Transcutaneous electrical acupoint stimulation shortens the time to extubation after surgery: a systemic review and meta-analysis

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The purpose of the study was to evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on the extubation time and adverse events after surgery. Methods The randomized controlled trials related to apply TEAS during perioperative period were searched in the database of Cochrane Library, PubMed, Web of Science, Embase, CNKI from the inception to Apil 2024. The main outcome was the extubation time after surgery, and the secondary outcomes were the consumption of analgesics, adverse events during extubation, time of surgery and anesthesia. Data were pooled and analyzed by RevMan 5.3 software. Results The study enrolled 9 studies, including 1039 participants. The current results indicated that the application of TEAS effectively shortened the extubation time after surgery (SMD − 0.55 95%-CI [-0.84; -0.26], P = 0.0002), as well as time to recall after surgery (SMD − 0.18 95%-CI [-0.32; -0.03], P = 0.02). TEAS also reduced the consumption of remifentanail during surgery (SMD − 1.15 95%-CI [-1.72, -0.59], P < 0.00001). In addition, TEAS reduced the incidence of PONV (RR 0.49, 95%-CI [0.32, 0.74], P = 0.007), cough (RR 0.53, 95%-CI [0.31, 0.90], P = 0.02) and agitation (RR 0.31, 95%-CI [0.14, 0.67], P = 0.003) during extubation period. While TEAS have no effects on surgical (SMD 0.12, 95%-CI [-0.01, 0.26], P = 0.07) and anesthesia time (SMD 0.15, 95%-CI [-0.15, 0.45], P = 0.32). Conclusions The study suggested that application of TEAS effectively shortened the time to extubation and recall after surgery. TEAS also reduce the consumption of analgesics, and adverse events after surgery, but have no effects on surgical and anesthesia time. Which may positively improve the enhanced recovery of patients after surgery. Trial registration CRD42018099275 transcutaneous electrical acupoint stimulation extubation anesthesia adverse event Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background Currently, with the rapid development of aging, more and more people may undergo one or more surgeries in their lifespan. Anesthesia ensures stability and safety of patients during surgery. Tracheal extubation after surgery is a main and maybe dangerous component during recovery period in Post Anesthesia Care Unit (PACU). Statistical displayed that about 20% complications of airway management occurred at the time of extubation, delayed the time to extubation may further increase the complications [ 1 ] . In addition, delayed extubation took up the limited medical resource, reduced the transportation efficiency of PACU [ 2 ] . Although personalized medication has helped shorten extubation time, many patients still experienced delayed extubation and its associated complications in clinical practice. There is currently lack of particularly effective methods for the management of delayed extubation, pharmacological treatment may bring other side effects. Thus, it is of great clinical significance to find other strategies to shorten the time to extubation, especially non- pharmacological methods. Transcutaneous electrical acupoint stimulation (TEAS) is a traditional Chinese medical treatment for various disease, has been attracted great attention from clinics currently [ 3 ] . Our previous meta-analysis indicated that perioperative application of TEAS obviously reduced the incidence of postoperative nausea and vomiting (PONV), a significant complication after surgery [ 4 ] . With the increasing emphasis on enhanced recovery after surgery (ERAS), rapid postoperative extubation after surgery may be a crucial step of ERAS, which promote the quality and safety of patients during anesthesia recovery [ 5 ] . Various reasons contributed to delayed extubation, like history of central nervous system’s diseases, chronic pulmonary disease, usage of sedatives and anesthetics, duration of surgery, etc. [ 6 , 7 ] . TEAS is non-invasive, easy to operate, and widely used during perioperative period. A recent meta-analysis suggested TEAS helped to improve the quality of recovery, reduced the postoperative pain [ 3 ] , which play an important role in ERAS. However, extubation as a main step after surgery, whether TEAS shorten the time to extubation and improve the quality of recovery is lack of adequate evidence, and there is no available meta-analysis focused on this. The present study aimed to explore the effect of TEAS on the time to extubation and adverse events during extubation. Methods The meta-analysis was registered in PROSPERO ( https://www.crd.york.ac.uk , registration No. CRD42023433959). 2.1 Literature search We conducted a comprehensive search based on the criteria in Cochrane Library, PubMed, Web of Science, Embase, CNKI database from the inception to Apil 2024. The search terms included terms associated with TEAS (including transcutaneous electrical acupoint stimulation, TEAS, transcutaneous acupoint electrical stimulation, TAES or acustimulation) and terms associated with extubation, enhanced recovery after surgery, adverse events during extubation period (including agitation, cough, delayed awake, etc.), without restrictions on dates, sex, or age, type of surgery and anesthesia, target acupoints of TEAS. We carefully searched the above terms in the titles and abstracts of potential relative papers. References of the retrieved researches, systemic reviews and meta-analysis were also reviewed for the underlying relevant studies. 