Non-Cochrane · intervention · PM41928215
Efficacy and safety of dexmedetomidine in orthognathic surgery: a systematic review and meta-analysis.
Molhem Ahmad M, Qasem Hanan M, Aldalati Abdullah Yousef, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-08177-x
Findings
Population Patients undergoing orthognathic surgery
55 findings
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Heart rate (bpm) Intraoperative · Leave-one-out sensitivity analysis: omitting Sumphaongern 2025 | MD -14.74 [-30.99, 1.51] GRADE not reported 3 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Operation time (min) Intraoperative · Leave-one-out sensitivity analysis: omitting Jin 2021 | MD -8.72 [-57.83, 40.39] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Anesthesia time (min) Intraoperative | MD -40.75 [-74.21, -7.29] GRADE not reported 4 studies · 192 participants |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Intraoperative blood loss (mL) Intraoperative · Leave-one-out sensitivity analysis: omitting Shin 2013 | MD -120.36 [-408.26, 167.53] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Intraoperative blood loss (mL) Intraoperative | MD -119.13 [-333.17, 94.92] GRADE not reported 6 studies · 1302 participants |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Intraoperative blood loss (mL) Intraoperative · Leave-one-out sensitivity analysis: omitting Hsiao 2025 | MD -101.63 [-378.88, 175.63] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Operation time (min) Intraoperative · Leave-one-out sensitivity analysis: omitting Shin 2013 | MD 0.78 [-35.78, 37.34] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Mean arterial pressure (mmHg) Intraoperative · Leave-one-out sensitivity analysis: omitting Sumphaongern 2025 | MD -0.64 [-3.39, 2.10] GRADE not reported 3 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Operation time (min) Intraoperative · Leave-one-out sensitivity analysis: omitting Hsiao 2025 | MD -1.09 [-37.77, 35.60] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Intraoperative blood loss (mL) Intraoperative · Leave-one-out sensitivity analysis: omitting Goswami 2021 | MD -157.46 [-414.57, 99.66] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Operation time (min) Intraoperative · Leave-one-out sensitivity analysis: omitting Rummasak 2014 | MD -7.31 [-54.48, 39.86] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Blood transfusion events Intraoperative | RR 0.60 [0.10, 3.55] GRADE not reported 4 studies · 1200 participants |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Mean arterial pressure (mmHg) Intraoperative · Leave-one-out sensitivity analysis: omitting Jin 2021 | MD -3.14 [-13.80, 7.51] GRADE not reported 3 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Intraoperative blood loss (mL) Intraoperative · Leave-one-out sensitivity analysis: omitting Jin 2021 | MD -134.32 [-420.78, 152.14] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Fentanyl consumption (mg) Intraoperative | MD -7.33 [-38.53, 23.87] GRADE not reported 3 studies · 1150 participants |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Intraoperative blood loss (mL) Intraoperative · Leave-one-out sensitivity analysis: omitting Rummasak 2014 | MD -153.43 [-401.92, 95.06] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Operation time (min) Intraoperative · Leave-one-out sensitivity analysis: omitting Goswami 2021 | MD -14.08 [-47.02, 18.86] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Anesthesia time (min) Intraoperative · Leave-one-out sensitivity analysis: omitting Rummasak 2014 | MD -49.40 [-67.74, -31.06] GRADE not reported 3 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Anesthesia time (min) Intraoperative · Leave-one-out sensitivity analysis: omitting Sumphaongern 2025 | MD -34.00 [-92.19, 24.18] GRADE not reported 3 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Mean arterial pressure (mmHg) Intraoperative · Leave-one-out sensitivity analysis: omitting Hsiao 2025 | MD -2.62 [-13.71, 