The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis
- Author:
Do Hyun KIM
1
;
Junuk LEE
;
Sung Won KIM
;
Se Hwan HWANG
Author Information
- Publication Type:Original Article
- From:Clinical and Experimental Otorhinolaryngology 2021;14(2):200-209
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