2.2 Inclusion and exclusion criteria Two of the authors independently identified the eligibilities of searched articles based on the following inclusion: (1) article type of randomized controlled trial (RCT); (2) intervention in experimental group was TEAS and control group received sham TEAS; (3) articles assessed the effects of TEAS on extubation time, quality of recovery, adverse events during extubation. Exclusion criteria including (1) article type of comments, case reports, crossover studies, letters, editorials, review articles, meta-analysis and retrospective studies; (2) studies of animal experiments; (3) studies involving data that cannot be extracted or lacking of relevant data. If there any discrepancies of included articles, the disagreements could be resolved through discussion or consult to the corresponding author. 2.3 Quality assessment Two of the authors independently assessed quality of including studies in the meta-analysis. The Cochrane Risk of Bias Tool was also applied to evaluated the risk of bias of included studies under the following criteria: (1) random sequence generation, (2) allocation concealment, (3) participants and personnel blinding, (4) blinded assessment of outcomes, (5) information of incomplete outcome, (6) whether included selective reporting. 2.4 Data extraction Two of the authors independently performed data extraction, which was evaluated by another author. The information of extracted data of included study including: first author's name, year of publication, country of the trial, sample size, type of surgery and anesthesia, detailed information of TEAS intervention, outcomes of interest. We also try to contact the corresponding author for insufficient or missing data existed. The main outcome was the extubation time, the secondary outcomes included the consumption of analgesics, adverse events during extubation and time of surgery and anesthesia. 2.5 Statistical analysis Statistical analyses in the meta-analysis were performed by using Review Manager version 5.3 statistical software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark). For continuous variables was represented by weighted mean difference (WMD) with 95% confidence interval (CI), while risk ratio (RR) with 95% CI for dichotomous variables. Chi-square test and I 2 statistic were used to test the heterogeneity. If a P -value of heterogeneity ≤ 0.10 existed, the Mantel-Haenszel randomized effect model was used to evaluate the results. Otherwise, the Mantel-Haenszel fixed effect model was applied. A P -values ≤ 0.05 were regarded as statistically significant. Subgroup or sensitivity analysis was performed to evaluate the influence of individual studies on the total stability of the meta-analysis result. Results 3.1 Literature research Based on the perspectives and search strategy, we identified 367 potential studies in the initial literature search. However, 329 studies were excluded based on the criteria after reading their titles and abstracts. Thirty-one studies were assessed for eligibility, after carefully the full text, we finally included 10 studies for data analyzed. The flow diagram of the study shown in Fig. 1 . 3.2 Study characteristics We finally included 10 studies [ 8 – 17 ] , involving 1147 participants (576 in TEAS treatment group, and 571 in control group). All studies the combined acupoints as target acupoints for TEAS, all studies were conducted in China. The detailed characteristics of the included studies were summarized in Table 1 . Table 1 Characteristic of the included studies Authors, year Country Age Sample size Type of surgery Acupoints Details of intervention Li et al, 2023 [ 8 ] China 3 ~ 15 29/29 orthopedic surgery L14, PC6 Distant-dense wave with a frequency of 2/10 Hz from 10 min before the induction of anesthesia until the end of surgery Bai et al, 2017 [ 9 ] China 60–70 37/38 supratentorial craniotomy LI4, PC6, LU7, LU5, LI18, ST9 Alternate dense disperse frequency of 2/10Hz, intensity ranged from 6 to 15 mA. The stimulus continued until 5 min before the end of surgery. Sun et al, 2017 [ 10 ] China 18–70 91/90 LC, LG L14, PC6 Alternating dense and disperse stimulation at frequency of 2/100H for 30min preoperatively Huang et al, 2015 [ 11 ] China ? 20/20 VATS lobectomy LI4, PC6, LU7, LI11 Alternating dense and disperse stimulation at frequency of 2/100Hz for 30min before induction Lu et al, 2021 [ 12 ] China 18–65 188/190 radical mastectomy PC6, CV17 Alternating dense and disperse stimulation at frequency of 2/10Hz, 30min before induction Wang et al, 2012 [ 13 ] China 29–60 30/30 sinusotomy L14, PC6, ST36 Intensity of 6–9 mA and dense disperse frequency of 2/10 Hz for 30 min before induction Wu et al, 2022 [ 14 ] China 40–70 44/40 major SP ST36, SP6 Alternating dense and disperse model, 2/15Hz for 30 min before induction and then at 2/100Hz throughout the operation Xing et al, 2022 [ 15 ] China ≥ 60 29/29 LGCS L14, PC6, ST36 2/100 Hz density wave and actual electric stimuli for 30min before anesthesia Pan et al, 2023 [ 16 ] China 18–60 52/53 LM L14, PC6, ST36, SP6 Dilatational wave with a frequency of 2/100 HZ for 30 minutes before the operation and lasting until the end of anesthesia. Zhang et al, 2024 [ 17 ] China 18–65 54/54 LC HT7, PC4 Alternating dense and disperse model, 2/10Hz, 30 minutes before induction until the end of surgery Note: LC, laparoscopic cholecystectomy; LG, laparoscopic gynecological surgery; VATS, Video-assisted thoracic surgical; SP, spinal surgery; LGCS, laparoscopic gastric cancer surgery; LM, laparoscopic myomectomy. L14, Hegu; PC6, Neiguan; LU7, Lieque; LU5, Chize; LI18, Futu; ST9, Renying; LI11, Quchi; SP6, Sanyinjiao; CV17, Danzhong, HT7, Shenmen; PC4, Ximen. 