8.48] GRADE not reported 3 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Operation time (min) Intraoperative | MD -7.24 [-42.50, 28.03] GRADE not reported 6 studies · 1302 participants |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Operation time (min) Intraoperative · Leave-one-out sensitivity analysis: omitting Labafchi 2023 | MD -12.22 [-57.98, 33.54] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Anesthesia time (min) Intraoperative · Leave-one-out sensitivity analysis: omitting Hsiao 2025 | MD -37.66 [-96.07, 20.74] GRADE not reported 3 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Intraoperative blood loss (mL) Intraoperative · Leave-one-out sensitivity analysis: omitting Sumphaongern 2025 | MD -55.38 [-195.01, 84.25] GRADE not reported 5 studies |
| Dexmedetomidine (sole hypotensive agent or add-on adjuvant) | Any control (hypotensive agents, sedatives, placebo or standard anesthesia) | Mean arterial pressure (mmHg) Intraoperative · Leave-one-out sensitivity analysis: omitting Shin 2013 | MD -3.52 [-12.81, 5.77] GRADE not reported 3 studies · 1170 participants |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Heart rate (bpm) Intraoperative · Leave-one-out sensitivity analysis: omitting Hsiao 2025 | MD -12.54 [-31.80, 6.73] GRADE not reported 3 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Anesthesia time (min) Intraoperative · Leave-one-out sensitivity analysis: omitting Shin 2013 | MD -38.80 [-108.36, 30.77] GRADE not reported 3 studies |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Mean arterial pressure (mmHg) Intraoperative | MD -2.47 [-8.26, 3.31] GRADE not reported 4 studies · 1232 participants |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Nausea/vomiting events Intraoperative | RR 0.22 [0.00, 10990.43] GRADE not reported 2 studies · 120 participants |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Heart rate (bpm) Intraoperative | MD -12.99 [-23.23, -2.75] GRADE not reported 4 studies · 1232 participants |
| Dexmedetomidine (sole hypotensive agent or add-on adjuvant) | Any control (hypotensive agents, sedatives, placebo or standard anesthesia) | Heart rate (bpm) Intraoperative · Leave-one-out sensitivity analysis: omitting Shin 2013 | MD -9.95 [-18.67, -1.24] GRADE not reported 3 studies · 1170 participants |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Hypotension events Intraoperative | RR 0.85 [0.00, 3205.80] GRADE not reported 2 studies · 90 participants |
| Dexmedetomidine (sole hypotensive agent or add-on) | Any control (hypotensive agents, sedatives, placebo or standard care) | Heart rate (bpm) Intraoperative · Leave-one-out sensitivity analysis: omitting Jin 2021 | MD -14.58 [-32.01, 2.85] GRADE not reported 3 studies |
| Dexmedetomidine | Hypotensive agents (nicardipine, nitroglycerin, clonidine, saline with labetalol) | Intraoperative blood loss (mL) Intraoperative · Control type: hypotensive agents | MD -127.48 [-549.41, 294.45] GRADE not reported 4 studies · 171 participants |
| Dexmedetomidine | Hypotensive agents (nicardipine, nitroglycerin, clonidine, saline with labetalol) | Heart rate (bpm) Intraoperative · Control type: hypotensive agents | MD -26.16 [-262.69, 210.36] GRADE not reported 2 studies · 101 participants |
| Dexmedetomidine | Hypotensive agents (nicardipine, nitroglycerin, clonidine, saline with labetalol) | Anesthesia time (min) Intraoperative · Control type: hypotensive agents | MD -34.87 [-97.00, 27.26] GRADE not reported 3 studies · 141 participants |
| Dexmedetomidine | Hypotensive agents (nicardipine, nitroglycerin, clonidine, saline with labetalol) | Operation time (min) Intraoperative · Control type: hypotensive agents | MD -0.20 [-104.50, 104.09] GRADE not reported 3 studies · 111 participants |
| Dexmedetomidine | Hypotensive agents (nicardipine, nitroglycerin, clonidine, saline with labetalol) | Mean arterial pressure (mmHg) Intraoperative · Control type: hypotensive agents | MD -3.60 [-58.19, 50.99] GRADE not reported 2 studies · 101 participants |
