The efficacy of dexmedetomidine for controlled hypotension in orthognathic surgery: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Jun ¹ , MA Yushan ² ,  JI Yang ¹

1. Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

JI Yang, Email: yangji7799@163.com

Keywords：

Dexmedetomidine; Orthognathic surgery; Controlled hypotension; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202404090

Video：

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Objective To systematically review the efficacy of dexmedetomidine for controlled hypotension in orthognathic surgery. Methods The PubMed, Embase, Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on dexmedetomidine for controlled hypotension in orthognathic surgery from inception to May, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.4 software. Results A total of 8 RCTs involving 371 patients were included. The results of meta-analysis showed that the operation time of dexmedetomidine group was not significantly different from that of hypotensive drug group, but was shorter than that of saline group (MD=−23.20, 95%CI −44.05 to −2.35, P=0.03). There were no statistically significant differences in the mean arterial pressure and the intraoperative blood loss between dexmedetomidine group and the control group. Compared with the control group, the heart rate (MD=−18.78, 95%CI −30.80 to −6.77, P=0.002) and the incidence of postoperative adverse events (OR=0.25, 95%CI 0.08 to 0.76, P=0.01) in dexmedetomidine group were less than the control group significantly. Conclusion Current evidence shows that dexmedetomidine can be used effectively for controlled hypotension in orthognathic surgery. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.

1.	Sharma H, Arora S, Bhatia N, et al. Tranexamic acid is associated with improved operative field in orthognathic surgery. J Oral Maxillofac Surg, 2020, 78(9): 1509-1517.
2.	Varol A, Basa S, Ozturk S. The role of controlled hypotension upon transfusion requirement during maxillary downfracture in double-jaw surgery. J Craniomaxillofac Surg, 2010, 38(5): 345-349.
3.	余柔, 刘进. 控制性降压在全髋、膝关节置换术中有效性和安全性的Meta分析. 中国循证医学杂志, 2021, 21(1): 40-46.
4.	Weerink MAS, Struys MMRF, Hannivoort LN, et al. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet, 2017, 56(8): 893-913.
5.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1. 0). The Cochrane Collaboration, 2011.
6.	张凌, 朱莹. 右美托咪定在口腔颌面外科正颌手术控制性降压中的作用. 中国口腔颌面外科杂志, 2016, 14(1): 62-65.
7.	董海平. 右美托咪定与艾司洛尔用于正颌手术控制性降压的比较研究. 上海: 上海交通大学, 2014.
8.	周丹, 刘瑞昌, 杨旭东, 等. 右美托咪定与尼卡地平用于正颌手术患者控制性降压的对比研究. 实用口腔医学杂志, 2016, 32(2): 256-259.
9.	余立荣, 张岩, 邓文伟, 等. 右美托咪定用于正颌外科手术麻醉的临床研究. 吉林医学, 2017, 38(9): 1626-1628.
10.	潘桂芳, 潘方立. 七氟醚联合右美托咪定在口腔颌面外科正颌手术中的应用. 实用药物与临床, 2020, 23(4): 329-332.
11.	Shin S, Lee JW, Kim SH, et al. Heart rate variability dynamics during controlled hypotension with nicardipine, remifentanil and dexmedetomidine. Acta Anaesthesiol Scand, 2014, 58(2): 168-176.
