Purpose: The safety and effectiveness of Dexmedetomidine (DEX) for intraoperative wake-up test are still controversial. The meta-analysis was performed to evaluate the safety and effectiveness of DEX for intraoperative wake-up test during spinal surgery.
Design: A systematic review with meta-analysis of twelve randomized controlled trials published since 2011.
Methods: We searched PubMed, EMbase, Ovid and The Cochrane Library and China National Knowledge Infrastructure (CNKI) for clinical Randomized Controlled Trial (RCT) about the effect of dexmedetomidine on intraoperative wake-up test during spinal surgery. RevMan 5.3 software was used for Meta analysis of included studies.
Findings: Twelve RCTs involving 628 patients were included in the study. The results of the meta-analysis showed that the application of DEX did not prolong wake-up time (Mean Difference [MD] = 0.35, 95% Confidence Intervals [CI] [-0.04, 0.71], P = 0.08), and provided better wake-up quality (Risk Ratio [RR] = 2.08, 95% CI [1.62, 2.67], P < 0.00001; RR = 1.58, 95% CI [1.22, 2.06], P = 0.006), lower incidence of emergence agitation (RR = 0.12, 95% CI [0.04, 0.36], P = 0.0001), lower mean arterial pressure (MAP) (MD = -10.92, 95% CI [-14.73, -7.11], P < 0.00001) and heart rate (HR) (MD = -13.90, 95% CI [-17.08, -10.73], P < 0.00001) response during wake-up test period in spinal surgery.
Conclusion: The meta-analysis suggested that dexmedetomidine did not prolong wake-up time and contributed to improve wake-up quality and decrease the hemodynamic response during wake-up test period in spinal surgery.
Dexmedetomidine; Meta-analysis; Scoliosis; Surgery; Wake-up test
Spinal surgeries, including vertebral fusion, congenital and traumatic scoliosis, are often associated with the risk of injuries to the spinal cord, potentially leading to postoperative neurologic deficit [1,2]. In order to avoid such injuries, the role of intraoperative monitoring of spinal cord function is particularly great importance. The intraoperative wake-up test is among the most direct methods to detect real-time neurologic condition, thus encouraging its use during such procedures to permit injuries to be reversed or minimized . The key to perform a successful wake-up test is requiring patients respond to verbal commands in a short time, which means that the wake-up process must be as smooth as possible. However, evidence suggested that the test tended to pose the risk of accidental removal of fixation devices or endotracheal tube because of the severe emergence agitation, and exposed patients to signs of pain, such as marked elevations in heart rate and blood pressure .
Dexmedetomidine (DEX) is a highly selective α2-adrenergic receptor agonist that causes of sedation and analgesia. Several advantages, such as hemodynamic stability, minimal respiratory depression and significant opioid-sparing effect, make it popular enough for intraoperative use as an anesthetic adjuvant . To date, researchers have reported the effects of DEX on neurophysiological monitoring during spinal surgeries [6-8]. However, the safety and effectiveness of DEX for intraoperative wake-up test are still controversial. Therefore, we conducted this meta-analysis to evaluate the safety and effectiveness of DEX for intraoperative wake-up test during spinal surgery.