Safety and sedative effect of intranasal dexmedetomidine in mandibular third molar surgery: a systematic review and meta-analysis

Abstract

Objective

The focus of this meta-analysis was to assess the sedative effect and safety of intranasal dexmedetomidine (Dex) in mandibular third molar surgery.

Methods

The PubMed/Medline, Web of Science, Cochrane Library, and China National Knowledge Infrastructure databases were searched for studies published until May 1, 2018. Eligible studies were restricted to randomized controlled trials (RCTs) and controlled clinical trials. The evaluation indicators mainly included the bispectral index, observer assessment of alertness/sedation scale, systolic blood pressure, and heart rate. Data for each period in the Dex and control groups were pooled to evaluate its sedative effect and safety.

Results

Five RCTs met the inclusion criteria. This study included 363 patients: 158 patients received intranasal inhalation of Dex before surgery, and 158 patients were negative controls. The pooled results showed a good sedative effect during tooth extraction when intranasal inhalation of Dex was performed 30 minutes before third molar extraction (assessment of alertness/sedation, Dex vs control SMD −1.20, 95% CI −1.73 to −0.67, I²=0, P=0.95; bispectral index, Dex vs control SMD −11.68, 95% CI −19.49 to −3.87, I²=89%; P=0.0001), and parameters returned to normal within 90 minutes after inhalation. During the operation, blood pressure and heart rate decreased to some extent, but the decreases did not exceed 20% of the baseline, and all patients returned to normal conditions within 90 minutes after inhalation.

Conclusion

Intranasal inhalation of Dex 30 minutes before third molar extraction can provide a good sedative effect, and large-sample multicenter RCTs are needed to evaluate the analgesic effect of Dex.

Keywords:

• intranasal dexmedetomidine
• sedation
• mandibular third molar
• meta-analysis

Supplementary material

Search strategies

Cochrane

• #1: Molars, third: ti, ab, kw or “third molar”: ti, ab, kw or “third molars”: ti, ab, kw or “tooth, wisdom”: ti, ab, kw or “wisdom tooth”: ti, ab, kw or “teeth, wisdom”: ti, ab, kw or “wisdom teeth”: ti, ab, kw or “molar, third”: ti, ab, kw or “tooth, impacted”: ti, ab, kw or “impacted teeth”: ti, ab, kw or “impacted tooth”: ti, ab, kw or “teeth impacted” (2,432)

• #2: PV-1440: ti, ab, kw or “MPV 1440”: ti, ab, kw or “MPV1440”: ti, ab, kw or “Precedex”: ti, ab, kw or “Hospira brand of dexmedetomidine hydrochloride”: ti, ab, kw or “dex-medetomidine hydrochloride”: ti, ab, kw or “hydrochloride, dexmedetomidine”: ti, ab, kw or “dexmedetomidine” (2,545) #3: #1 AND #2 (13)

Web of Science

• #1: TS = (molars, third OR third molar OR third molars OR tooth, wisdom OR wisdom tooth OR teeth, wisdom OR wisdom teeth OR molar, third OR tooth, impacted OR impacted teeth OR impacted tooth OR teeth impacted) (31,537)

• #2: TS = (MPV-1440 OR MPV 1440 OR MPV1440 OR Precedex OR dexmedetomidine hydrochloride OR hydrochloride, dexmedetomidine OR dexmedetomidine) (8,195)

• #3: #1 AND #2 (18)

PubMed

• #1: “dexmedetomidine”[MeSH] (2,814)

• #2: (MPV-1440[Title/Abstract]) OR (MPV 1440[Title/Abstract]) OR (MPV1440[Title/Abstract]) OR (Precedex[Title/Abstract]) OR (Dexmedetomidine Hydrochloride[Title/Abstract]) OR (Hydrochloride, Dexmedetomidine[Title/Abstract]) (105)

• #3: #1 or #2 (2,855)

• #4: “molar, third”[MeSH] (5,893)

• #5: (Molars, Third[Title/Abstract]) OR (Third Molar[Title/Abstract]) OR (Third Molars[Title/Abstract]) OR (Tooth, Wisdom[Title/Abstract]) OR (Wisdom Tooth[Title/Abstract]) OR (Teeth, Wisdom[Title/Abstract]) OR (Wisdom Teeth[Title/Abstract]) (11613)

• #6: #4 or #5 (11,935)

• #7: #3 and #6 (11)

Acknowledgments

Tingting Yu and Huaqiang Zhao are to be considered co-correspondence authors.

Disclosure

The authors report no conflicts of interest in this work.