The effects of intravenous dexmedetomidine on hemodynamic response in patients undergoing skull-pin head-holder application during neurosurgery - A meta-analysis of randomized controlled trials

Chang-Hoon Koo, Sooyoung Jeon, Jinhee Kim, Jung-Hee Ryu
Clinical Neurology and Neurosurgery 2020 May 20, 195: 105939

OBJECTIVES: Skull-pin head-holder application during neurosurgery is a highly noxious stimulus that may lead to abrupt hemodynamic change, which is an unfavorable response to maintain hemodynamics stability. The aim of this meta-analysis was to evaluate the effects of intravenous dexmedetomidine on hemodynamic response (blood pressure and heart rate) resulting from the application of skull-pin head-holder in neurosurgery.

PATIENTS AND METHODS: A systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The protocol was registered with the International Prospective Register of Systematic Reviews (CRD 420119127876). Electronic databases were searched, without discrimination of publication year, language, and region, to identify all randomized controlled trials investigating the effects of dexmedetomidine on hemodynamic response resulting from skull-pin head-holder application during general anesthesia for neurosurgery. The mean arterial pressure and heart rate were analyzed using random-effect model, and the mean difference (MD) was calculated.

RESULTS: Seventeen trials were identified; a total of 878 patients were enrolled. The analysis indicated that dexmedetomidine infusion reduced the mean arterial pressure (MD -11.70, 95% confidence interval [CI] -16.33 to -7.07, p < 0.00001) and heart rate (MD -14.48, 95% CI -23.10 to -5.86, p = 0.001) during skull-pin head-holder application. Subgroup analysis showed that dexmedetomidine was superior to fentanyl for the attenuation of hemodynamic response. Dexmedetomidine infusion also reduced the incidence of hypertension, tachycardia and brain relaxation score.

CONCLUSION: The result of this analysis indicates that intraoperative dexmedetomidine administration could decrease the hemodynamic response and provide hemodynamic stability during skull-pin head-holder application in neurosurgery.

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