{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T17:24:05Z","timestamp":1788715445187,"version":"build-2803163510"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>This meta-analysis aimed to analyze and compare the efficacy and safety of remifentanil and dexmedetomidine applied respectively for controlled hypotension under general anesthesia. We searched the Cochrane Library, PubMed, EMBASE, Web of Science, CNKI, SinoMed, Wanfang, and VIP databases, as well as dissertations and conference papers, to obtain randomized controlled trials comparing remifentanil and dexmedetomidine applied respectively for controlled hypotension before August 23, 2021. The primary outcomes included hemodynamic profiles, surgical field score, and blood loss. Extubation time, sedation and pain score at the PACU, and perioperative adverse events were the secondary outcomes. Nine randomized controlled trials with 543 patients (272 in the dexmedetomidine group and 271 in the remifentanil group) were eventually included. This meta-analysis indicated no significant difference between dexmedetomidine and remifentanil in terms of surgical field score, blood loss, minimum values of mean arterial pressure (MD 0.24 with 95% CI [-1.65, 2.13], P = 0.80, I<jats:sup>2<\/jats:sup> = 66%) and heart rate (MD 0.42 [-1.33, 2.17], P = 0.64, I<jats:sup>2<\/jats:sup> = 40%), sedation scores at the PACU (MD -0.09 [-0.69, 0.50], P = 0.76, I<jats:sup>2<\/jats:sup> = 92%), and incidence of bradycardia (OR 2.24 [0.70, 7.15], P = 0.17, I<jats:sup>2<\/jats:sup> = 0%). Compared with remifentanil, dexmedetomidine as the controlled hypotensive agent showed a lower visual analogue score at the PACU (MD -1.01 [-1.25, -0.77], P&lt;0.00001, I<jats:sup>2<\/jats:sup> = 0%) and incidence of shivering (OR 0.22 [0.08, 0.60], P = 0.003, I<jats:sup>2<\/jats:sup> = 0%), nausea, and vomiting (OR 0.34 [0.13, 0.89], P = 0.03, I<jats:sup>2<\/jats:sup> = 0%). However, extubation time was shorter in the remifentanil group (MD 3.34 [0.75, 5.93], P = 0.01, I<jats:sup>2<\/jats:sup> = 90%). In conclusion, dexmedetomidine and remifentanil are both effective in providing satisfactory controlled hypotension and surgical conditions. Dexmedetomidine is better in easing postoperative pain at the PACU and reducing the occurrence of shivering, nausea, and vomiting. Meanwhile, remifentanil is a fast-track anesthesia with a shorter extubation time. Given the limitations of this meta-analysis, further studies are needed for a more definitive comparison of the efficacy and safety of dexmedetomidine and remifentanil.<\/jats:p>","DOI":"10.1371\/journal.pone.0278846","type":"journal-article","created":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T03:58:04Z","timestamp":1674014284000},"page":"e0278846","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Dexmedetomidine versus remifentanil for controlled hypotension under general anesthesia: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8634-3159","authenticated-orcid":true,"given":"Ning","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linmu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7747-0228","authenticated-orcid":true,"given":"Wei","family":"Rong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"key":"pone.0278846.ref001","first-page":"532","article-title":"Controlled hypotension in modern anaesthesia: A review and update.","volume":"6","author":"SP Upadhyay","year":"2015","journal-title":"International Journal of Biological & Pharmaceutical Research."},{"key":"pone.0278846.ref002","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.2165\/00003495-200767070-00007","article-title":"Controlled hypotension: A guide to drug choice.","volume":"67","author":"CS Degoute","year":"2007","journal-title":"Drugs"},{"key":"pone.0278846.ref003","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1093\/bja\/47.7.745","article-title":"The history of controlled hypotension","volume":"47","author":"JM Leigh","year":"1975","journal-title":"Br J Anaesth"},{"key":"pone.0278846.ref004","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1517\/14740331003672579","article-title":"Remifentanil, a different opioid: Potential clinical applications and safety aspects.","volume":"9","author":"C Stroumpos","year":"2010","journal-title":"Expert Opin Drug Saf"},{"key":"pone.0278846.ref005","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1177\/000348941312200702","article-title":"Comparison between dexmedetomidine and remifentanil for controlled hypotension and recovery in endoscopic sinus surgery","volume":"122","author":"J Lee","year":"2013","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"pone.0278846.ref006","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/SCS.0000000000000603","article-title":"Effects of perioperative remifentanil with controlled hypotension on intraoperative bleeding and postoperative edema and ecchymosis in open rhinoplasty","volume":"25","author":"M Ko\u015fucu","year":"2014","journal-title":"J Craniofac Surg"},{"key":"pone.0278846.ref007","doi-asserted-by":"crossref","first-page":"151","DOI":"10.4077\/CJP.2017.BAF461","article-title":"Comparative induction of controlled hypotension by electroacupuncture at DU20 acupoint and remifentanil in lumbar laminectomy","volume":"60","author":"M Ghaemi","year":"2017","journal-title":"Chin J Physiol"},{"key":"pone.0278846.ref008","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1007\/s40262-017-0507-7","article-title":"Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine.","volume":"56","author":"MAS Weerink","year":"2017","journal-title":"Clin Pharmacokinet."