| Dexmedetomidine as sole hypotensive agent | Any control | Operation time (min) Intraoperative · Dexmedetomidine role: sole | MD -3.70 [-114.17, 106.76] GRADE not reported 3 studies · 132 participants |
| Dexmedetomidine as sole hypotensive agent | Any control | Anesthesia time (min) Intraoperative · Dexmedetomidine role: sole | MD -27.28 [-256.27, 201.71] GRADE not reported 2 studies · 102 participants |
| Dexmedetomidine as sole hypotensive agent | Any control | Intraoperative blood loss (mL) Intraoperative · Dexmedetomidine role: sole | MD -5.63 [-287.37, 276.11] GRADE not reported 3 studies · 132 participants |
| Dexmedetomidine as add-on adjuvant | Any control | Intraoperative blood loss (mL) Intraoperative · Dexmedetomidine role: add-on | MD -242.99 [-786.79, 300.82] GRADE not reported 3 studies · 1170 participants |
| Dexmedetomidine as add-on adjuvant | Any control | Operation time (min) Intraoperative · Dexmedetomidine role: add-on | MD -6.73 [-78.78, 65.32] GRADE not reported 3 studies · 1170 participants |
| Dexmedetomidine as add-on adjuvant | Any control | Mean arterial pressure (mmHg) Intraoperative · Dexmedetomidine role: add-on | MD -3.52 [-12.81, 5.77] GRADE not reported 3 studies · 1170 participants |
| Dexmedetomidine as add-on adjuvant | Any control | Anesthesia time (min) Intraoperative · Dexmedetomidine role: add-on | MD -54.78 [-56.48, -53.08] GRADE not reported 2 studies · 90 participants |
| Dexmedetomidine as add-on adjuvant | Any control | Heart rate (bpm) Intraoperative · Dexmedetomidine role: add-on | MD -9.95 [-18.67, -1.24] GRADE not reported 3 studies · 1170 participants |
| Dexmedetomidine | Any control | Operation time (min) Intraoperative · Study design: RCTs | MD 0.30 [-57.40, 58.00] GRADE not reported 4 studies · 192 participants |
| Dexmedetomidine | Any control | Anesthesia time (min) Intraoperative · Study design: RCTs | MD -37.66 [-96.07, 20.74] GRADE not reported 3 studies · 162 participants |
| Dexmedetomidine | Any control | Mean arterial pressure (mmHg) Intraoperative · Study design: RCTs | MD -3.66 [-57.30, 49.97] GRADE not reported 2 studies · 122 participants |
| Dexmedetomidine | Any control | Intraoperative blood loss (mL) Intraoperative · Study design: RCTs | MD -115.02 [-533.05, 303.00] GRADE not reported 4 studies · 192 participants |
| Dexmedetomidine | Any control | Heart rate (bpm) Intraoperative · Study design: RCTs | MD -14.59 [-103.41, 74.22] GRADE not reported 2 studies · 122 participants |
| Dexmedetomidine | Any control | Mean arterial pressure (mmHg) Intraoperative · Study design: observational studies | MD -1.04 [-7.56, 5.48] GRADE not reported 2 studies · 1110 participants |
| Dexmedetomidine | Any control | Intraoperative blood loss (mL) Intraoperative · Study design: observational studies | MD -117.99 [-1068.42, 832.44] GRADE not reported 2 studies · 1110 participants |
| Dexmedetomidine | Any control | Operation time (min) Intraoperative · Study design: observational studies | MD -22.47 [-342.23, 297.30] GRADE not reported 2 studies · 1110 participants |
| Dexmedetomidine | Any control | Heart rate (bpm) Intraoperative · Study design: observational studies | MD -11.17 [-48.15, 25.81] GRADE not reported 2 studies · 1110 participants |
Included primary studies 16
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Goswami 2021 Comparison of Efficacy of Dexmedetomidine and Clonidine Infusion to Produce Hypotensive Anesthesia in Patients Undergoing Orthognathic… DOI:10.1016/j.joms.2021.06.035 | 2022 | this review only | not stated | not extracted yet |
| Goswami 2021 Comparison of Efficacy of Dexmedetomidine and Clonidine Infusion to Produce Hypotensive Anesthesia in Patients Undergoing Orthognathic… PMID:34339618 | 2022 | this review only | not stated | not extracted yet |
| Ham 2014 Dexmedetomidine does not reduce emergence agitation in adults following orthognathic surgery DOI:10.1111/aas.12379 | 2014 | this review only | not stated | not extracted yet |
