Dexmedetomidine as an Adjunctive Sedative in Patients Undergoing Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis.

Autor:	Abosheaishaa H; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals, Queens, New York, USA., Abdallfatah A; Faculty of Medicine, October 6 University, 6 of October City, Giza, Egypt., Abdelghany A; Faculty of Medicine, October 6 University, 6 of October City, Giza, Egypt., Sethi A; Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals, Queens, New York, USA., Ismail A; University of Maryland Medical Center Midtown Campus, 827 Linden Ave, Baltimore, MD 21201, USA., Mohamed D; Faculty of Medicine, October 6 University, 6 of October City, Giza, Egypt., Aboeldahb M; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. SW Rochester, MN 55905, USA., Abdelhalim O; Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals, Queens, New York, USA., Mohamed I; Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri School of Medicine, Room CE405, 1 Hospital Dr, Columbia, MO 65201, USA., Azzam AY; Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA., Essibayi MA; Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA.; Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA., Altschul DJ; Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA.; Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA., Nassar M; Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA., Bilal M; Division of Gastroenterology and Hepatology, Department of Medicine, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2024 Nov 16. Date of Electronic Publication: 2024 Nov 16.
DOI:	10.1101/2024.11.14.24317324
Abstrakt:	Introduction: Endoscopic submucosal dissection (ESD) allows for curative en-bloc resection of dysplastic gastrointestinal (GI) tract lesions. However, it is associated with postoperative adverse events (AEs) such as pain, bleeding, and perforation. Dexmedetomidine, an α2-receptor agonist, has emerged as a promising adjunct sedative for ESD under moderate sedation, offering anxiolysis and analgesia. We conducted a systematic review and meta-analysis to evaluate its efficacy and safety for use in ESD. Methods: A comprehensive systematic search was conducted across multiple databases, including Embase, Medline, Scopus, and Web of Science. Studies that involved ESD utilizing dexmedetomidine as an adjunctive medication in combination with other sedatives, were included. Data extraction and risk of bias assessment were independently performed by two reviewers. Meta-analysis was carried out with RevMan using a random-effects model. Results: Eight studies were included in the final analysis. Dexmedetomidine showed no significant difference in en-bloc or complete resection rates compared to controls. Sedation and procedure times were similar between the two groups as well. Dexmedetomidine significantly reduced restlessness (OR 0.15, 95% CI:0.07 to 0.29) and increased bradycardia (OR 7.15, 95% CI 3.17 to 16.11) compared to controls. Upon subgroup analysis, Dexmedetomidine plus Propofol, and Dexmedetomidine plus Midazolam, revealed the same findings regarding restlessness and bradycardia compared to controls which confirmed the adjunctive effects of Dexmedetomidine. Conclusions: Dexmedetomidine as an adjunctive sedative appears safe and effective in ESD, reducing restlessness without significant adverse events. The risk of bradycardia is increased, which may be reflective of reduced physiological stress. Future studies should explore optimal dosing and compare Dexmedetomidine with other sedatives in diverse populations. Competing Interests: 6.Declarations: Conflicts of Interest: N/A.
Databáze:	MEDLINE
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