},{"key":"pone.0278846.ref009","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1177\/0194599817733735","article-title":"Can dexmedetomidine influence recovery profiles from General Anesthesia in nasal surgery?","volume":"158","author":"HS Lee","year":"2018","journal-title":"Otolaryngol Head Neck Surg."},{"key":"pone.0278846.ref010","first-page":"e64032","article-title":"Controlled hypotension During rhinoplasty: A comparison of dexmedetomidine with magnesium sulfate","volume":"7","author":"F Rokhtabnak","year":"2017","journal-title":"Anesth Pain Med"},{"key":"pone.0278846.ref011","first-page":"779","article-title":"Effects of dexmedetomidine combined with remifentanil on intraoperative controlled hypotensive effect and prognosis in patients undergoing knee arthroplasty","volume":"56","author":"ZM Zhang","year":"2021","journal-title":"Chin Med J (Engl)."},{"key":"pone.0278846.ref012","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.bjorl.2019.08.008","article-title":"The efficacy of esmolol, remifentanil and nitroglycerin in controlled hypotension for functional endoscopic sinus surgery","volume":"87","author":"A Alkan","year":"2021","journal-title":"Braz J Otorhinolaryngol"},{"key":"pone.0278846.ref013","doi-asserted-by":"crossref","first-page":"e28400","DOI":"10.1097\/MD.0000000000028400","article-title":"Efficacy and safety of sevoflurane vs propofol in combination with remifentanil for anesthesia maintenance during craniotomy: A meta-analysis.","volume":"100","author":"Z Zhou","year":"2021","journal-title":"Med (Baltim)."},{"key":"pone.0278846.ref014","first-page":"2309499017716251","article-title":"Comparison of clinical efficacy among remifentanil, nicardipine, and remifentanil plus nicardipine continuous infusion for hypotensive anesthesia during arthroscopic shoulder surgery","volume":"25","author":"JY Kim","year":"2017","journal-title":"J Orthop Surg (Hong Kong)."},{"key":"pone.0278846.ref015","doi-asserted-by":"crossref","first-page":"24","DOI":"10.4103\/ija.IJA_417_19","article-title":"Controlled hypotension for FESS: A randomised double-blinded comparison of magnesium sulphate and dexmedetomidine.","volume":"64","author":"A Chhabra","year":"2020","journal-title":"Indian J Anaesth"},{"key":"pone.0278846.ref016","doi-asserted-by":"crossref","first-page":"e0227410","DOI":"10.1371\/journal.pone.0227410","article-title":"Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials","volume":"15","author":"B Lang","year":"2020","journal-title":"PLOS ONE"},{"key":"pone.0278846.ref017","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s42077-020-00072-z","article-title":"Dexmedetomidine versus remifentanil infusion for controlled hypotension in shoulder arthroscopy: A comparative study.","volume":"12","author":"MA Menshawi","year":"2020","journal-title":"Ain-Shams J Anesthesiol"},{"key":"pone.0278846.ref018","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00405-016-4220-1","article-title":"Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil.","volume":"274","author":"S Karabayirli","year":"2017","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"pone.0278846.ref019","first-page":"60","article-title":"Comparison of the effect of dexmedetomidine and remifentanil on controlled hypotension During rhinoplasty: A clinical trial study.","volume":"24","author":"F Zamani","year":"2021","journal-title":"Int Tinnitus J."},{"key":"pone.0278846.ref020","doi-asserted-by":"crossref","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The PRISMA statement","volume":"339","author":"PRISMA Group","year":"2009","journal-title":"BMJ"},{"key":"pone.0278846.ref021","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1213\/00000539-198606000-00021","article-title":"Controlled hypotension for orthognathic surgery","volume":"65","author":"GA Fromme","year":"1986","journal-title":"Anesth Analg"},{"key":"pone.0278846.ref022","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"Cochrane Statistical Methods Group. The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"JP Higgins","year":"2011","journal-title":"BMJ"},{"key":"pone.0278846.ref023","doi-asserted-by":"crossref","first-page":"e66959","DOI":"10.5812\/aapm.66959","article-title":"A comparative study of the amount of bleeding and hemodynamic changes between dexmedetomidine infusion and remifentanil infusion for controlled hypotensive anesthesia in lumbar discopathy surgery: A double-blind, randomized, clinical trial.","volume":"8","author":"F Javaherforooshzadeh","year":"2018","journal-title":"Anesth Pain Med."