Efficacy and safety of intraoperative controlled hypotension: a systematic review and meta-analysis of randomised trials

被引:0
|
作者
Dauterman, Leah [1 ]
Khan, Nabia [1 ]
Tebbe, Connor [1 ]
Li, Jiangqiong [2 ]
Sun, Yanhua [3 ]
Gunderman, David [1 ]
Liu, Ziyue [2 ]
Adams, David C. [4 ]
Sessler, Daniel I. [5 ]
Meng, Lingzhong [4 ]
机构
[1] Indiana Univ, Indiana Univ Sch Med, Indianapolis, IN USA
[2] Indiana Univ Sch Med, Dept Biostat & Hlth Data Sci, Indianapolis, IN USA
[3] Nanjing Univ, Nanjing Drum Tower Hosp, Affiliated Hosp, Dept Anesthesiol,Med Sch, Nanjing, Peoples R China
[4] Indiana Univ Sch Med, Dept Anesthesia, Indianapolis, IN 46202 USA
[5] Cleveland Clin, Dept Anesthesiol, Outcomes Res Consortium, Cleveland, OH USA
关键词
anaesthesia; controlled hypotension; efficacy; randomised trial; safety; surgery; BLOOD-LOSS; DELIBERATE HYPOTENSION; ORTHOGNATHIC SURGERY; MYOCARDIAL INJURY; SURGICAL FIELD; DOUBLE-BLIND; SODIUM-NITROPRUSSIDE; NONCARDIAC SURGERY; MAGNESIUM-SULFATE; ANESTHESIA;
D O I
暂无
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Intraoperative controlled hypotension improves surgical field visibility by reducing blood loss (efficacy) but poses potential risks linked to organ hypoperfusion (safety). The use of controlled hypotension persists despite increasing evidence of associations between intraoperative inadvertent hypotension and adverse outcomes. Therefore, we tested the hypothesis that the focus and results of intraoperative controlled hypertension research differ across anaesthesia and surgery investigators because of differing priorities. Methods: We systematically reviewed randomised trials comparing controlled hypotension with usual care with trials categorised by investigators' affiliation. Results: We identified 48 eligible trials, of which 37 were conducted by anaesthesia investigators and 11 by surgery investigators. For the primary outcome, 54% of the anaesthesia-led trials focused on safety, whereas all (100%) surgery-led trials focused on efficacy (P=0.004). = 0.004). Compared with usual care, mean arterial pressure in controlled hypotension was 23% (95% confidence interval [CI] 17-29%) lower in anaesthesia trials and 30% (95% CI 14-37%) lower in surgery trials; estimated blood loss was 44% (95% CI 30-55%) less in anaesthesia trials and 38% (95% CI 30-49%) less in surgery trials. Overall, blood loss was reduced by 43% (95% CI 32-53%), and trial sequential analysis supported an efficacy conclusion. Mean arterial pressure and estimated blood loss reductions were associated (R2=0.41, 2 = 0.41, P=0.002). = 0.002). All trials were underpowered for safety outcomes, and none adequately evaluated myocardial or renal injury. Conclusions: Anaesthesia researchers prioritised safety outcomes, whereas surgery researchers emphasised efficacy in controlled hypotension trials. Controlled hypotension significantly reduces blood loss. In contrast, safety outcomes were poorly studied. Given increasing observational evidence linking inadvertent hypotension to myocardial and renal injury, the safety of controlled hypotension remains to be addressed.
引用
收藏
页码:940 / 954
页数:15
相关论文
共 50 条
  • [31] The Efficacy and Safety of Telerehabilitation for Fibromyalgia: Systematic Review and Meta-analysis of Randomized Controlled Trials
    Wu, Yong-Qiang
    Long, Yi
    Peng, Wei-Jie
    Gong, Cheng
    Liu, Yue-Quan
    Peng, Xu-Miao
    Zhong, Yan-Biao
    Luo, Yun
    Wang, Mao -Yuan
    JOURNAL OF MEDICAL INTERNET RESEARCH, 2023, 25
  • [32] Efficacy and safety of aminoglycoside monotherapy: systematic review and meta-analysis of randomized controlled trials
    Vidal, Liat
    Gafter-Gvili, Anat
    Borok, Sara
    Fraser, Abigail
    Leibovici, Leonard
    Paul, Mical
    JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2007, 60 (02) : 247 - 257
  • [33] Efficacy and safety of mirikizumab in psoriasis: a systematic review and meta-analysis of randomized controlled trials
    Pereira, Mable
    Franco, Ancy Jenil
    Chintharala, Karthik
    Vieira, Ana Carolina Putini
    de Jesus, Ana Carolina Ventura de Santana
    Lajczak, Pawel
    Alhwaishel, Khaled
    Castaneda, Mario Saul Lira
    Weba, Elizabet Taylor Pimenta
    Reich, Kristian
    INFLAMMOPHARMACOLOGY, 2025, 33 (03) : 1033 - 1042
  • [34] Efficacy of moisturizers in paediatric atopic dermatitis: A systematic review and meta-analysis of randomised controlled trials
    Kritsanaviparkporn, Chawan
    Sangaphunchai, Phoomphut
    Treesirichod, Arucha
    INDIAN JOURNAL OF DERMATOLOGY VENEREOLOGY & LEPROLOGY, 2022, 88 (01): : 22 - 31
  • [35] The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: a systematic review and meta-analysis
    Galloway, Ricky
    Watson, Hunna
    Greene, Danyelle
    Shafran, Roz
    Egan, Sarah J.
    COGNITIVE BEHAVIOUR THERAPY, 2022, 51 (02) : 170 - 184
  • [36] Efficacy of ultrasound guidance for lumbar punctures: a systematic review and meta-analysis of randomised controlled trials
    Shu, LiPei
    Huang, Jiao
    Liu, Jing Chen
    POSTGRADUATE MEDICAL JOURNAL, 2021, 97 (1143) : 40 - 47
  • [37] Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials
    Johnson, N
    Barlow, D
    Lethaby, A
    Tavender, E
    Curr, L
    Garry, R
    BMJ-BRITISH MEDICAL JOURNAL, 2005, 330 (7506): : 1478 - 1481
  • [38] Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data
    Islam, Rakibul M.
    Bell, Robin J.
    Green, Sally
    Page, Matthew J.
    Davis, Susan R.
    LANCET DIABETES & ENDOCRINOLOGY, 2019, 7 (10): : 754 - 766
  • [39] Efficacy and Safety of Statins for Pulmonary Hypertension: A Meta-Analysis of Randomised Controlled Trials
    Zhang, Yitao
    Zeng, Weijie
    Cheng, Shiyao
    Chen, Zhichong
    Xue, Jiaojie
    Wang, Qing
    Ou, Maode
    Cheng, Kanglin
    HEART LUNG AND CIRCULATION, 2017, 26 (05): : 425 - 432
  • [40] Safety and Efficacy of Inclisiran in Hyperlipidemia: An Updated Meta-Analysis of Randomised Controlled Trials
    Basit, Jawad
    Ahmed, Mushood
    Singh, Priyansha
    Ahsan, Areeba
    Zulfiqar, Eeshal
    Iqbal, Javed
    Fatima, Maurish
    Upreti, Prakash
    Hamza, Mohammad
    Alraies, M. Chadi
    ENDOCRINOLOGY DIABETES & METABOLISM, 2025, 8 (02)