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The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis
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논문 기본 정보

Type
Academic journal
Author
Kim Do-Hyun (가톨릭대학교) Junuk Lee (가톨릭대학교) Kim Sung won (가톨릭대학교) Hwang Se Hwan (가톨릭대학교)
Journal
대한이비인후과학회 Clinical and Experimental Otorhinolaryngology Clinical and Experimental Otorhinolaryngology 제14권 제2호 KCI Accredited Journals
Published
2021.1
Pages
200 - 209 (10page)

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The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis
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Abstract· Keywords

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Objectives. A systematic review of the literature was conducted to evaluate hypotensive agents in terms of their adverse effects and associations with perioperative morbidity in patients undergoing nasal surgery. Methods. Two authors independently searched databases (Medline, Scopus, and Cochrane databases) up to February 2020 for randomized controlled trials comparing the perioperative administration of a hypotensive agent with a placebo or other agent. The outcomes of interest for this analysis were intraoperative morbidity, operative time, intraoperative bleeding, hypotension, postoperative nausea/vomiting, and postoperative pain. Both a standard pairwise meta-analysis and network meta-analysis were conducted. Results. Our analysis was based on 37 trials. Treatment networks consisting of six interventions (placebo, clonidine, dexmedetomidine, beta-blockers, opioids, and nitroglycerine) were defined for the network meta-analysis. Dexmedetomidine resulted in the greatest differences in intraoperative bleeding (?0.971; 95% confidence interval [CI], ?1.161 to ?0.781), intraoperative fentanyl administration (?3.683; 95% CI, ?4.848 to ?2.518), and postoperative pain (?2.065; 95% CI, ?3.170 to ?0.960) compared with placebo. The greatest difference in operative time compared with placebo was achieved with clonidine (?0.699; 95% CI, ?0.977 to ?0.421). All other agents also had beneficial effects on the measured outcomes. Dexmedetomidine was less likely than other agents to cause adverse effects. Conclusion. This study demonstrated the superiority of the systemic use of dexmedetomidine as a perioperative hypotensive agent compared with the other five tested agents. However, the other agents were also superior to placebo in improving operative time, intraoperative bleeding, and postoperative pain.
#Keywords. Antihypertensive Agents #Nasal Surgical Procedures #Morbidity #Controlled Hypotension

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Shams T / 2013 / Induced hypotension for functional endoscopic sinus surgery: a comparative study of dexmedetomidine versus esmolol / Saudi J Anaesth 7(2):175~180 google schola Kyoungkyun Lee / 2013 / General anesthesia versus monitored anesthetic care with dexmedetomidine for closed reduction of nasal bone fracture / Korean Journal of Anesthesiology 65(3):209~214 dbpia 김현주 / 2015 / Efficacy of intraoperative dexmedetomidine infusion on visualization of the surgical field in endoscopic sinus surgery / Korean Journal of Anesthesiology 68(5):449~454 google schola Bunker JP / 1964 / Anesthetic effects on surgical blood loss / Ann N Y Acad Sci 115:418~421 google schola Akata T / 2007 / General anesthetics and vascular smooth muscle: direct actions of general anesthetics on cellular mechanisms regulating vascular tone / Anesthesiology 106(2):365~391 google schola

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