• Li Wang, Jiantong Shen, Long Ge, Miguel F Arango, Xueli Tang, Jessica Moodie, Brieanne McConnell, Davy Cheng, and Janet Martin.
• Department of Anesthesia, and Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada; Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China. Electronic address: wangli1@mcmaster.ca.
• J Clin Anesth. 2019 May 1; 54: 114-125.

Study ObjectiveTo assess the efficacy and safety of dexmedetomidine as an adjunct to general anesthesia for craniotomy.DesignA meta-analysis after systematically searching PubMed, Medline, EMBASE, and Cochrane library for randomized trials (RCTs). Relative risk (RR) and weighted mean difference (WMD) were calculated using random-effects meta-analysis.SettingPerioperative setting.PatientsTwenty-two RCTs (1348 patients) with craniotomy under general anesthesia were included.InterventionsDexmedetomidine as an adjunct to general anesthesia versus placebo or other anesthetics.MeasurementsPrimary outcomes included procedure success and postoperative pain; Secondary outcomes included cardiac adverse events, postoperative nausea and vomiting (PONV) and other clinically important outcomes.Main ResultsDexmedetomidine vs. Placebo: High to moderate quality evidence suggested that dexmedetomidine reduced postoperative pain (WMD -0.25 cm, 95%CI -0.43 to -0.07 cm on a 10 cm visual analogue scale), postoperative nausea and vomiting (PONV, RR 0.57, 95%CI 0.39 to 0.84), hypertension (RR 0.37, 95%CI 0.22 to 0.61) and tachycardia (RR 0.32, 95%CI 0.12 to 0.85) with no significant increase of hypotension and bradycardia. Moderate quality evidence suggested no significant difference in procedural success. Dexmedetomidine vs. Active Comparators (including remifentanil, fentanyl, or propofol): Moderate quality evidence showed no difference in procedural success and postoperative pain.ConclusionsDexmedetomidine as an adjunct to general anesthesia shows small benefits in reduction of pain, PONV, and maintains more stable hemodynamics with comparable effects on procedural success versus placebo. Very limited evidence explored comparative effects between dexmedetomidine and active controls. Further evidence is required to evaluate patient-important outcomes and optimal dosing strategies, particularly versus active comparators.Copyright © 2018 Elsevier Inc. All rights reserved.

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