Postoperative recovery of colorectal patients enhanced with dexmedetomidine (PReCEDex): a systematic review and meta-analysis of randomized controlled trials.

Autor: Sharma S; Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada., Khamar J; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada., Petropolous JA; Health Sciences Library, McMaster University, Hamilton, ON, Canada., Ghuman A; Division of General Surgery, Department of Surgery, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. aghuman@providencehealth.bc.ca.; Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada. aghuman@providencehealth.bc.ca.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 Oct; Vol. 38 (10), pp. 5935-5947. Date of Electronic Publication: 2024 Jul 26.
DOI: 10.1007/s00464-024-11060-x
Abstrakt: Background: Intraoperative administration of dexmedetomidine has shown promise in improving postoperative gastrointestinal function. In the context of colorectal surgery, the results remain inconsistent. This review aims to provide a synthesis of studies assessing the effect of dexmedetomidine on postoperative gastrointestinal function in colorectal surgery patients.
Methods: CENTRAL, Emcare, Embase, and MEDLINE were searched up to September 2023. Randomized controlled trials involving adult patients (≥ 18 years) undergoing elective colorectal surgery, comparing dexmedetomidine administration to a control group, and reporting on postoperative gastrointestinal function were included. Non-comparative and emergent procedures were excluded. Primary outcome was time to first flatus or bowel movement, and secondary outcomes included length of stay and time to solid oral intake. Risk of bias was assessed using the Cochrane risk of bias tool for randomized studies.
Results: After screening 1194 citations, eight studies were included. Studies comprised of 570 patients in the dexmedetomidine group (mean age: 65.8 years, 43% female, mean BMI: 22.7 kg/m 2 ) and 556 patients in control group (mean age 70.6 years, 40% female, mean BMI 22.5 kg/m 2 ). Dexmedetomidine administration resulted in a shorter time to flatus (MD -4.55 h, 95% CI: 20.14-8.95, p < 0.005, very low certainty of evidence), a shorter time to first bowel movement (MD -11.9 h, 95% CI: 18.74-5.05, p < 0.005, very low certainty of evidence), a shorter time to solid oral intake (MD -4.34 h, 95% CI: 17.43-11.24, p < 0.005, moderate certainty of evidence), and a shorter length of stay (MD -.06 days, 95% CI: 1.99-0.12, p < 0.05, very low certainty of evidence).
Conclusion: In adult patients undergoing elective colorectal surgery, intraoperative use of dexmedetomidine results in clinically meaningful improvements in postoperative gastrointestinal function and consequently, shorter length of stay. Therefore, dexmedetomidine may serve as a valuable adjunct in enhancing postoperative recovery of patients following elective colorectal surgery, thereby reducing healthcare utilization, and improving patient outcomes.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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