The effect of dexmedetomidine on perioperative events of orthognathic surgery: a systematic review of randomized controlled trials.

Background: Orthognathic surgery is a complex invasive procedure associated with common postoperative symptoms and patient-related events. Dexmedetomidine is an emerging sedative and hypotensive agent that has demonstrated safety and efficacy in perioperative care of other craniofacial procedures.

Material and methods: An electronic search was performed in seven primary databases (Cochrane Library, Embase, LILACS, MedLine via PubMed, SciELO, Scopus, and Web of Science) and one additional (EASY) to partially capture the gray literature. The PICO strategy was used to identify randomized clinical trials evaluating the effect of dexmedetomidine on perioperative events in patients undergoing orthognathic surgery compared to placebo or control groups, without restrictions on publication language and year. Two independent reviewers performed data extraction and assessed the risk of bias using the RoB 2.0 tool.

Results: The search identified 401 records, of which six studies met the eligibility criteria, including 282 patients from five countries, and published between 2008 and 2023. Outcomes were categorized into six groups based on available data: 1) Airway and Respiratory Events, 2) Emetic Events, 3) Hemodynamic Events, 4) Length of Hospital Stay, 5) Neurological Events, and 6) Pain Burden. Dexmedetomidine reduced coughing and maintained hemodynamic stability but did not prevent emergence agitation. It was associated with lower intraoperative fentanyl use and reduced rescue analgesia requirements. Postoperatively, dexmedetomidine effectively controlled pain, nausea, and vomiting, with significantly lower pain scores and reduced analgesic demand. Among the six studies, only one was classified as high risk of bias due to issues in the randomization process, while the others were categorized as low risk of bias. A meta-analysis was planned but could not be conducted due to high heterogeneity among studies.

Conclusions: Dexmedetomidine appears to be a safe and effective option for reducing postoperative symptoms such as pain, nausea, vomiting, and cough in orthognathic surgery, while maintaining hemodynamic stability.