},{"key":"pone.0278846.ref024","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1017\/S0265021508003761","article-title":"Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty.","volume":"25","author":"F Richa","year":"2008","journal-title":"Eur J Anaesthesiol"},{"key":"pone.0278846.ref025","first-page":"2305","article-title":"Comparison between remifentanil and dexmedetomidine for controlled hypotension in endoscopie sinus surgery","volume":"14","author":"K Xu","year":"2014","journal-title":"J Pract Med"},{"key":"pone.0278846.ref026","first-page":"1048","article-title":"Observation of the effect of sevoflurane compounded with remifentanil or dexmedetomidine in functional nasal endoscopic sinus surgery anesthesia","volume":"52","author":"WG Zhan","year":"2017","journal-title":"Jiangxi Med"},{"key":"pone.0278846.ref027","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1177\/1945892420927291","article-title":"Effectiveness comparison of dexmedetomidine and remifentanil for perioperative management in patients undergoing endoscopic sinus surgery","volume":"34","author":"H Huh","year":"2020","journal-title":"Am J Rhinol Allergy"},{"key":"pone.0278846.ref028","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/S0952-8180(00)00185-9","article-title":"Effectiveness of remifentanil versus traditional fentanyl-based anesthetic in high-risk outpatient surgery","volume":"12","author":"JJ Mackey","year":"2000","journal-title":"J Clin Anesth"},{"issue":"4Suppl: 7","key":"pone.0278846.ref029","article-title":"A review of the pharmacokinetics and pharmacodynamics of remifentanil.","volume":"89","author":"PSA Glass","year":"1999","journal-title":"Anesth Analg."},{"key":"pone.0278846.ref030","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/00000542-200008000-00016","article-title":"The effects of increasing plasma concentrations of dexmedetomidine in humans","volume":"93","author":"TJ Ebert","year":"2000","journal-title":"Anesthesiology"},{"key":"pone.0278846.ref031","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1097\/00000542-199212000-00014","article-title":"Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes","volume":"77","author":"BC Bloor","year":"1992","journal-title":"Anesthesiology"},{"key":"pone.0278846.ref032","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1186\/s13019-020-01339-0","article-title":"Effect of remifentanil-based fast-track anesthesia on postoperative analgesia and sedation in adult patients undergoing transthoracic device closure of ventricular septal defect.","volume":"15","author":"N Xu","year":"2020","journal-title":"J Cardiothorac Surg"},{"issue":"4","key":"pone.0278846.ref033","article-title":"Inpatient experience with remifentanil.","volume":"89","author":"F Camu","year":"1999","journal-title":"Anesth Analg."},{"key":"pone.0278846.ref034","doi-asserted-by":"crossref","first-page":"323","DOI":"10.4097\/kja.19259","article-title":"Dexmedetomidine: Present and future directions.","volume":"72","author":"S. Lee","year":"2019","journal-title":"Korean J Anesthesiol"},{"key":"pone.0278846.ref035","first-page":"112","article-title":"Effect of intravenously administered dexmedetomidine on pain after laparoscopic tubal ligation","volume":"73","author":"MS Aho","year":"1991","journal-title":"Anesth Analg"},{"key":"pone.0278846.ref036","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/jcpt.12793","article-title":"Comparison of sedation with dexmedetomidine vs propofol during hysteroscopic surgery: Single-centre randomized controlled trial","volume":"44","author":"T Bingol Tanriverdi","year":"2019","journal-title":"J Clin Pharm Ther"},{"key":"pone.0278846.ref037","first-page":"253","article-title":"Post\u2013operative nausea and vomiting (PONV): A review Article.","volume":"48","author":"S Islam","year":"2004","journal-title":"Indian J Anaesth"},{"key":"pone.0278846.ref038","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jss.2015.03.011","article-title":"Parecoxib for the prevention of shivering after general anesthesia","volume":"197","author":"H Shen","year":"2015","journal-title":"J Surg Res"},{"key":"pone.0278846.ref039","first-page":"313","article-title":"Incidence of hypotension and bradycardia during integrated epidural\/general anesthesia. An epidemiologic observational study on 1200 consecutive patients. Italian Study Group on Integrated Anesthesia.","volume":"64","author":"G Fanelli","year":"1998","journal-title":"Minerva Anestesiol."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0278846","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T03:58:44Z","timestamp":1674014324000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0278846"}},"subtitle":[],"editor":[{"given":"Shweta Rahul","family":"Yemul Golhar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,1,17]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0278846","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,17]]}}}