3.3 Risk of bias assessment and sensitivity analysis For the 10 studies included in this meta-analysis, risk of bias assessment was made. Seven studies had detailed information of random sequence generation, 6 studies have mentioned detailed allocation concealment and blinding of participants and personnel. Eight studies in accord to principal of blinding outcome assessment. Seven studies had no incomplete outcome data and 9 studies without selective reporting. The risk of bias was shown in Fig. 2 . 3.4 TEAS shortened the time to extubation after surgery Ten included studies [ 8 – 17 ] recorded the time to extubation after surgery. Among the studies, there was heterogeneity existed ( I 2 = 80%). However, random effects model suggested that TEAS helped to shorten the time to extubation after surgery than control group (SMD − 0.55 95%-CI [-0.84; -0.26], P = 0.0002). Figure 3 . 3.5 TEAS accelerated the time to recall Early recall after surgery plays an important role in shortening the time to extubation. Five studies [ 9 , 12 , 13 , 16 , 17 ] recorded the time to recall after surgery. No significance existed of the time to recall between TEAS and control group ( I 2 = 49%). The result indicated that TEAS helped to accelerate the time to recall (SMD − 0.18 95%-CI [-0.32; -0.03], P = 0.02). Figure 4 . 3.6 TEAS reduced the consumption of remifentanail We known that the usage of analgesics intraoperatively may also play a role in delayed removal of extubation tube. So, we also analyzed the consumption of analgesics of propofol and remifentanail. Five included studies [ 9 , 11 , 13 , 14 , 17 ] recorded the intraoperative consumption of propofol, and 4 studies [ 9 , 11 , 13 , 14 ] recorded the usage of remifentanail. There was no significant difference between the consumption of propofol between TEAS and control group (SMD − 0.18 95%-CI [-0.69; 0.33], P = 0.49). However, the consumption of remifentanail in TEAS group was lower than that in control group (SMD − 1.15 95%-CI [-1.72, -0.59], P < 0.00001). Figure 5 . 3.7 TEAS reduced the incidence of adverse events during extubation Some adverse events may occur during extubation, like PONV, agitation and cough. Five included studies [ 8 , 9 , 11 , 13 , 15 ] documented the incidence of PONV, the result suggested that TEAS reduced the incidence of PONV (RR 0.49, 95%-CI [0.32, 0.74], P = 0.007), as our previous meta-analysis indicated [ 4 ] . Additionally, 2 included studies [ 9 , 16 ] recorded the incidence of cough, as well as agitation [ 8 , 9 ] during extubation. The results indicated that the incidence of cough (RR 0.53, 95%-CI [0.31, 0.90], P = 0.02) and agitation (RR 0.31, 95%-CI [0.14, 0.67], P = 0.003) during extubation period in TEAS group was lower than that in Control group. Figure 6 . 3.8 TEAS have no effects on surgical and anesthesia time The duration of surgical and anesthesia time may also have a role in extubation time. We analyzed the surgical and anesthesia time in this meta-analysis. Nine included studies [8-15, 17] recorded the surgical time, and 6 studies [9, 10, 12-14, 17] recorded the anesthesia time. The result suggested TEAS had no effects on surgical (SMD 0.12, 95%-CI [-0.01, 0.26], P = 0.07) and anesthesia time (SMD 0.15, 95%-CI [-0.15, 0.45], P = 0.32). Figure 7. Discussion 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. Conclusion In summary, application of TEAS perioperatively is a reasonable modality to incorporate into non-pharmacological approach for early extubation after surgery. It helps to reduce the consumption of analgesics, as well as the incidence of adverse events during extubation, promoted the quality and safety of extubation. For limitations mentioned above, more strictly designed, involving larger sample size and different races studies are needed to further prove the results of this meta-analysis. Declarations Author contributions L.H. and Q.T. contributed to conception and design of the study. Y.W. organized the database. Y. Z. and X.Z. performed the statistical analysis. Y.Z. and Q.T., L.W. wrote the first draft of the manuscript. Q.T. and L.H. were responsible for the supervision of the manuscript. All authors contributed to manuscript revision, read, and approved the finally submitted version. Data availability All data generated or analyzed during this study are included in this article. Conflicts of competing interest The authors declared that they had no conflict of interest. Ethical approval Not applicable. Sources of funding None Consent for publication Not applicable. References Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617-631. Gal J, Hunter S, Reich D, et al. Delayed extubation in spine surgery is associated with increased postoperative complications and hospital episode-based resource utilization. J Clin Anesth. 2022; 77:110636. Szmit M, Krajewski R, Rudnicki J, Agrawal S. 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Effect of Transcutaneous Electrical Acupoint Stimulation Combined with Transversus Abdominis Plane Block on Postoperative Recovery in Elderly Patients Undergoing Laparoscopic Gastric Cancer Surgery: A Randomized Controlled Trial. Pain Ther . 2022;11(4):1327-1339. Pan Y, Shao Y, Chi Z, Jin S, Wang J. Transcutaneous Electrical Acupoint Stimulation Accelerates the Recovery of Patients Undergoing Laparoscopic Myomectomy: A Randomized Controlled Trial. J Pain Res . 2023; 16:809-819. Zhang M, Cairen Z, Liu X, et al. Transcutaneous electric acupoint stimulation reduced consumption of profopol in patients undergoing laparoscopic surgery: A randomized clinical trial. Medicine (Baltimore) . 