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KMID : 1195620210140020200
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Clinical and Experimental Otorhinolaryngology
2021 Volume.14 No. 2 p.200 ~ p.209
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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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Kim Do-Hyun
Lee Jun-Uk
Kim Sung-Won
Hwang Se-Hwan
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Abstract
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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.
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KEYWORD
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Antihypertensive Agents, Nasal Surgical Procedures, Morbidity, Controlled Hypotension
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