The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis
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 data...
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Korean Society of Otorhinolaryngology-Head and Neck Surgery
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doaj-ea9de59bd40b42afa86112b14ea9806a2021-05-10T04:29:05ZengKorean Society of Otorhinolaryngology-Head and Neck SurgeryClinical and Experimental Otorhinolaryngology1976-87102005-07202021-05-0114220020910.21053/ceo.2020.00584735The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-AnalysisDo Hyun Kim0Junuk Lee1Sung Won Kim2Se Hwan Hwang3 Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, KoreaObjectives 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.http://www.e-ceo.org/upload/pdf/ceo-2020-00584.pdfantihypertensive agentsnasal surgical proceduresmorbiditycontrolled hypotension |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Do Hyun Kim Junuk Lee Sung Won Kim Se Hwan Hwang |
spellingShingle |
Do Hyun Kim Junuk Lee Sung Won Kim Se Hwan Hwang The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis Clinical and Experimental Otorhinolaryngology antihypertensive agents nasal surgical procedures morbidity controlled hypotension |
author_facet |
Do Hyun Kim Junuk Lee Sung Won Kim Se Hwan Hwang |
author_sort |
Do Hyun Kim |
title |
The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis |
title_short |
The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis |
title_full |
The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis |
title_fullStr |
The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis |
title_full_unstemmed |
The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis |
title_sort |
efficacy of hypotensive agents on intraoperative bleeding and recovery following general anesthesia for nasal surgery: a network meta-analysis |
publisher |
Korean Society of Otorhinolaryngology-Head and Neck Surgery |
series |
Clinical and Experimental Otorhinolaryngology |
issn |
1976-8710 2005-0720 |
publishDate |
2021-05-01 |
description |
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. |
topic |
antihypertensive agents nasal surgical procedures morbidity controlled hypotension |
url |
http://www.e-ceo.org/upload/pdf/ceo-2020-00584.pdf |
work_keys_str_mv |
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