背景:右美托咪定越来越多地用于需要全身麻醉的手术患者。然而,其对以患者为中心的结局的有效性仍不确定.我们的主要目的是评估术中右美托咪定对全身麻醉下需要手术的成年患者的以患者为中心的有效性。
方法:我们对MEDLINE进行了系统搜索,Embase,中部,WebofScience,和CINAHL从成立到2023年10月。随机对照试验(RCT)比较术中使用右美托咪定与安慰剂,阿片类药物包括在全身麻醉下需要手术的成年患者的常规护理。研究选择,数据提取,偏倚风险评估由两名评审员独立进行.我们使用随机效应贝叶斯回归框架合成数据,以得出效应估计和临床重要效应的概率。对于连续的结果,我们使用标准化平均差(SMD)汇集了具有相似结构的仪器,并在适当时将SMD和可信区间(CrIs)转换为原始量表.我们使用建议分级评估来评估证据的确定性,开发和评估(等级)方法。我们的主要结果是手术后的恢复质量。为了指导原始尺度的解释,使用回收质量-15(QoR-15)仪器(范围0-150点,6分的最小重要差异[MID])。
结果:我们确定了49,069条引文,纳入5904名参与者的44项RCT符合资格.术中给予右美托咪定与术后QoR-15的改善相关(平均差异9,95%CrI4-14,n=21个随机对照试验,证据的适度确定性)。我们发现任何益处的概率为99%,实现MID的概率为88%。慢性疼痛发生率降低(比值比[OR]0.42,95%CrI0.19-0.79,n=7个随机对照试验,证据的确定性低)。还增加了临床上明显的低血压的风险(OR1.98,95%CrI0.84-3.92,后验伤害概率94%,n=8RCT)和临床显着心动过缓(OR1.74,95%CrI0.93-3.34,后验伤害概率95%,n=10个随机对照试验),两者的证据确定性都很低。告知其他以患者为中心的次要结局的证据有限。
结论:与安慰剂或标准治疗相比,术中右美托咪定可能导致术后恢复质量和慢性疼痛的显著改善.然而,它可能增加临床上重要的心动过缓和低血压。
■PROSPERO(CRD42023439896)。
BACKGROUND: Dexmedetomidine is increasingly used for surgical patients requiring general anaesthesia. However, its effectiveness on patient-centred outcomes remains uncertain. Our main objective was to evaluate the patient-centred effectiveness of intraoperative dexmedetomidine for adult patients requiring surgery under general anaesthesia.
METHODS: We conducted a systematic search of MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL from inception to October 2023. Randomised controlled trials (RCTs) comparing intraoperative use of dexmedetomidine with placebo, opioid, or usual care in adult patients requiring surgery under general anaesthesia were included. Study selection, data extraction, and risk of bias assessment were performed by two reviewers independently. We synthesised data using a random-effects Bayesian regression framework to derive effect estimates and the probability of a clinically important effect. For continuous outcomes, we pooled instruments with similar constructs using standardised mean differences (SMDs) and converted SMDs and credible intervals (CrIs) to their original scale when appropriate. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our primary outcome was quality of recovery after surgery. To guide interpretation on the original scale, the Quality of Recovery-15 (QoR-15) instrument was used (range 0-150 points, minimally important difference [MID] of 6 points).
RESULTS: We identified 49,069 citations, from which 44 RCTs involving 5904 participants were eligible. Intraoperative dexmedetomidine administration was associated with improvement in postoperative QoR-15 (mean difference 9, 95% CrI 4-14, n=21 RCTs, moderate certainty of evidence). We found 99% probability of any benefit and 88% probability of achieving the MID. There was a reduction in chronic pain incidence (odds ratio [OR] 0.42, 95% CrI 0.19-0.79, n=7 RCTs, low certainty of evidence). There was also increased risk of clinically significant hypotension (OR 1.98, 95% CrI 0.84-3.92, posterior probability of harm 94%, n=8 RCTs) and clinically significant bradycardia (OR 1.74, 95% CrI 0.93-3.34, posterior probability of harm 95%, n=10 RCTs), with very low certainty of evidence for both. There was limited evidence to inform other secondary patient-centred outcomes.
CONCLUSIONS: Compared with placebo or standard of care, intraoperative dexmedetomidine likely results in meaningful improvement in the quality of recovery and chronic pain after surgery. However, it might increase clinically important bradycardia and hypotension.
UNASSIGNED: PROSPERO (CRD42023439896).