Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: Mar 12, 2025

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

DMD, MSc,
DMD,
BDS, MPH, MSc, PhD,
BSc, MSc, DDS, and
DDS, MSc, EdD
Page Range: 9 – 23
DOI: 10.2344/23-0059
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Objective

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.

Methods

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.

Results

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.

Conclusion

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

Keywords: Dexmedetomidine; Esmolol; Hemodynamic; Laryngoscopy; Intubation
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Copyright: © 2025 by the American Dental Society of Anesthesiology
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Figure 1.
Figure 1.

PRISMA Flow Diagram

Figure 2.
Figure 2.

Risk of Bias (RoB2) Summary

Figure 3.
Figure 3.

Forest Plot for Heart Rate Response to Laryngoscopy and Tracheal Intubation Using Dexmedetomidine Compared With Esmolol

Figure 4.
Figure 4.

Forest Plot for Systolic Blood Pressure Response to Laryngoscopy and Tracheal Intubation Using Dexmedetomidine Compared With Esmolol

Figure 5.
Figure 5.

Forest Plot for Diastolic Blood Pressure Response to Laryngoscopy and Tracheal Intubation Using Dexmedetomidine Compared With Esmolol

Figure 6.
Figure 6.

Forest Plot for Mean Arterial Pressure Response to Laryngoscopy and Tracheal Intubation Using Dexmedetomidine Compared With Esmolol

Contributor Notes

Address correspondence to Dr Michelle Wong, 124 Edward Street, Toronto, ON, M5G 1G6, Canada; michelle.wong@dentistry.utoronto.ca.
Received: Dec 04, 2023
Accepted: Jul 03, 2024