2024;103(4): e35730. Iguidbashian JP, Chang PH, Iguidbashian J, Lines J, Maxwell BG. Enhanced recovery and early extubation after pediatric cardiac surgery using single-dose intravenous methadone. Ann Card Anaesth . 2020;23(1):70-74. Mandell MS, Campsen J, Zimmerman M, Biancofiore G, Tsou MY. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4282264","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":295564373,"identity":"f8571a02-c380-4df0-9727-7deccf279589","order_by":0,"name":"Yushan Zhong","email":"","orcid":"","institution":"Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yushan","middleName":"","lastName":"Zhong","suffix":""},{"id":295564375,"identity":"313cd53c-fafe-4187-98c9-9a6b79af079b","order_by":1,"name":"Yabing Zhu","email":"","orcid":"","institution":"Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yabing","middleName":"","lastName":"Zhu","suffix":""},{"id":295564377,"identity":"784f7b6e-0182-4b82-8c2c-f9ff9959e7fe","order_by":2,"name":"Yufei Wang","email":"","orcid":"","institution":"Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yufei","middleName":"","lastName":"Wang","suffix":""},{"id":295564379,"identity":"01ccdd72-519e-4058-9890-f90fe032660b","order_by":3,"name":"Xiang Zhou","email":"","orcid":"","institution":"Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiang","middleName":"","lastName":"Zhou","suffix":""},{"id":295564381,"identity":"8d824286-87c7-4918-8501-1aa43e9773b8","order_by":4,"name":"Lu Wang","email":"","orcid":"","institution":"Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lu","middleName":"","lastName":"Wang","suffix":""},{"id":295564383,"identity":"def1e9eb-1f54-4151-b4ef-a9704fc15cf5","order_by":5,"name":"Qing Tu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYJCCAwwMEjxs7M0HDnz4QYRyHogWCzk+nmOJB2f2EKkFCCqM5SR8jA9zsBGhxV4ieePhgl8SiW0SPB8OA02Q5xc7QMAWibSCwzP7gFqkezccLrBgMJw5O4GQlhyDw7w9QC0yZzccnsHDkGBwm2gtEjkPDvOwEauF54eEMZtEDgORWs48KzjM2yAhx8ZzzAAYyBKE/cLenrz5M8+fOh759ubHHz78sJHnlyagBQgMGBjb4BwJgsohWhj+EKVwFIyCUTAKRioAADM+RLlifz4hAAAAAElFTkSuQmCC","orcid":"","institution":"Shanghai Jiao Tong University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Qing","middleName":"","lastName":"Tu","suffix":""},{"id":295564384,"identity":"febde28a-90e2-4f47-b4d2-fccf04b3473c","order_by":6,"name":"Lina Huang","email":"","orcid":"","institution":"Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lina","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2024-04-17 13:35:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4282264/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4282264/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55767002,"identity":"fb357ec2-52e3-46fc-ac64-76a28bc96223","added_by":"auto","created_at":"2024-05-02 20:13:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55161,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of study selection in the meta-analysis.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4282264/v1/df3afd2bbddc08f623c42ce2.png"},{"id":55767003,"identity":"77f162a3-b4d6-4fd2-b1e3-497f5e6ea32f","added_by":"auto","created_at":"2024-05-02 20:13:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":168644,"visible":true,"origin":"","legend":"\u003cp\u003ePotential risk of bias of included studies. \"+\" indicates low risk; \"?\" indicates unclear risk; \"-\" indicates high risk.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4282264/v1/24be5c82e4522085fcfa071c.png"},{"id":55765088,"identity":"68189d3f-6317-4412-a6d1-c9fcc630aaaf","added_by":"auto","created_at":"2024-05-02 20:05:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":179633,"visible":true,"origin":"","legend":"\u003cp\u003eForest plots comparing the time to extubation after surgery between TEAS and control groups. TEAS, transcutaneous electrical acupoint stimulation.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4282264/v1/66f0df1349730f6204f71ae8.png"},{"id":55765086,"identity":"e7f20a2d-2622-4beb-bab5-ecea00d743d4","added_by":"auto","created_at":"2024-05-02 20:05:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":78191,"visible":true,"origin":"","legend":"\u003cp\u003eForest plots comparing the time to recall after surgery between TEAS and control groups. TEAS, transcutaneous electrical acupoint stimulation.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4282264/v1/9410a3603cc5404dac07eb68.png"},{"id":55765085,"identity":"7e27de77-8be0-4ce4-8c17-99a22c39c74c","added_by":"auto","created_at":"2024-05-02 20:05:43","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":231869,"visible":true,"origin":"","legend":"\u003cp\u003eForest plots comparing the intraoperative consumption of propofol and remifentanail between TEAS and control groups. TEAS, transcutaneous electrical acupoint stimulation.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-4282264/v1/e2af63164c03730065e67485.png"},{"id":55765083,"identity":"21d3a680-5c61-4a22-ba39-5bea04363761","added_by":"auto","created_at":"2024-05-02 20:05:43","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":275183,"visible":true,"origin":"","legend":"\u003cp\u003eForest plots comparing the incidence of PONV, agitation and cough during extubation between TEAS and control groups. TEAS, transcutaneous electrical acupoint stimulation.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-4282264/v1/aabea8ef988ee47fc7bcc102.png"},{"id":55765087,"identity":"0371a544-1157-490a-821a-ed692161ceb0","added_by":"auto","created_at":"2024-05-02 20:05:43","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":302241,"visible":true,"origin":"","legend":"\u003cp\u003eForest plots comparing the surgical and anesthesia time between TEAS and control groups. TEAS, transcutaneous electrical acupoint stimulation.