{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T18:23:46Z","timestamp":1780079026445,"version":"3.54.0"},"reference-count":70,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>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 <jats:italic>P<\/jats:italic> &lt; .05 was considered statistically significant. Heterogeneity was quantified using the I<jats:sup>2<\/jats:sup> statistic. Subgroup analyses exploring different drug regimens were performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Dexmedetomidine blunts the hemodynamic response to TI more effectively vs esmolol.<\/jats:p>\n<\/jats:sec>","DOI":"10.2344\/23-0059","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:02:28Z","timestamp":1742860948000},"page":"9-23","source":"Crossref","is-referenced-by-count":2,"title":["Effects of Dexmedetomidine vs Esmolol on Postintubation Hemodynamics: A Meta-Analysis"],"prefix":"10.2344","volume":"72","author":[{"given":"Abbass","family":"Saleh","sequence":"first","affiliation":[{"name":"Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy","family":"Kan","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonica","family":"Singhal","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aviv","family":"Ouanounou","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Wong","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1191","reference":[{"issue":"2","key":"i1878-7177-72-1-9-b01","series-title":"J Clin Anesth","first-page":"132","article-title":"Hemodynamic and catecholamine response to tracheal intubation: direct laryngoscopy compared with fiberoptic intubation","volume":"15","author":"Barak M,","year":"2003","unstructured":"Barak M,\nZiser A,\nGreenberg A,\nLischinsky S,\nRosenberg B. 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Open Access Maced J Med Sci. 2018;6(11):2045\u20132050."},{"key":"i1878-7177-72-1-9-b16","series-title":"Can J Anaesth","first-page":"849","article-title":"Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian Multicentre Trial","volume":"38","author":"Miller DR,","year":"1991","unstructured":"Miller DR,\nMartineau RJ,\nWynands JE,\nHill J. Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian Multicentre Trial. Can J Anaesth. 1991;38:849\u2013858."},{"key":"i1878-7177-72-1-9-b17","article-title":"Esmolol","author":"Pevtsov A,","year":"2023","unstructured":"Pevtsov A,\nKerndt CC,\nAhmed I, et al. Esmolol. [Updated July 30, 2023]. Treasure Island, FL: StatPearls Publishing; 2023. 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Acta Anaesthesiol Scand. 2001;45(8):1011\u20131022."},{"key":"i1878-7177-72-1-9-b20","series-title":"Anesthesiol Res Pract","first-page":"236089","article-title":"The effect of prophylactic dexmedetomidine on hemodynamic disturbances to double-lumen endotracheal intubation: a prospective, randomized, double-blind, and placebo-controlled trial","volume":"2013","author":"Pipanmekaporn T,","year":"2013","unstructured":"Pipanmekaporn T,\nPunjasawadwong Y,\nCharuluxananan S,\nLapisatepun W,\nBunburaphong P. The effect of prophylactic dexmedetomidine on hemodynamic disturbances to double-lumen endotracheal intubation: a prospective, randomized, double-blind, and placebo-controlled trial. Anesthesiol Res Pract. 2013;2013:236089."},{"issue":"2","key":"i1878-7177-72-1-9-b21","series-title":"Anesth Essays Res","first-page":"128","article-title":"Current role of dexmedetomidine in clinical anesthesia and intensive care","volume":"5","author":"Kaur M,","year":"2011","unstructured":"Kaur M,\nSingh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res. 2011;5(2):128\u2013133."},{"issue":"8","key":"i1878-7177-72-1-9-b22","series-title":"Clin Pharmacokinet","first-page":"893","article-title":"Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine","volume":"56","author":"Weerink MA,","year":"2017","unstructured":"Weerink MA,\nStruys MM,\nHannivoort LN,\nBarends CR,\nAbsalom AR,\nColin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. 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Adv Anesthesia. 2006;24:177\u2013192."},{"key":"i1878-7177-72-1-9-b25","series-title":"J Clin Anesth","first-page":"110287","article-title":"Effect of dexmedetomidine on hemodynamic responses to tracheal intubation: A meta-analysis with meta-regression and trial sequential analysis","volume":"72","author":"De Cassai A,","year":"2021","unstructured":"De Cassai A,\nBoscolo A,\nGeraldini F, et al. Effect of dexmedetomidine on hemodynamic responses to tracheal intubation: A meta-analysis with meta-regression and trial sequential analysis. J Clin Anesth. 2021;72:110287."},{"key":"i1878-7177-72-1-9-b26","series-title":"Biomed Res Int","first-page":"6791971","article-title":"Comparison of intravenous dexmedetomidine versus esmolol for attenuation of hemodynamic response to tracheal intubation after rapid sequence induction: a systematic review and meta-analysis","volume":"2019","author":"Li Z,","year":"2019","unstructured":"Li Z,\nXu L,\nZheng J,\nWang Q. 