• Alessandro De Cassai, Annalisa Boscolo, Federico Geraldini, Francesco Zarantonello, Tommaso Pettenuzzo, Laura Pasin, Margherita Iuzzolino, Nicolò Rossini, Elisa Pesenti, Giovanni Zecchino, Nicolò Sella, Marina Munari, and Paolo Navalesi.
• UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy. Electronic address: alessandro.decassai@aopd.veneto.it.
• J Clin Anesth. 2021 Sep 1; 72: 110287.

Study ObjectiveAn uncontrolled adrenergic response during tracheal intubation may lead to life-threatening complications. Dexmedetomidine binds to α2-receptors and may attenuate this response. The primary aim of our meta-analysis is to investigate dexmedetomidine efficacy in attenuating sympathetic response to tracheal intubation, compared with placebo or no dexmedetomidine, in terms of heart rate and blood pressure at intubation.DesignMeta-analysis with meta-regression and trial sequential analysis.SettingSystematic search from inception until December 1, 2020 in the following databases: Pubmed, Scopus, the Cochrane Central Register of Controlled Trials, EMBASE and Google Scholar.InterventionsAll randomized controlled trials investigating intravenous dexmedetomidine as premedication in adult patients undergoing tracheal intubation were included in our study. Studies were included without any language or publication date restriction. A trial sequential analysis and a post-hoc meta-regression were performed on the main outcomes.MeasurementsHemodynamic parameters and heart rate at tracheal intubation, dose of anesthetic needed for induction of anesthesia, total anesthetic requirement throughout the operative procedure, postoperative pain and percentage of patients requiring analgesics at 24 postoperative hours, postoperative nausea and vomiting, intraoperative and postoperative bradycardia, hypotension, dizziness, shivering and/or respiratory depression.Main ResultsNinety-nine included studies randomized 6833 patients. During laryngoscopy, all hemodynamic parameters were significantly greater in the no dexmedetomidine group. In particular, in the dexmedetomidine group, systolic blood pressure differed by -21.8 mm Hg (95% CI -26.6 to -17.1, p-value < 0.001, I2 97%), mean arterial pressure by -12.8 mm Hg (95% CI -15.6 to -10.0, p-value < 0.001, I2 98%), and heart rate by -16.9 bpm (95% CI -19.8 to -13.9, p-value < 0.001, I2 98%).ConclusionsPatients receiving premedication with dexmedetomidine for tracheal intubation, compared with no dexmedetomidine, have a lower blood pressure and heart rate, however, the risk of bradycardia and hypotension is relevant and its use during daily practice should be cautiously evaluated for each patient.Copyright © 2021 Elsevier Inc. All rights reserved.

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