\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-4282264/v1/549da40ef2480638e2354c97.png"},{"id":62926328,"identity":"79f8f932-2a81-48eb-89a5-800a3289b28c","added_by":"auto","created_at":"2024-08-21 06:49:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1883055,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4282264/v1/c6b54bdf-b60b-4f8a-ac08-11bc3ab5024a.pdf"},{"id":55765079,"identity":"7ee74062-df6a-482e-9ced-13796948e9c9","added_by":"auto","created_at":"2024-05-02 20:05:43","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":65024,"visible":true,"origin":"","legend":"","description":"","filename":"PRISMA2009checklist.doc","url":"https://assets-eu.researchsquare.com/files/rs-4282264/v1/d6a74259b2d4205760e5e84f.doc"},{"id":55765081,"identity":"55fe3e99-97f0-4732-b2b7-b707ebb1b69b","added_by":"auto","created_at":"2024-05-02 20:05:43","extension":"doc","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":61952,"visible":true,"origin":"","legend":"","description":"","filename":"PRISMA2009flowdiagram.doc","url":"https://assets-eu.researchsquare.com/files/rs-4282264/v1/40870bf4736e1c62adb2964a.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transcutaneous electrical acupoint stimulation shortens the time to extubation after surgery: a systemic review and meta-analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eCurrently, with the rapid development of aging, more and more people may undergo one or more surgeries in their lifespan. Anesthesia ensures stability and safety of patients during surgery. Tracheal extubation after surgery is a main and maybe dangerous component during recovery period in Post Anesthesia Care Unit (PACU). Statistical displayed that about 20% complications of airway management occurred at the time of extubation, delayed the time to extubation may further increase the complications \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In addition, delayed extubation took up the limited medical resource, reduced the transportation efficiency of PACU \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Although personalized medication has helped shorten extubation time, many patients still experienced delayed extubation and its associated complications in clinical practice. There is currently lack of particularly effective methods for the management of delayed extubation, pharmacological treatment may bring other side effects. Thus, it is of great clinical significance to find other strategies to shorten the time to extubation, especially non- pharmacological methods.\u003c/p\u003e \u003cp\u003eTranscutaneous electrical acupoint stimulation (TEAS) is a traditional Chinese medical treatment for various disease, has been attracted great attention from clinics currently \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Our previous meta-analysis indicated that perioperative application of TEAS obviously reduced the incidence of postoperative nausea and vomiting (PONV), a significant complication after surgery \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. With the increasing emphasis on enhanced recovery after surgery (ERAS), rapid postoperative extubation after surgery may be a crucial step of ERAS, which promote the quality and safety of patients during anesthesia recovery \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Various reasons contributed to delayed extubation, like history of central nervous system\u0026rsquo;s diseases, chronic pulmonary disease, usage of sedatives and anesthetics, duration of surgery, etc. \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. TEAS is non-invasive, easy to operate, and widely used during perioperative period. A recent meta-analysis suggested TEAS helped to improve the quality of recovery, reduced the postoperative pain \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, which play an important role in ERAS. However, extubation as a main step after surgery, whether TEAS shorten the time to extubation and improve the quality of recovery is lack of adequate evidence, and there is no available meta-analysis focused on this. The present study aimed to explore the effect of TEAS on the time to extubation and adverse events during extubation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe meta-analysis was registered in PROSPERO (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.crd.york.ac.uk\u003c/span\u003e\u003cspan address=\"https://www.crd.york.ac.uk\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, registration No. CRD42023433959).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Literature search\u003c/h2\u003e \u003cp\u003eWe conducted a comprehensive search based on the criteria in Cochrane Library, PubMed, Web of Science, Embase, CNKI database from the inception to Apil 2024. The search terms included terms associated with TEAS (including transcutaneous electrical acupoint stimulation, TEAS, transcutaneous acupoint electrical stimulation, TAES or acustimulation) and terms associated with extubation, enhanced recovery after surgery, adverse events during extubation period (including agitation, cough, delayed awake, etc.), without restrictions on dates, sex, or age, type of surgery and anesthesia, target acupoints of TEAS. We carefully searched the above terms in the titles and abstracts of potential relative papers. References of the retrieved researches, systemic reviews and meta-analysis were also reviewed for the underlying relevant studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Inclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eTwo of the authors independently identified the eligibilities of searched articles based on the following inclusion: (1) article type of randomized controlled trial (RCT); (2) intervention in experimental group was TEAS and control group received sham TEAS; (3) articles assessed the effects of TEAS on extubation time, quality of recovery, adverse events during extubation. Exclusion criteria including (1) article type of comments, case reports, crossover studies, letters, editorials, review articles, meta-analysis and retrospective studies; (2) studies of animal experiments; (3) studies involving data that cannot be extracted or lacking of relevant data. If there any discrepancies of included articles, the disagreements could be resolved through discussion or consult to the corresponding author.