Peri-operative dexmedetomidine and emergence agitation in adults undergoing nasal surgery: A systematic review and meta-analysis

BACKGROUND There is a high risk of emergence agitation associated with nasal surgery. OBJECTIVE We aimed to assess the effect of dexmedetomidine on the incidence of emergence agitation during anaesthetic recovery in patients undergoing nasal surgeries under general anaesthesia. DESIGN A systematic review and meta-analysis of randomised controlled trials. DATA SOURCES A systematic search was conducted in Embase, Web of Science (all databases), Cochrane Library and PubMed up to 20 June 2024, following the recommendations of the Cochrane Handbook and the PRISMA statement. ELIGIBILITY CRITERIA Adult patients undergoing nasal surgeries under general anaesthesia (P), peri-operative dexmedetomidine use (I), placebo (C) and emergence agitation assessment (O). RESULTS Nine randomised controlled trials with a total of 620 patients were included in the analysis. The incidence of emergence agitation with the use of dexmedetomidine was significantly lower than with placebo (relative risk (RR) = 0.31, 95% CI 0.19 to 0.49, P < 0.0001, I2 = 63%, GRADE: moderate). No significant difference was found in the incidence of severe emergence agitation (RR = 0.5, 95% CI 0.24 to 1.02, P = 0.0552, I2 = 0%, GRADE: Very low). A trial sequential analysis (TSA) was conducted to assess the reliability of the findings, with parameters set at a type 1 error (alpha) of 5% and a power (1-beta) of 80%. TSA confirmed the result for emergence agitation, but did not reach required information size for severe emergence agitation. Both assessment results were consistent and not dependent on any single study, as shown by the leave-one-out sensitivity analysis. CONCLUSIONS The use of dexmedetomidine significantly reduces the incidence of emergence agitation in patients undergoing nasal surgeries under general anaesthesia.