosmetic surgery, body appreciation, and nasal obstruction on patient satisfaction after Rhinoplasty. Facial Plast Surg Aesthetic Med. 2023;25(3):206–11.
doi: 10.1089/fpsam.2022.0085
Talih G, Yüksek A, Şahin E. Evaluation of emergence agitation after general anaesthesia in rhinoplasty patients: inhalation anaesthesia versus total intravenous anaesthesia. Am J Otolaryngol. 2020;41(3):102387.
pubmed: 31926597
doi: 10.1016/j.amjoto.2020.102387
Demir CY, Yuzkat N. Prevention of Emergence Agitation with ketamine in Rhinoplasty. Aesthetic Plast Surg. 2018;42(3):847–53.
pubmed: 29464385
doi: 10.1007/s00266-018-1103-4
Lee HS, Yoon HY, Jin HJ, Hwang SH. Can Dexmedetomidine Influence Recovery profiles from General Anesthesia in nasal surgery? Otolaryngology–Head Neck Surg. 2018;158(1):43–53.
doi: 10.1177/0194599817733735
Fields A, Huang J, Schroeder D, Sprung J, Weingarten T. Agitation in adults in the post-anaesthesia care unit after general anaesthesia. Br J Anaesth. 2018;121(5):1052–8.
pubmed: 30336849
doi: 10.1016/j.bja.2018.07.017
Yu D, Chai W, Sun X, Yao L. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anaesth. 2010;57(9):843–8.
pubmed: 20526708
doi: 10.1007/s12630-010-9338-9
Makarem J, Larijani AH, Eslami B, Jafarzadeh A, Karvandian K, Mireskandari SM. Risk factors of inadequate emergence following general anesthesia with an emphasis on patients with substance dependence history. Korean J Anesthesiol. 2020;73(4):302–10.
pubmed: 31612693
doi: 10.4097/kja.19214
Chen L, Xu M, Li GY, Cai WX, Zhou JX, Incidence. Risk factors and consequences of Emergence Agitation in Adult patients after Elective Craniotomy for Brain Tumor: a prospective cohort study. PLoS ONE. 2014;9(12):e114239.
pubmed: 25493435
pmcid: 4262354
doi: 10.1371/journal.pone.0114239
Munk L, Andersen G, Møller AM. Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences. Acta Anaesthesiol Scand. 2016;60(8):1059–66.
pubmed: 26968337
doi: 10.1111/aas.12717
Viswanath O, Kerner B, Jean Y-K, Soto R, Rosen G. Emergence delirium: a narrative review. J Anesthesiol Clin Sci. 2015;4(2):e1–8.