12.	Goswami D, Yadav P, Bhatt R, et al. Comparison of efficacy of dexmedetomidine and clonidine infusion to produce hypotensive anesthesia in patients undergoing orthognathic surgery: a randomized controlled trial. J Oral Maxillofac Surg, 2022, 80(1): 55-62.
13.	Rummasak D, Apipan B. Evaluation of the advantageous anesthetic properties of dexmedetomidine used as hypotensive agent compared with nitroglycerin in orthognathic surgery. J Oral Maxillofac Surg, 2014, 72(12): 2428-2433.
14.	Bendersky J, Uribe M, Bravo M, et al. Systematic mapping review of interventions to prevent blood loss, infection and relapse in orthognathic surgery. Med Oral Patol Oral Cir Bucal, 2023, 28(2): e116-e125.
15.	Farah GJ, de Moraes M, Filho LI, et al. Induced hypotension in orthognathic surgery: a comparative study of 2 pharmacological protocols. J Oral Maxillofac Surg, 2008, 66(11): 2261-2269.
16.	Jeong J, Portnof JE, Kalayeh M, et al. Hypotensive anesthesia: comparing the effects of different drug combinations on mean arterial pressure, estimated blood loss, and surgery time in orthognathic surgery. J Craniomaxillofac Surg, 2016, 44(7): 854-858.
17.	Carlos E, Monnazzi MS, Castiglia YM, et al. Orthognathic surgery with or without induced hypotension. Int J Oral Maxillofac Surg, 2014, 43(5): 577-580.
18.	Rehab S, El-Kalla, Mona B, et al. Deliberate hypotensive anesthesia during maxillofacial surgery: a comparative study between dexmedetomidine and sodium nitroprusside. Ain-Shams J Anesthesiol, 2016, 9: 201-206.
19.	Kim JE, Lee JS, Kim MK, et al. Nicardipine infusion for hypotensive anesthesia during orthognathic surgery has protective effect on renal function. J Oral Maxillofac Surg, 2014, 72(1): 41-46.
20.	Degoute CS. Controlled hypotension: a guide to drug choice. Drugs, 2007, 67(7): 1053-1076.
21.	Munhall CC, Warner BK, Nguyen SA, et al. Use of dexmedetomidine for controlled hypotension in middle ear surgery: a systematic review and meta-analysis. Am J Otolaryngol, 2023, 44(4): 103917.
22.	Lin S, McKenna SJ, Yao CF, et al. Effects of hypotensive anesthesia on reducing intraoperative blood loss, duration of operation, and quality of surgical field during orthognathic surgery: a systematic review and meta-analysis of randomized controlled trials. J Oral Maxillofac Surg, 2017, 75(1): 73-86.
23.	谢珊珊, 郭珍珍, 蓝丽芳, 等. 右美托咪定与硝酸甘油用于正颌手术麻醉中的控制性降压效果及对血流动力学的影响. 中外医疗, 2023, 42(31): 98-101.
24.	王立宽, 李炳华, 杨旭东. 尼卡地平用于正颌手术控制性降压的系统评价和Meta分析. 实用口腔医学杂志, 2017, 33(4): 503-509.
25.	王丽, 孙文冲, 裴凌. 右美托咪定用于功能性鼻内镜手术术中控制性降压有效性和安全性的Meta分析. 中国药房, 2020, 31(5): 617-621.
26.	Kang WS, Kim SY, Son JC, et al. The effect of dexmedetomidine on the adjuvant propofol requirement and intraoperative hemodynamics during remifentanil-based anesthesia. Korean J Anesthesiol, 2012, 62(2): 113-118.

