OBJECTIVES Skull-pin head-holder application during neurosurgery is a highly noxious stimulus that may lead to abrupt hemodynamic change, which is an unfavorable response to maintain hemodynamics stability. The aim of this meta-analysis was to evaluate the effects of intravenous dexmedetomidine on hemodynamic response (blood pressure and heart rate) resulting from the application of skull-pin head-holder in neurosurgery. PATIENTS AND METHODS A systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The protocol was registered with the International Prospective Register of Systematic Reviews (CRD 420119127876). Electronic databases were searched, without discrimination of publication year, language, and region, to identify all randomized controlled trials investigating the effects of dexmedetomidine on hemodynamic response resulting from skull-pin head-holder application during general anesthesia for neurosurgery. The mean arterial pressure and heart rate were analyzed using random-effect model, and the mean difference (MD) was calculated. RESULTS Seventeen trials were identified; a total of 878 patients were enrolled. The analysis indicated that dexmedetomidine infusion reduced the mean arterial pressure (MD -11.70, 95% confidence interval [CI] -16.33 to -7.07, p < 0.00001) and heart rate (MD -14.48, 95% CI -23.10 to -5.86, p = 0.001) during skull-pin head-holder application. Subgroup analysis showed that dexmedetomidine was superior to fentanyl for the attenuation of hemodynamic response. Dexmedetomidine infusion also reduced the incidence of hypertension, tachycardia and brain relaxation score. CONCLUSION The result of this analysis indicates that intraoperative dexmedetomidine administration could decrease the hemodynamic response and provide hemodynamic stability during skull-pin head-holder application in neurosurgery.

中文翻译：

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静脉注射右美托咪定对神经外科颅骨针头固定器应用患者血流动力学反应的影响——随机对照试验的荟萃分析

目的在神经外科手术中使用颅骨针头固定器是一种高度有害的刺激，可能导致血流动力学的突然变化，这是维持血流动力学稳定性的不利反应。本荟萃分析的目的是评估静脉注射右美托咪定对颅骨针头固定器在神经外科应用引起的血流动力学反应（血压和心率）的影响。患者和方法 根据系统评价和 Meta 分析的首选报告项目 (PRISMA) 声明指南进行系统评价和 Meta 分析。该方案已在国际前瞻性系统评价注册中心 (CRD 420119127876) 注册。检索电子数据库，不分出版年份、语言、地区，确定所有随机对照试验，研究右美托咪定对神经外科全身麻醉期间应用颅骨针头固定器引起的血流动力学反应的影响。使用随机效应模型分析平均动脉压和心率，并计算平均差（MD）。结果 确定了 17 项试验；共招募了 878 名患者。分析表明右美托咪定输注降低了平均动脉压（MD -11.70，95% 置信区间 [CI] -16.33 至 -7.07，p < 0.00001）和心率（MD -14.48，95% CI -23.10 至 -5.86， p = 0.001) 在颅骨针头固定器应用期间。亚组分析显示右美托咪定在减弱血流动力学反应方面优于芬太尼。右美托咪定输注还降低了高血压、心动过速和脑松弛评分的发生率。结论 该分析结果表明，术中给予右美托咪定可以降低颅骨针头固定器在神经外科应用过程中的血流动力学反应并提供血流动力学稳定性。