Effectiveness of dexmedetomidine during surgery under general anaesthesia on patient-centred outcomes: a systematic review and Bayesian meta-analysis protocol
Brian Hutton,
Dean A Fergusson,
Manoj M Lalu,
Daniel I McIsaac,
Guillaume Martel,
Alexis F Turgeon,
Husein Moloo,
Mélanie Bérubé,
Ian Gilron,
Patricia Poulin,
Stuart Nicholls,
Jason McVicar,
Maxime Le,
Michael Verret,
Fiona Zivkovic,
Megan Graham,
Allison Geist,
Helena Daudt,
John Bao Phuc Le
Affiliations
Brian Hutton
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Dean A Fergusson
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Manoj M Lalu
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Daniel I McIsaac
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Guillaume Martel
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Alexis F Turgeon
Departments of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
Husein Moloo
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Mélanie Bérubé
Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec, Quebec, Canada
Ian Gilron
Department of Anesthesiology and Perioperative Medicine, Queen`s University, Kingston, Ontario, Canada
Patricia Poulin
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Stuart Nicholls
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Jason McVicar
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Maxime Le
Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
Michael Verret
Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec, Quebec, Canada
Fiona Zivkovic
Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
Megan Graham
Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
Allison Geist
Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
Helena Daudt
Pain Canada, Pain BC, Vancouver, Alberta, Canada
John Bao Phuc Le
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
Introduction Dexmedetomidine is a promising pharmaceutical strategy to minimise opioid use during surgery. Despite its growing use, it is uncertain whether dexmedetomidine can improve patient-centred outcomes such as quality of recovery and pain.Methods and analysis We will conduct a systematic review and meta-analysis following the recommendations of the Cochrane Handbook for Systematic Reviews. We will search MEDLINE, Embase, CENTRAL, Web of Science and CINAHL approximately in October 2023. We will include randomised controlled trials evaluating the impact of systemic intraoperative dexmedetomidine on patient-centred outcomes. Patient-centred outcome definition will be based on the consensus definition established by the Standardised Endpoints in Perioperative Medicine initiative (StEP-COMPAC). Our primary outcome will be the quality of recovery after surgery. Our secondary outcomes will be patient well-being, function, health-related quality of life, life impact, multidimensional assessment of postoperative acute pain, chronic pain, persistent postoperative opioid use, opioid-related adverse events, hospital length of stay and adverse events. Two reviewers will independently screen and identify trials and extract data. We will evaluate the risk of bias of trials using the Cochrane Risk of Bias Tool (RoB 2.0). We will synthesise data using a random effects Bayesian model framework, estimating the probability of achieving a benefit and its clinical significance. We will assess statistical heterogeneity with the tau-squared and explore sources of heterogeneity with meta-regression. We have involved patient partners, clinicians, methodologists, and key partner organisations in the development of this protocol, and we plan to continue this collaboration throughout all phases of this systematic review.Ethics and dissemination Our systematic review does not require research ethics approval. It will help inform current clinical practice guidelines and guide development of future randomised controlled trials. The results will be disseminated in open-access peer-reviewed journals, presented at conferences and shared among collaborators and networks.PROSPERO registration number CRD42023439896.
