The results of the current study indicated that application of TEAS helped to shorten the time to recall and extubation after surgery. TEAS also reduced the consumption of remifentanail, the incidence of PONV, cough and agitation during PACU, suggesting TEAS improve the quality of recovery after surgery. Which maybe be effective non-pharmacological measure to enhance recovery of surgical patients.
Clinical anesthesiologists have been using various methods, like optimizing intraoperative medication, residual anesthetics antagonizing, etc., to shorten the time to extubation after surgery. Although no consensus defined the definition of early extubation, it was supported by a large body of evidence showing that it was contributed to enhance recovery after surgery [18]. Multiple reasons affected the time to extubation, foremost among these were the usage of analgesics and sedatives [19]. But in order to meet the requirements of surgical procedures, it is necessary to maintain sufficient depth of anesthesia and level of analgesia and sedation, sometimes it’s difficult to find an optimal timing of discontinuation of medication. Naloxone is commonly used to antagonize residual opioids after surgery [20]. But its side effects involving multi-systems, like circulation, gastrointestinal, and central nervous system. So, its urger to find non-pharmacological measurements to early extubation after surgery.
TEAS is currently promoted by clinicians. TEAS helped to maintain the stability of the circulation, reduced the consumption of analgesics, provided sedation effects, etc. No available meta-analysis assessed the effectives of TEAS on the time to extubation and recovery quality after surgery. The included studies indicated that TEAS effectively shorten the time to extubation. But heterogeneity existed among the studies, the possible reasons maybe refer to the type of surgery, which determines the duration of surgery and anesthesia, and the usage of analgesics, deciding the time to extubation. Sensitivity analysis by dropping individual studies suggesting no influence existed on the total stability of the result. Additionally, TEAS shorten the time to recall, which played an important role in early extubation. Early in 2002, study found that TEAS provided analgesic effect as morphine [21], suggesting TEAS was an effective method to alleviate pain intensity, and cut-down the use of analgesics. The results indicated the consumption in TEAS group is markedly lower than that in control group, which may also contribute to shorten the time to extubation. Although extubation is a main step of anesthesia, serious adverse events may occur during this procedure, like PONV, cough and agitation, etc. We also assessed the adverse events. The results indicated that TEAS reduced the incidence of PONV, consistent with our previous meta-analysis [4]. Severe cough and agitation seriously affect the safety of extubation, bring life-threatening consequences, such as cardiac arrest and respiratory depression [22]. Two of included studies recorded the incidence of cough, as well as agitation during extubation. The results shown that TEAS reduced the incidence of cough and agitation during extubation, improving the safety of extubation after surgery. For TEAS is easy to operate, so it may not affect the surgical and anesthesia time.
Limitations
The findings in the meta-analysis should be interpreted with cautions because of the limitations, although TEAS shown superiority in shortening time to extubation. Firstly, all of the included studies were conducted in China, which proposed a certain impact on the reliability of these results. So, more studies involving different countries and race are needed to justified the results of the meta-analysis. Secondary, all included studies chose combined acupoints as target acupoints, whether there is a difference between single acupoint or combined acupoints, it still needs evidences. Thirdly, although TEAS shown positive benefits, it also accompanied with side effects, like itchiness, skin redness and swelling of the target acupoints. All of the included studies did not record these side effects. Lastly, the study did not follow the long-term effects of TEAS of extubation, for some patients may experience hoarseness, swelling and pain of the throat, etc. The study only assessed the effectiveness of TEAS on the time to extubation, but there is no prospective research specifically aimed at evaluating whether TEAS promotes early extubation. Therefore, more strictly designed prospective studies are needed to justify the results of this meta-analysis.