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Quality assessment\u003c/h2\u003e \u003cp\u003eTwo of the authors independently assessed quality of including studies in the meta-analysis. The Cochrane Risk of Bias Tool was also applied to evaluated the risk of bias of included studies under the following criteria: (1) random sequence generation, (2) allocation concealment, (3) participants and personnel blinding, (4) blinded assessment of outcomes, (5) information of incomplete outcome, (6) whether included selective reporting.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data extraction\u003c/h2\u003e \u003cp\u003eTwo of the authors independently performed data extraction, which was evaluated by another author. The information of extracted data of included study including: first author's name, year of publication, country of the trial, sample size, type of surgery and anesthesia, detailed information of TEAS intervention, outcomes of interest. We also try to contact the corresponding author for insufficient or missing data existed. The main outcome was the extubation time, the secondary outcomes included the consumption of analgesics, adverse events during extubation and time of surgery and anesthesia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical analysis\u003c/h2\u003e \u003cp\u003e Statistical analyses in the meta-analysis were performed by using Review Manager version 5.3 statistical software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark). For continuous variables was represented by weighted mean difference (WMD) with 95% confidence interval (CI), while risk ratio (RR) with 95% CI for dichotomous variables. Chi-square test and \u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e statistic were used to test the heterogeneity. If a \u003cem\u003eP\u003c/em\u003e-value of heterogeneity\u0026thinsp;\u0026le;\u0026thinsp;0.10 existed, the Mantel-Haenszel randomized effect model was used to evaluate the results. Otherwise, the Mantel-Haenszel fixed effect model was applied. A \u003cem\u003eP\u003c/em\u003e-values\u0026thinsp;\u0026le;\u0026thinsp;0.05 were regarded as statistically significant. Subgroup or sensitivity analysis was performed to evaluate the influence of individual studies on the total stability of the meta-analysis result.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Literature research\u003c/h2\u003e \u003cp\u003eBased on the perspectives and search strategy, we identified 367 potential studies in the initial literature search. However, 329 studies were excluded based on the criteria after reading their titles and abstracts. Thirty-one studies were assessed for eligibility, after carefully the full text, we finally included 10 studies for data analyzed. The flow diagram of the study shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Study characteristics\u003c/h2\u003e \u003cp\u003eWe finally included 10 studies \u003csup\u003e[\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e–\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, involving 1147 participants (576 in TEAS treatment group, and 571 in control group). All studies the combined acupoints as target acupoints for TEAS, all studies were conducted in China. The detailed characteristics of the included studies were summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristic of the included studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthors, year\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eType of surgery\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAcupoints\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDetails of intervention\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLi et al, 2023\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 ~ 15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29/29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eorthopedic surgery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eL14, PC6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDistant-dense wave with a frequency of 2/10 Hz from 10 min before the induction of anesthesia until the end of surgery\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBai et al, 2017 \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60–70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37/38\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esupratentorial craniotomy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLI4, PC6, LU7, LU5, LI18, ST9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAlternate dense disperse frequency of 2/10Hz, intensity ranged from 6 to 15 mA. The stimulus continued until 5 min before the end of surgery.