The effect of intravenous dexmedetomidine on hemodynamic response in patients undergoing skull-pin head-holder application during neurosurgery

Abstract

연구 배경. 신경외과 수술에서 두개골 핀 고정은 갑작스러운 혈역학적 변화를 일으키는 매우 강력한 자극으로 알려져 있다. 이 메타분석의 목적은 신경외과 수술에서 두개골 핀 고정시 발생하는 혈역학적 변화(혈압 및 심박수)에 덱스메데토미딘 주입이 어떤 영향을 미치는지에 대한 효과를 평가하기 위한 것이다.

연구 방법. 전신마취 중 신경외과 수술에서 두개골 핀 고정시 혈역학적 변화에 미치는 덱스메데토미딘의 효과에 대한 무작위 대조시험을 대상으로 문헌검색을 하였다. PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 지침에 따라 체계적인 검토 및 메타 분석을 수행하였고 이 프로토콜은 International Prospective Register of Systematic Reviews(CRD 420119127876)에 등록되었다.변량효과모형(random-effect models)을 사용하여 평균동맥압과 심박수를 분석하였고 평균차(mean difference, MD)를 계산하였다.

결과. 878명의 환자가 포함된 17개의 연구를 분석하였다. 두개골 핀 고정시 덱스메데토미딘 주입은 평균 동맥압을 평균차 -11.70, 95% 신뢰구간 -16.33 to -7.07, p < 0.00001, 심박수를 평균차 -14.48, 95% CI -23.10 to -5.86, p = 0.001만큼 감소시켰다. 하위집단(subgroup) 분석에서는 덱스메데토미딘이 펜타닐에 비해 혈역학적 반응을 완화시키는 것이 더 우수하였다. 또한 덱스메데토미딘은 고혈압, 빈맥, 뇌이완점수(brain relaxation score)를 감소시켰다.

결론. 신경외과 수술에서 두개골 핀 고정시 덱스메데토미딘 주입은 혈역학적 변화를 감소시켜 혈역학적 안정성을 제공할 수 있다.

Objectives. Skull-pin head-holder application during neurosurgery is a highly noxious stimulus that may lead to abrupt hemodynamic change, which is an unfavorable response to maintain hemodynamics stability. The aim of this meta-analysis was to evaluate the effects of intravenous dexmedetomidine on hemodynamic response (blood pressure and heart rate) resulting from the application of skull-pin head-holder in neurosurgery.

Methods. A systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The protocol was registered with the International Prospective Register of Systematic Reviews (CRD 420119127876). Electronic databases were searched, without discrimination of publication year, language, and region, to identify all randomized controlled trials investigating the effects of dexmedetomidine on hemodynamic response resulting from skull-pin head-holder application during general anesthesia for neurosurgery. The mean arterial pressure and heart rate were analyzed using random-effect model, and the mean difference (MD) was calculated.

Results. Seventeen trials were identified; a total of 878 patients were enrolled. The analysis indicated that dexmedetomidine infusion reduced the mean arterial pressure (MD -11.70, 95% confidence interval [CI] -16.33 to -7.07, p < 0.00001) and heart rate (MD -14.48, 95% CI -23.10 to -5.86, p = 0.001) during skull-pin head-holder application. Subgroup analysis showed that dexmedetomidine was superior to fentanyl for the attenuation of hemodynamic response. Dexmedetomidine infusion also reduced the incidence of hypertension, tachycardia and brain relaxation score.

Conclusion. The result of this analysis indicates that intraoperative dexmedetomidine administration could decrease the hemodynamic response and provide hemodynamic stability during skull-pin head-holder application in neurosurgery.