Safety and Efficacy of Dexmedetomidine as a Sedative Agent for Performing Awake Intubation: A Meta-analysis
Safety and Efficacy of Dexmedetomidine as a Sedative Agent for Performing Awake Intubation: A Meta-analysis
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右美托咪定作为清醒插管镇静剂的安全性和有效性：荟萃分析
DOI：
10.1097/mjt.0000000000000319
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发表时间：
2016
影响因子：
4.2
通讯作者：
Lihuiping Tao
中科院分区：
文献类型：
--
作者：
Luo;Xiangzhi Fang;Ju Gao;Yang Zhangm;Lihuiping Tao
比较右美托咪定与其他替代镇静剂在清醒插管中的疗效和安全性。我们进行了一项随机对照试验（RCTs）的荟萃分析，比较了右美托咪定与清醒插管时使用的其他替代镇静剂的效果。在生物医学数据库PubMed、Science Direct和Cochrane Library中检索相关的rct，没有对发表语言的限制。评估疗效（镇静水平、首次插管成功率、插管时间、插管条件和患者满意度）和安全性（高血压、低血压、心动过速、心动过缓、缺氧、术后记忆、声音嘶哑和喉咙痛的发生率）。本荟萃分析纳入了13项随机对照试验，共纳入591例患者。右美托咪定使用后Ramsay镇静评分较高[平均差值（MD）： 1.02, 95%可信区间（CI）， 0.77 ~ 1.28, P < 0.00001]，声带运动评分（MD = 0.72, 95% CI, 0.20 ~ 1.24, P = 0.007），咳嗽评分（MD = 0.66, 95% CI, 0.10 ~ 1.22, P = 0.02），肢体运动评分（MD = 0.69, 95% CI, 0.47 ~ 0.91, P < 0.00001）；心动过缓[相对危险度（RR）： 3.03, 95% CI, 1.38 ~ 6.68, P = 0.006]和低血压（RR: 2.87, 95% CI, 1.44 ~ 5.75, P = 0.003）的风险增加；较低的缺氧风险（RR: 0.32, 95% CI, 0.15 ~ 0.70; P = 0.004）和术后记忆风险（RR: 0.50, 95% CI, 0.35 ~ 0.72, P = 0.0002）。根据我们的结果，右美托咪定似乎是一种有效且耐受性良好的清醒插管剂。与传统镇静剂相比，它的使用与更好的插管条件、保持气道通畅和减少插管召回有关。与其他镇静剂相比，右美托咪定发生心动过缓和低血压的风险明显更高。然而，这些很容易用阿托品和血管活性药物治疗。
To compare the efficacy and safety of dexmedetomidine with other alternative sedative agents used for performing awake intubation. We conducted a meta-analysis of randomized controlled trials (RCTs) that compared the effects of dexmedetomidine with other alternative sedative agents used during awake intubation. The biomedical databases PubMed, Science Direct, and the Cochrane Library were searched for relevant RCTs with no restriction on the language of publication. The efficacy (level of sedation, success rate for intubation at the first attempt, intubation time, intubation conditions, and patient satisfaction) and safety (incidence of hypertension, hypotension, tachycardia, bradycardia, hypoxia, postsurgical memory, hoarseness, and sore throat) were assessed. Thirteen RCTs with a combined subject population of 591 patients came within the purview of this meta-analysis. Use of dexmedetomidine was associated with a higher Ramsay sedation scale score [mean difference (MD): 1.02, 95% confidence interval (CI), 0.77–1.28, P < 0.00001], vocal cord movement score (MD = 0.72, 95% CI, 0.20–1.24, P = 0.007), coughing scores (MD = 0.66, 95% CI, 0.10–1.22, P = 0.02), limb movement scores (MD = 0.69, 95% CI, 0.47–0.91, P < 0.00001); increased risk of bradycardia [relative risk (RR): 3.03, 95% CI, 1.38–6.68, P = 0.006] and hypotension (RR: 2.87, 95% CI, 1.44–5.75, P = 0.003); and lower risk of hypoxia (RR: 0.32, 95% CI, 0.15–0.70; P = 0.004) and postsurgical memory (RR: 0.50, 95% CI, 0.35–0.72, P = 0.0002). As indicated by our results, dexmedetomidine appears to be an effective and well-tolerated agent for performing awake intubation. Its use was associated with better intubation conditions, preservation of airway patency, and reduced recall of intubation, as compared with the traditional sedative agents. The risk of bradycardia and hypotension was significantly higher with dexmedetomidine as compared with that with other sedatives. However, these were easily managed with atropine and vasoactive agents.
使用右美托咪定靶控输注镇静清醒插管：五例报告
影响因子：
2.8
作者：
Kunisawa T;Nagashima M;Hanada S;Suzuki A;Takahata O;Iwasaki H
通讯作者：
Iwasaki H