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSun et al,\u003c/p\u003e \u003cp\u003e2017 \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18–70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91/90\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLC, LG\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eL14, PC6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAlternating dense and disperse stimulation at frequency of 2/100H for 30min preoperatively\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHuang et al, 2015 \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20/20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVATS lobectomy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLI4, PC6, LU7, LI11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAlternating dense and disperse stimulation at frequency of 2/100Hz for 30min before induction\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLu et al, 2021 \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18–65\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e188/190\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eradical mastectomy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePC6, CV17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAlternating dense and disperse stimulation at frequency of 2/10Hz, 30min before induction\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWang et al, 2012 \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29–60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30/30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esinusotomy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eL14, PC6, ST36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIntensity of 6–9 mA and dense disperse frequency of 2/10 Hz for 30 min before induction\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWu et al, 2022 \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40–70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44/40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emajor SP\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eST36, SP6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAlternating dense and disperse model, 2/15Hz for 30\u0026nbsp;min before induction and then at 2/100Hz throughout the operation\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXing et al, 2022 \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e≥ 60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29/29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLGCS\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eL14, PC6, ST36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2/100 Hz density wave and actual electric stimuli for 30min before anesthesia\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePan et al, 2023 \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18–60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52/53\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLM\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eL14, PC6, ST36, SP6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDilatational wave with a frequency of 2/100 HZ for 30 minutes before the operation and lasting until the end of anesthesia.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZhang et al, 2024 \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18–65\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54/54\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHT7, PC4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAlternating dense and disperse model, 2/10Hz, 30 minutes before induction\u003c/p\u003e \u003cp\u003euntil the end of surgery\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNote: LC, laparoscopic cholecystectomy; LG, laparoscopic gynecological surgery; VATS, Video-assisted thoracic surgical; SP, spinal surgery; LGCS, laparoscopic gastric cancer surgery; LM, laparoscopic myomectomy. L14, Hegu; PC6, Neiguan; LU7, Lieque; LU5, Chize; LI18, Futu; ST9, Renying; LI11, Quchi; SP6, Sanyinjiao; CV17, Danzhong, HT7, Shenmen; PC4, Ximen.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Risk of bias assessment and sensitivity analysis\u003c/h2\u003e \u003cp\u003eFor the 10 studies included in this meta-analysis, risk of bias assessment was made. Seven studies had detailed information of random sequence generation, 6 studies have mentioned detailed allocation concealment and blinding of participants and personnel. Eight studies in accord to principal of blinding outcome assessment. Seven studies had no incomplete outcome data and 9 studies without selective reporting. The risk of bias was shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4 TEAS shortened the time to extubation after surgery\u003c/h2\u003e \u003cp\u003eTen included studies \u003csup\u003e[\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e–\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e recorded the time to extubation after surgery. Among the studies, there was heterogeneity existed (\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e = 80%). However, random effects model suggested that TEAS helped to shorten the time to extubation after surgery than control group (SMD − 0.55 95%-CI [-0.84; -0.26], \u003cem\u003eP\u003c/em\u003e = 0.0002). Figure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.5 TEAS accelerated the time to recall\u003c/h2\u003e \u003cp\u003eEarly recall after surgery plays an important role in shortening the time to extubation. Five studies \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e recorded the time to recall after surgery. No significance existed of the time to recall between TEAS and control group (\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e = 49%). The result indicated that TEAS helped to accelerate the time to recall (SMD − 0.18 95%-CI [-0.32; -0.03], \u003cem\u003eP\u003c/em\u003e = 