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Ann Card Anaesth. 2012;15(1):39\u201343."},{"issue":"1","key":"i1878-7177-72-1-9-b35","series-title":"Perspective Med Res","first-page":"23","article-title":"The effect of dexmedetomidine versus esmolol on attenuation of stress response to endotracheal intubation in patients undergoing elective off pump coronary artery bypass grafting","volume":"4","author":"Mudgalkar N,","year":"2016","unstructured":"Mudgalkar N,\nReddy KR,\nRamprasad LS. The effect of dexmedetomidine versus esmolol on attenuation of stress response to endotracheal intubation in patients undergoing elective off pump coronary artery bypass grafting. 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Prospective randomized comparative trial of dexmedetomidine versus esmolol for attenuation of extubation response. Med J Dr DY Patil Univ. 2019;12(2):131\u2013135."},{"key":"i1878-7177-72-1-9-b39","article-title":"Comparative evaluation of dexmedetomidine and esmolol for attenuation of intubation stress response in well controlled hypertensive patients\u2013a double-blind randomized control study","author":"Amutharani R,","year":"2019","unstructured":"Amutharani R,\nSukumaran M,\nVijayanand G. Comparative evaluation of dexmedetomidine and esmolol for attenuation of intubation stress response in well controlled hypertensive patients\u2013a double-blind randomized control study. 2019. 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Efficacy of dexmedetomidine and esmolol for attenuation of cardiovascular response during laryngoscopy and endotracheal intubation in cases with controlled hypertension. IJMA. 2020;3(1):261\u2013263."},{"issue":"2","key":"i1878-7177-72-1-9-b42","series-title":"Int J Basic Clin Pharmacol","first-page":"306","article-title":"Comparative assessment of efficacy of lignocaine (1.5 mg\/kg), esmolol (300 \u00b5g\/kg), and dexmedetomidine (0.5 \u00b5g\/kg) in minimizing the pressor response to laryngoscopy and intubation","volume":"4","author":"Dass P,","year":"2015","unstructured":"Dass P,\nGulabani M,\nPatil BV,\nVardhamane SH. Comparative assessment of efficacy of lignocaine (1.5 mg\/kg), esmolol (300 \u00b5g\/kg), and dexmedetomidine (0.5 \u00b5g\/kg) in minimizing the pressor response to laryngoscopy and intubation. Int J Basic Clin Pharmacol. 2015;4(2):306."},{"key":"i1878-7177-72-1-9-b43","series-title":"Int J Sci Res","first-page":"59","article-title":"Comparative evaluation of dexmedetomidine and esmolol for attenuation of hemodynamic response to laryngoscopy and intubation in adult patients undergoing elective general surgery: a prospective, randomized double-blinded study","volume":"9","author":"Dixit A,","year":"2020","unstructured":"Dixit A,\nTiwari M. Comparative evaluation of dexmedetomidine and esmolol for attenuation of hemodynamic response to laryngoscopy and intubation in adult patients undergoing elective general surgery: a prospective, randomized double-blinded study. 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Indian J Clin Anaesth. 2019;6(4):576\u2013580."},{"issue":"6","key":"i1878-7177-72-1-9-b57","series-title":"Eur J Anaesthesiol","first-page":"517","article-title":"A comparison of esmolol and dexmedetomidine for attenuation of intraocular pressure and haemodynamic responses to laryngoscopy and tracheal intubation","volume":"25","author":"Yavascaoglu B,","year":"2008","unstructured":"Yavascaoglu B,\nKaya FN,\nBaykara M,\nBozkurt M,\nKorkmaz S. A comparison of esmolol and dexmedetomidine for attenuation of intraocular pressure and haemodynamic responses to laryngoscopy and tracheal intubation. Eur J Anaesthesiol. 2008;25(6):517\u2013519."},{"key":"i1878-7177-72-1-9-b58","series-title":"Benumof and Hagberg\u2019s Airway Management","first-page":"184","article-title":"Physiologic and pathophysiologic responses to intubation","author":"Joffe AM,","year":"2013","unstructured":"Joffe AM,\nDeem SA. Physiologic and pathophysiologic responses to intubation. In: \nHagberg CA,\nGabel JC, eds. 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Haemodynamic and electroencephalograph responses to intubation during induction with propofol or propofol\/fentanyl. Can J Anaesth. 1998;45:19\u201322."},{"issue":"2","key":"i1878-7177-72-1-9-b61","series-title":"Br J Anaesth","first-page":"126","article-title":"Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and perioperative fentanyl","volume":"68","author":"Scheinin B,","year":"1992","unstructured":"Scheinin B,\nLindgren L,\nRandell T,\nScheinin H,\nScheinin M. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and perioperative fentanyl. Br J Anaesth. 1992;68(2):126\u2013131."},{"key":"i1878-7177-72-1-9-b62","article-title":"Physiology, Myocardial Oxygen Demand","author":"Boyette LC,","year":"2023","unstructured":"Boyette LC,\nManna B. Physiology, Myocardial Oxygen Demand. [Updated July 4, 2023]. Treasure Island, FL: StatPearls Publishing; 2023. 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