Dexmedetomidine as an Adjunctive Sedative in Patients Undergoing Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis.

ASIDE gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-03-11 DOI:10.71079/aside.gi.0109257
Hazem Abosheaishaa, Abdallfatah Abdallfatah, Abdelmalek Abdelghany, Arshia Sethi, Abdellatif Ismail, Doha Mohamed, Moataz Aboeldahb, Omar Abdelhalim, Islam Mohamed, Ahmed Y Azzam, Muhammed Amir Essibayi, David J Altschul, Mahmoud Nassar, Mohammad Bilal
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Abstract

Introduction: Endoscopic submucosal dissection (ESD) is a technique for removing dysplastic lesions in the gastrointestinal tract but carries risks like pain and perforation. Dexmedetomidine, an α2-receptor agonist, offers potential benefits as an adjunct sedative during ESD by providing anxiolysis and analgesia. This systematic review and meta-analysis assesses its efficacy and safety.

Methodology: We searched databases including Embase, Medline/PubMed, Scopus, and Web of Science up to April 21, 2024, following PRISMA guidelines. Eligible studies used dexmedetomidine with other sedatives for ESD. We analyzed outcomes such as en-bloc and complete resection rates, sedation duration, and adverse events, using RevMan for meta-analysis with a random-effects model.

Results: The initial search retrieved 216 studies and after screening, eight studies were included in the final analysis. Dexmedetomidine showed no significant difference in en-bloc or complete resection rates compared to controls. Sedation and procedure times were similar between the two groups as well. Dexmedetomidine significantly reduced restlessness (OR 0.15, 95% CI:0.07 to 0.29) and increased bradycardia (OR 7.15, 95% CI 3.17 to 16.11) compared to controls. Upon subgroup analysis, Dexmedetomidine plus Propofol, and Dexmedetomidine plus Midazolam, revealed the same findings regarding restlessness and bradycardia compared to controls which confirmed the adjunctive effects of Dexmedetomidine.

Conclusion: Dexmedetomidine as an adjunctive sedative appears safe and effective in ESD, reducing restlessness without significant adverse events. The risk of bradycardia is increased, which may be reflective of reduced physiological stress. Future studies should explore optimal dosing and compare Dexmedetomidine with other sedatives in diverse populations.

右美托咪定作为内镜下粘膜夹层患者的辅助镇静剂:一项系统综述和荟萃分析。
内镜下粘膜剥离术(ESD)是一种清除胃肠道发育不良病变的技术,但存在疼痛和穿孔等风险。右美托咪定是一种α2受体激动剂,在ESD中作为辅助镇静剂具有镇静和镇痛的作用,具有潜在的益处。本系统综述和荟萃分析评估了其有效性和安全性。方法:根据PRISMA指南,我们检索了截至2024年4月21日的数据库,包括Embase、Medline/PubMed、Scopus和Web of Science。符合条件的研究使用右美托咪定和其他镇静剂治疗ESD。我们分析了整体和完全切除率、镇静持续时间和不良事件等结果,使用RevMan进行随机效应模型的荟萃分析。结果:初始检索检索到216项研究,筛选后,8项研究被纳入最终分析。与对照组相比,右美托咪定在整体或完全切除率方面没有显着差异。镇静和手术时间在两组之间也相似。与对照组相比,右美托咪定显著减少躁动(OR 0.15, 95% CI:0.07至0.29)和增加心动缓(OR 7.15, 95% CI 3.17至16.11)。在亚组分析中,右美托咪定加异丙酚,右美托咪定加咪达唑仑,与对照组相比,在躁动和心动过缓方面显示出相同的结果,这证实了右美托咪定的辅助作用。结论:右美托咪定辅助镇静治疗ESD安全有效,可减少躁动,无明显不良反应。心动过缓的风险增加,这可能是生理应激减少的反映。未来的研究应探索最佳剂量,并在不同人群中将右美托咪定与其他镇静剂进行比较。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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