| Ham 2014 Dexmedetomidine does not reduce emergence agitation in adults following orthognathic surgery. PMID:25132201 | 2014 | this review only | not stated | not extracted yet |
| Hsiao 2025 Dexmedetomidine infusion on blood loss in orthognathic surgery: A retrospective study on its efficacy DOI:10.1016/j.jfma.2025.02.009 | 2026 | this review only | not stated | not extracted yet |
| Hsiao 2025 Dexmedetomidine infusion on blood loss in orthognathic surgery: A retrospective study on its efficacy. PMID:39952888 | 2026 | this review only | not stated | not extracted yet |
| Jin 2021 Effect of continuous infusion of dexmedetomidine on blood loss in orthognathic surgery: a retrospective study DOI:10.1186/s40001-021-00551-5 | 2021 | this review only | not stated | not extracted yet |
| Jin 2021 Effect of continuous infusion of dexmedetomidine on blood loss in orthognathic surgery: a retrospective study. PMID:34284825 | 2021 | this review only | not stated | not extracted yet |
| Labafchi 2023 The Beneficial Effect of Preoperative Dexmedetomidine in Controlling Postoperative Pain, Nausea, and Vomiting After Orthognathic Surgery:… DOI:10.1016/j.joms.2023.04.014 | 2023 | this review only | not stated | not extracted yet |
| Labafchi 2023 The Beneficial Effect of Preoperative Dexmedetomidine in Controlling Postoperative Pain, Nausea, and Vomiting After Orthognathic Surgery:… PMID:37209710 | 2023 | this review only | not stated | not extracted yet |
| Rummasak 2014 Evaluation of the Advantageous Anesthetic Properties of Dexmedetomidine Used as Hypotensive Agent Compared With Nitroglycerin in… DOI:10.1016/j.joms.2014.07.026 | 2014 | this review only | not stated | not extracted yet |
| Rummasak 2014 Evaluation of the advantageous anesthetic properties of dexmedetomidine used as hypotensive agent compared with nitroglycerin in… PMID:25308408 | 2014 | this review only | not stated | not extracted yet |
| Shin 2013 Heart rate variability dynamics during controlled hypotension with nicardipine, remifentanil and dexmedetomidine DOI:10.1111/aas.12233 | 2013 | this review only | not stated | not extracted yet |
| Shin 2013 Heart rate variability dynamics during controlled hypotension with nicardipine, remifentanil and dexmedetomidine. PMID:24261345 | 2014 | this review only | not stated | not extracted yet |
| Sumphaongern 2025 Effect of Dexmedetomidine on Blood Loss and Patient Outcomes in Orthognathic Surgery: A Randomised Clinical Trial DOI:10.1016/j.identj.2025.01.009 | 2025 | this review only | not stated | not extracted yet |
| Sumphaongern 2025 Effect of Dexmedetomidine on Blood Loss and Patient Outcomes in Orthognathic Surgery: A Randomised Clinical Trial. PMID:39880716 | 2025 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients undergoing orthognathic surgery | Orthognathic surgery patients (n=1432; 704 dexmedetomidine, 728 control) |
| Intervention | Dexmedetomidine as sole hypotensive agent or add-on adjuvant | Dexmedetomidine sole (n=4 comparisons) or add-on (n=4) in orthognathic surgery |
| Comparison | Any comparator: other sedative agents, specific hypotensive agents (nitroglycerin, clonidine), placebo or routine standard anesthetic management | Nitroglycerin, clonidine, nicardipine, remifentanil, labetalol/normal saline, placebo or standard anesthesia |
| Outcomes | Intraoperative blood loss, operation time, anesthesia time, postoperative recovery time, adverse events; primary: blood loss, anesthesia time, operation time, MAP, heart rate; secondary: fentanyl consumption, nausea/vomiting, bradycardia, hypotension | Blood loss (n=6), anesthesia time (n=4), operation time (n=6), MAP (n=4), HR (n=4), fentanyl (n=3), blood transfusion (n=4), hypotension (n=2), nausea/vomiting (n=2) |
| Study designs | RCTs and observational studies | 6 RCTs and 2 cohort studies (n=8) |
| Timing | Not specified | Not specified |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Partial Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |