Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials
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 sear...
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Elsevier
2025-11-01
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| Series: | Brazilian Journal of Anesthesiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001425000752 |
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| author | Lucas Cael Azevedo Ramos Bendaham Altair Pereira de Melo Neto Hilária Saugo Faria André Richard da Silva Oliveira Filho Carlos Henrique de Oliveira Ferreira Marcela da Silva Kazitani Cunha Victor Gonçalves Soares Ocílio Ribeiro Gonçalves Milene Vitória Sampaio Sobral Mohamed Doma Denis Maltz Grutcki Fabrício Tavares Mendonça |
| author_facet | Lucas Cael Azevedo Ramos Bendaham Altair Pereira de Melo Neto Hilária Saugo Faria André Richard da Silva Oliveira Filho Carlos Henrique de Oliveira Ferreira Marcela da Silva Kazitani Cunha Victor Gonçalves Soares Ocílio Ribeiro Gonçalves Milene Vitória Sampaio Sobral Mohamed Doma Denis Maltz Grutcki Fabrício Tavares Mendonça |
| author_sort | Lucas Cael Azevedo Ramos Bendaham |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-643c548c426f40758e5c8e12a1d026da |
| institution | Kabale University |
| issn | 0104-0014 |
| language | English |
| publishDate | 2025-11-01 |
| publisher | Elsevier |
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| series | Brazilian Journal of Anesthesiology |
| spelling | doaj-art-643c548c426f40758e5c8e12a1d026da2025-08-20T03:44:36ZengElsevierBrazilian Journal of Anesthesiology0104-00142025-11-0175684465910.1016/j.bjane.2025.844659Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trialsLucas Cael Azevedo Ramos Bendaham0Altair Pereira de Melo Neto1Hilária Saugo Faria2André Richard da Silva Oliveira Filho3Carlos Henrique de Oliveira Ferreira4Marcela da Silva Kazitani Cunha5Victor Gonçalves Soares6Ocílio Ribeiro Gonçalves7Milene Vitória Sampaio Sobral8Mohamed Doma9Denis Maltz Grutcki10Fabrício Tavares Mendonça11Universidade Federal de Roraima, Boa Vista, RR, Brazil; Corresponding author.Universidade Federal de Roraima, Boa Vista, RR, BrazilUniversidade Federal de Santa Maria, Santa Maria, RS, BrazilUniversidade Federal da Paraíba, João Pessoa, PB, BrazilUniversidade Federal da Paraíba, João Pessoa, PB, BrazilSanta Casa de Misericórdia de Marília, Marília, SP, BrazilUniversidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, BrazilUniversidade Federal do Piauí, Teresina, PI, BrazilUniversidade do Oeste Paulista, Presidente Prudente, SP, BrazilAlexandria Faculty of Medicine, EgyptHCA Florida Health Care, Florida, United States of AmericaHospital de Base do Distrito Federal, Departamento de Anestesiologia, Brasilia, DF, BrazilBackground: 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.http://www.sciencedirect.com/science/article/pii/S0104001425000752Adrenergic beta-antagonistsAirway extubationComplicationsMeta-analysisRandomized controlled trials |
| spellingShingle | Lucas Cael Azevedo Ramos Bendaham Altair Pereira de Melo Neto Hilária Saugo Faria André Richard da Silva Oliveira Filho Carlos Henrique de Oliveira Ferreira Marcela da Silva Kazitani Cunha Victor Gonçalves Soares Ocílio Ribeiro Gonçalves Milene Vitória Sampaio Sobral Mohamed Doma Denis Maltz Grutcki Fabrício Tavares Mendonça Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials Brazilian Journal of Anesthesiology Adrenergic beta-antagonists Airway extubation Complications Meta-analysis Randomized controlled trials |
| title | Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials |
| title_full | Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials |
| title_short | Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials |
| title_sort | respiratory outcomes of adrenergic beta antagonists in patients undergoing tracheal extubation a systematic review and meta analysis of randomized controlled trials |
| topic | Adrenergic beta-antagonists Airway extubation Complications Meta-analysis Randomized controlled trials |
| url | http://www.sciencedirect.com/science/article/pii/S0104001425000752 |
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