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Authors Liu S, Wang Y, Zhu Y, Yu T, Zhao H
Received 16 November 2018
Accepted for publication 15 February 2019
Published 23 April 2019 Volume 2019:13 Pages 1301—1310
DOI https://doi.org/10.2147/DDDT.S194894
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 3
Editor who approved publication: Professor Manfred Ogris
Objective: The focus
of this meta-analysis was to assess the sedative effect and safety of
intranasal dexmedetomidine (Dex) in mandibular third molar surgery.
Methods: The
PubMed/Medline, Web of Science, Cochrane Library, and China National Knowledge
Infrastructure databases were searched for studies published until May 1, 2018.
Eligible studies were restricted to randomized controlled trials (RCTs) and
controlled clinical trials. The evaluation indicators mainly included the
bispectral index, observer assessment of alertness/sedation scale, systolic
blood pressure, and heart rate. Data for each period in the Dex and control
groups were pooled to evaluate its sedative effect and safety.
Results: Five RCTs
met the inclusion criteria. This study included 363 patients: 158 patients
received intranasal inhalation of Dex before surgery, and 158 patients were
negative controls. The pooled results showed a good sedative effect during
tooth extraction when intranasal inhalation of Dex was performed 30 minutes
before third molar extraction (assessment of alertness/sedation, Dex vs control
SMD -1.20, 95% CI -1.73 to -0.67, I 2=0, P =0.95; bispectral index, Dex vs control SMD -11.68,
95% CI -19.49 to -3.87, I 2=89%; P =0.0001), and parameters returned to normal within 90
minutes after inhalation. During the operation, blood pressure and heart rate
decreased to some extent, but the decreases did not exceed 20% of the baseline,
and all patients returned to normal conditions within 90 minutes after
inhalation.
Conclusion: Intranasal
inhalation of Dex 30 minutes before third molar extraction can provide a good
sedative effect, and large-sample multicenter RCTs are needed to evaluate the
analgesic effect of Dex.
Keywords: intranasal
dexmedetomidine, sedation, mandibular third molar, meta-analysis