The anesthesia induction effect of dexmedetomidine in patients undergoing laryngeal mask intubation: a systematic review and meta-analysis of 7 RCTs

Abstract

Background: During laryngeal mask airway (LMA) insertion, patients need to enter a sufficient depth of sedation to prevent limb movement, coughing, laryngospasm, and other adverse reactions. This study conducted a meta-analysis to investigate the effect of dexmedetomidine on anesthesia induction in patients undergoing laryngeal mask intubation (LMI). Methods: The Embase, PubMed, Cochrane, and Web of Science databases were searched using the keywords [Dexmedetomidine] AND [Laryngeal mask/Laryngeal mask intubation/LMI] OR [Anesthesia induction] to retrieve articles on randomized controlled trials (RCTs) in which dexmedetomidine sedation had been used in the LMI surgery. After screening the articles, the Jadad scale was used to assess the bias of the studies, and Stata16.0 software was used for the analysis to determine the anesthetic-induction effects of dexmedetomidine, fentanyl, morphine, and midazolam as sedatives. Results: In total, 352 articles were initially retrieved, and 7 articles with a total of 410 patients were ultimately included in the meta-analysis. The effective rate of LMI induced by dexmedetomidine-assisted sedation was better than that of the control group [odds ratio (OR) =1.10, 95% confidence interval (CI): 0.78, 1.53], but the difference between the 2 groups was not significant (Z=0.533, P=0.594). The respiratory rate of the dexmedetomidine group at 5 minutes after dexmedetomidine catheterization was higher than that of the control group [standardized mean difference (SMD) =3.17, 95% CI: 1.38, 4.96; Z=3.476, P=0.001]. The heart rate of the dexmedetomidine group at 1 minute after dexmedetomidine catheterization was significantly lower than that of the control group (SMD =−1.31, 95% CI: −1.91, −0.71; Z=−4.255, P=0.000). The mean arterial pressure (MAP) of the dexmedetomidine group at 1 minute after dexmedetomidine catheterization was lower than that of the control group (SMD =−0.24, 95% CI: −0.94, 0.45), but the difference was not statistically significant (Z=−0.684, P=0.494). The coughing count rate of the dexmedetomidine group was lower than that of the control group (OR =0.36, 95% CI: 0.15, 0.86; Z=−2.286, P=0.022) Discussion: The application of dexmedetomidine in the anesthesia induction with LMI has a good sedative effect, improves the success rate of LMI, reduces adverse reactions.