Clin Exp Otorhinolaryngol.  2021 May;14(2):200-209. 10.21053/ceo.2020.00584.

The Efficacy of Hypotensive Agents on Intraoperative Bleeding and Recovery Following General Anesthesia for Nasal Surgery: A Network Meta-Analysis

• Kim DH
• Lee J
• Kim SW
• Hwang SH

• KMID: 2515433
• DOI: http://doi.org/10.21053/ceo.2020.00584

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.

Keyword

Antihypertensive Agents; Nasal Surgical Procedures; Morbidity; Controlled Hypotension

Figure

• 

  Fig. 1. Diagram of the study selection process.

• 

  Fig. 2. Evidence structure of eligible comparisons (left) and forest plots (right) for the network meta-analysis. (A) Operative time, (B) fentanyl administration, (C) intraoperative bleeding, (D) postoperative pain, (E) hypotension, and (F) nausea and vomiting. Lines indicate direct comparisons in the eligible randomized controlled studies (RCTs). The width of the lines represents the number of RCTs for each pairwise comparison. The standardized mean differences and relative risks of intraoperative and postoperative events are shown. SMD, standardized mean difference; CI, confidence interval; OR, odds ratio.

• 

  Fig. 3. Funnel plot for publication bias. (A) Placebo. (B) Beta-blocker. (C) Clonidine. (D) Dexmedetomidine. (E) Opioids. (F) Nitroglycerin.

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