1. Sharma H, Arora S, Bhatia N, et al. Tranexamic acid is associated with improved operative field in orthognathic surgery. J Oral Maxillofac Surg, 2020, 78(9): 1509-1517.
2. Varol A, Basa S, Ozturk S. The role of controlled hypotension upon transfusion requirement during maxillary downfracture in double-jaw surgery. J Craniomaxillofac Surg, 2010, 38(5): 345-349.
3. 余柔, 刘进. 控制性降压在全髋、膝关节置换术中有效性和安全性的Meta分析. 中国循证医学杂志, 2021, 21(1): 40-46.
4. Weerink MAS, Struys MMRF, Hannivoort LN, et al. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet, 2017, 56(8): 893-913.
5. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1. 0). The Cochrane Collaboration, 2011.
6. 张凌, 朱莹. 右美托咪定在口腔颌面外科正颌手术控制性降压中的作用. 中国口腔颌面外科杂志, 2016, 14(1): 62-65.
7. 董海平. 右美托咪定与艾司洛尔用于正颌手术控制性降压的比较研究. 上海: 上海交通大学, 2014.
8. 周丹, 刘瑞昌, 杨旭东, 等. 右美托咪定与尼卡地平用于正颌手术患者控制性降压的对比研究. 实用口腔医学杂志, 2016, 32(2): 256-259.
9. 余立荣, 张岩, 邓文伟, 等. 右美托咪定用于正颌外科手术麻醉的临床研究. 吉林医学, 2017, 38(9): 1626-1628.
10. 潘桂芳, 潘方立. 七氟醚联合右美托咪定在口腔颌面外科正颌手术中的应用. 实用药物与临床, 2020, 23(4): 329-332.
11. Shin S, Lee JW, Kim SH, et al. Heart rate variability dynamics during controlled hypotension with nicardipine, remifentanil and dexmedetomidine. Acta Anaesthesiol Scand, 2014, 58(2): 168-176.
12. Goswami D, Yadav P, Bhatt R, et al. Comparison of efficacy of dexmedetomidine and clonidine infusion to produce hypotensive anesthesia in patients undergoing orthognathic surgery: a randomized controlled trial. J Oral Maxillofac Surg, 2022, 80(1): 55-62.
13. Rummasak D, Apipan B. Evaluation of the advantageous anesthetic properties of dexmedetomidine used as hypotensive agent compared with nitroglycerin in orthognathic surgery. J Oral Maxillofac Surg, 2014, 72(12): 2428-2433.
14. Bendersky J, Uribe M, Bravo M, et al. Systematic mapping review of interventions to prevent blood loss, infection and relapse in orthognathic surgery. Med Oral Patol Oral Cir Bucal, 2023, 28(2): e116-e125.
15. Farah GJ, de Moraes M, Filho LI, et al. Induced hypotension in orthognathic surgery: a comparative study of 2 pharmacological protocols. J Oral Maxillofac Surg, 2008, 66(11): 2261-2269.
16. Jeong J, Portnof JE, Kalayeh M, et al. Hypotensive anesthesia: comparing the effects of different drug combinations on mean arterial pressure, estimated blood loss, and surgery time in orthognathic surgery. J Craniomaxillofac Surg, 2016, 44(7): 854-858.
17. Carlos E, Monnazzi MS, Castiglia YM, et al. Orthognathic surgery with or without induced hypotension. Int J Oral Maxillofac Surg, 2014, 43(5): 577-580.
18. Rehab S, El-Kalla, Mona B, et al. Deliberate hypotensive anesthesia during maxillofacial surgery: a comparative study between dexmedetomidine and sodium nitroprusside. Ain-Shams J Anesthesiol, 2016, 9: 201-206.
19. Kim JE, Lee JS, Kim MK, et al. Nicardipine infusion for hypotensive anesthesia during orthognathic surgery has protective effect on renal function. J Oral Maxillofac Surg, 2014, 72(1): 41-46.
20. Degoute CS. Controlled hypotension: a guide to drug choice. Drugs, 2007, 67(7): 1053-1076.
21. Munhall CC, Warner BK, Nguyen SA, et al. Use of dexmedetomidine for controlled hypotension in middle ear surgery: a systematic review and meta-analysis. Am J Otolaryngol, 2023, 44(4): 103917.
22. Lin S, McKenna SJ, Yao CF, et al. Effects of hypotensive anesthesia on reducing intraoperative blood loss, duration of operation, and quality of surgical field during orthognathic surgery: a systematic review and meta-analysis of randomized controlled trials. J Oral Maxillofac Surg, 2017, 75(1): 73-86.
23. 谢珊珊, 郭珍珍, 蓝丽芳, 等. 右美托咪定与硝酸甘油用于正颌手术麻醉中的控制性降压效果及对血流动力学的影响. 中外医疗, 2023, 42(31): 98-101.
24. 王立宽, 李炳华, 杨旭东. 尼卡地平用于正颌手术控制性降压的系统评价和Meta分析. 实用口腔医学杂志, 2017, 33(4): 503-509.
25. 王丽, 孙文冲, 裴凌. 右美托咪定用于功能性鼻内镜手术术中控制性降压有效性和安全性的Meta分析. 中国药房, 2020, 31(5): 617-621.
26. Kang WS, Kim SY, Son JC, et al. The effect of dexmedetomidine on the adjuvant propofol requirement and intraoperative hemodynamics during remifentanil-based anesthesia. Korean J Anesthesiol, 2012, 62(2): 113-118.

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