Effects of Dexmedetomidine vs Esmolol on Postintubation Hemodynamics: A Meta-Analysis

Tracheal intubation (TI) consistently induces tachycardia and elevated blood pressure which may be deleterious to patients, particularly those with existing cardiac conditions. Use of dexmedetomidine or esmolol has been described to attenuate this sympathetic response. This study aimed to determine the effectiveness of dexmedetomidine vs esmolol in attenuating the hemodynamic response during TI.

A systematic review and meta-analysis were performed using PRISMA guidelines. A systematic literature search in electronic databases and grey literature was completed. Researchers assessed article eligibility, performed data extraction, and completed risk of bias assessment. Results were expressed as pooled differences for cardiovascular parameters between the drugs as the weighted mean difference with 95% CI. A P < .05 was considered statistically significant. Heterogeneity was quantified using the I2 statistic. Subgroup analyses exploring different drug regimens were performed.

Of 112 publications, 19 randomized controlled trials were included for descriptive analysis and 15 were selected for the meta-analysis with 948 patients. The use of dexmedetomidine vs esmolol provided lower heart rates and mean arterial pressures at 1, 3, 5, and 10 minutes and lower systolic and diastolic pressures at 1, 3, and 5 minutes after TI.

Dexmedetomidine blunts the hemodynamic response to TI more effectively vs esmolol.