Effectiveness and safety of intravenous application of dexmedetomidine for cesarean section under general anesthesia: a meta-analysis of randomized trials
Authors Ao L, Shi J, Bai Y, Zheng Y, Gan J
Received 5 December 2018
Accepted for publication 8 February 2019
Published 25 March 2019 Volume 2019:13 Pages 965—974
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 2
Editor who approved publication: Dr Tuo Deng
Li Ao,1,* Jinlin Shi,2,* Yaowu Bai,1 Yujuan Zheng,1 Jianhui Gan2
1Department of Anesthesiology, Tangshan Maternity and Child Healthcare Hospital, Tangshan 063000, Hebei, China; 2Department of Anesthesiology, Tangshan People’s Hospital, North China University of Science and Technology, Tangshan 063000, Hebei, China
*These authors contributed equally to this work
Objective: The meta-analysis was conducted to assess the effectiveness and safety of intravenous administration of dexmedetomidine for cesarean section under general anesthesia, as well as neonatal outcomes.
Materials and methods: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials and the China National Knowledge Infrastructure database for relevant randomized controlled trials (RCTs) about the application of intravenous dexmedetomidine under general anesthesia for cesarean section. RevMan 5.3 was used to conduct the meta-analysis of the outcomes of interest.
Results: Eight RCTs involved 376 participants were included in this study. The meta-analysis showed that the mean blood pressure at the time of intubation (weighted mean difference [WMD]: –15.67, 95% CI: –21.21, –10.13, P<0.00001), skin incision (WMD: –12.83, 95% CI –20.53, –5.14, P=0.001), and delivery (WMD: –11.65, 95% CI –17.18, –6.13, P<0.0001) in dexmedetomidine group were significantly lower than that in the control group. The heart rate (HR) at the time of intubation (WMD: –31.41, 95% CI –35.01, –27.81, P<0.00001), skin incision (WMD: –22.32, 95% CI –34.55, –10.10, P=0.0003), and delivery (WMD: –19.07, 95% CI –22.09, –16.04, P<0.00001) were also lower than that in control group. For neonatal parameters, no differences existed in umbilical blood gases at delivery, and Apgar scores at 1 minute (WMD: –0.12, 95% CI –0.37, 0.12, P=0.33) and 5 minutes (WMD: –0.17, 95% CI –0.13, 0.46, P=0.27) among two groups.
Conclusion: Intravenous administration of dexmedetomidine could efficiently attenuate the maternal cardiovascular response during cesarean section, without affecting Apgar score of the neonate.
Keywords: dexmedetomidine, general anesthesia, cesarean section, cardiovascular response, meta-analysis, randomized controlled trial
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