Effects of Dexmedetomidine Use on the Renal Function of Elderly Patients Undergoing Laparoscopic Surgery: A Systematic Review and Meta-Analysis.

Abstract

Postoperative acute renal injury (ARI) is a common complication found in patients after laparoscopic surgery. This study aims to review the literature systematically to check the effect of dexmedetomidine (DEX) on ARI. A systematic review was conducted, encompassing abstracts published from January 2016 to August 2024, focusing on patients aged 60 years or older undergoing laparoscopic surgery. The focus of this study was on dexmedetomidine, which was used alone or with other anesthetics during the time around surgery, at any dose. The comparator of interest was a placebo or any perioperative medication used for the same purpose. ARI, urinary output, and length of stay (LOS) were the outcomes of interest. The studies of interest were clinical trials. Remote database searches were performed at PubMed, SCOPUS, Web of Science, Embase, and Cochrane, as well as full manuscript bibliographies. The risk of bias was assessed with Cochrane's RoB2 and result confidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). We analyzed 13 studies. A consistent but not significant nephroprotective effect of DEX was observed. A neutral effect was observed in urinary output and LOS, and there is evidence of reporting bias for LOS. The confidence in these findings is either poor or moderate. The use of DEX in the elderly population undergoing laparoscopy surgeries did not reduce the LOS or urinary output, but there is moderate confidence that it has a potential nephroprotective effect.