Brazilian journal of anesthesiology (Elsevier) · 2025
Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Bendaham Lucas Cael Azevedo Ramos, Neto Altair Pereira de Melo, Faria Hilária Saugo, Filho André Richard da Silva Oliveira, Ferreira Carlos Henrique de Oliveira, Cunha Marcela da Silva Kazitani, Soares Victor Gonçalves, Gonçalves Ocílio Ribeiro, Sobral Milene Vitória Sampaio, Doma Mohamed, Grutcki Denis Maltz, Mendonça Fabrício Tavares
Аннотация
BACKGROUND: Tracheal extubation after general anesthesia may cause hemodynamic and respiratory complications, with no established strategies to prevent them. We conducted a meta-analysis to evaluate the safety and efficacy of beta-blockers in patients undergoing tracheal extubation.
METHODS: We searched the MEDLINE, EMBASE and CENTRAL databases for randomized controlled trials up to 2024 comparing beta-blockers to placebo in patients undergoing tracheal extubation.
PRIMARY OUTCOME: cough intensity; secondary: bronchospasm, bucking, hypertension. Risk Ratios (RR) with 95% Confidence Intervals (95% CI) were computed. Leave-one-out sensitivity and meta-regression analyses were performed for outcomes with high heterogeneity.
RESULTS: We included 31 randomized studies, comprising 1,803 patients, of whom 965 received beta-blockers. The risk of moderate/severe cough (RR = 0.21; 95% CI 0.13 to 0.34; p < 0.001; I2 = 0%) and hypertension (RR = 0.28; 95% CI 0.13 to 0.58; p < 0.001; I2 = 45%) was significantly lower in the beta-blockers group compared with the placebo group. There were no statistically significant differences between groups in the risk of bronchospasm (RR = 0.58; 95% CI 0.17 to 1.94; p = 0.375; I2 = 0%) or bucking (RR = 0.47; 95% CI 0.20 to 1.13; p = 0.093; I2 = 72%). Sensitivity analysis identified Mendonça (2023) as the main heterogeneity source in bucking.
CONCLUSION: Our study demonstrates that beta-blockers reduced moderate/severe cough and hypertension in patients undergoing tracheal extubation compared with placebo with no significant difference in the risk of bronchospasm and bucking. These findings suggest beta-blockers may be a valuable strategy for preventing peri-extubation hemodynamic instability and airway hyperresponsiveness.
PROSPERO REGISTER: CRD42024542103.
METHODS: We searched the MEDLINE, EMBASE and CENTRAL databases for randomized controlled trials up to 2024 comparing beta-blockers to placebo in patients undergoing tracheal extubation.
PRIMARY OUTCOME: cough intensity; secondary: bronchospasm, bucking, hypertension. Risk Ratios (RR) with 95% Confidence Intervals (95% CI) were computed. Leave-one-out sensitivity and meta-regression analyses were performed for outcomes with high heterogeneity.
RESULTS: We included 31 randomized studies, comprising 1,803 patients, of whom 965 received beta-blockers. The risk of moderate/severe cough (RR = 0.21; 95% CI 0.13 to 0.34; p < 0.001; I2 = 0%) and hypertension (RR = 0.28; 95% CI 0.13 to 0.58; p < 0.001; I2 = 45%) was significantly lower in the beta-blockers group compared with the placebo group. There were no statistically significant differences between groups in the risk of bronchospasm (RR = 0.58; 95% CI 0.17 to 1.94; p = 0.375; I2 = 0%) or bucking (RR = 0.47; 95% CI 0.20 to 1.13; p = 0.093; I2 = 72%). Sensitivity analysis identified Mendonça (2023) as the main heterogeneity source in bucking.
CONCLUSION: Our study demonstrates that beta-blockers reduced moderate/severe cough and hypertension in patients undergoing tracheal extubation compared with placebo with no significant difference in the risk of bronchospasm and bucking. These findings suggest beta-blockers may be a valuable strategy for preventing peri-extubation hemodynamic instability and airway hyperresponsiveness.
PROSPERO REGISTER: CRD42024542103.