0.02). Figure\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.6 TEAS reduced the consumption of remifentanail\u003c/h2\u003e \u003cp\u003eWe known that the usage of analgesics intraoperatively may also play a role in delayed removal of extubation tube. So, we also analyzed the consumption of analgesics of propofol and remifentanail. Five included studies \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e recorded the intraoperative consumption of propofol, and 4 studies \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e recorded the usage of remifentanail. There was no significant difference between the consumption of propofol between TEAS and control group (SMD − 0.18 95%-CI [-0.69; 0.33], \u003cem\u003eP\u003c/em\u003e = 0.49). However, the consumption of remifentanail in TEAS group was lower than that in control group (SMD − 1.15 95%-CI [-1.72, -0.59], \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.00001). Figure\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.7 TEAS reduced the incidence of adverse events during extubation\u003c/h2\u003e \u003cp\u003eSome adverse events may occur during extubation, like PONV, agitation and cough.\u003c/p\u003e \u003cp\u003eFive included studies \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e documented the incidence of PONV, the result suggested that TEAS reduced the incidence of PONV (RR 0.49, 95%-CI [0.32, 0.74], \u003cem\u003eP\u003c/em\u003e = 0.007), as our previous meta-analysis indicated \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Additionally, 2 included studies \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e recorded the incidence of cough, as well as agitation \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e during extubation. The results indicated that the incidence of cough (RR 0.53, 95%-CI [0.31, 0.90], \u003cem\u003eP\u003c/em\u003e = 0.02) and agitation (RR 0.31, 95%-CI [0.14, 0.67], \u003cem\u003eP\u003c/em\u003e = 0.003) during extubation period in TEAS group was lower than that in Control group. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cp\u003e\u003cstrong\u003e3.8 TEAS have no effects on surgical and anesthesia time\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe duration of surgical and anesthesia time may also have a role in extubation time. We analyzed the surgical and anesthesia time in this meta-analysis. Nine included studies \u003csup\u003e[8-15, 17]\u003c/sup\u003e recorded the surgical time, and 6 studies \u003csup\u003e[9, 10, 12-14, 17]\u003c/sup\u003e recorded the anesthesia time. The result suggested TEAS had no effects on surgical (SMD 0.12, 95%-CI [-0.01, 0.26], \u003cem\u003eP\u003c/em\u003e = 0.07) and anesthesia time (SMD 0.15, 95%-CI [-0.15, 0.45], \u003cem\u003eP\u003c/em\u003e = 0.32). \u003cstrong\u003eFigure 7.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eClinical 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 \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Multiple reasons affected the time to extubation, foremost among these were the usage of analgesics and sedatives \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. 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 \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. 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.\u003c/p\u003e \u003cp\u003eTEAS 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 \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, 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 \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Severe cough and agitation seriously affect the safety of extubation, bring life-threatening consequences, such as cardiac arrest and respiratory depression \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. 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.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, application of TEAS perioperatively is a reasonable modality to incorporate into non-pharmacological approach for early extubation after surgery. It helps to reduce the consumption of analgesics, as well as the incidence of adverse events during extubation, promoted the quality and safety of extubation. For limitations mentioned above, more strictly designed, involving larger sample size and different races studies are needed to further prove the results of this meta-analysis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eL.H. and Q.T. contributed to conception and design of the study. Y.W. organized the database. Y. Z. and X.Z. performed the statistical analysis. Y.Z. and Q.T., L.W. wrote the first draft of the manuscript. Q.T. and L.H. were responsible for the supervision of the manuscript. All authors contributed to manuscript revision, read, and approved the finally submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that they had no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of funding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617-631.\u003c/li\u003e\n\u003cli\u003eGal J, Hunter S, Reich D, et al. Delayed extubation in spine surgery is associated with increased postoperative complications and hospital episode-based resource utilization. J Clin Anesth. 2022; 77:110636.\u003c/li\u003e\n\u003cli\u003eSzmit M, Krajewski R, Rudnicki J, Agrawal S. Application and efficacy of transcutaneous electrical acupoint stimulation (TEAS) in clinical practice: A systematic review. \u003cem\u003eAdv Clin Exp Med\u003c/em\u003e. 2023;32(9):1063-1074.\u003c/li\u003e\n\u003cli\u003eChen J, Tu Q, Miao S, Zhou Z, Hu S. Transcutaneous electrical acupoint stimulation for preventing postoperative nausea and vomiting after general anesthesia: A meta-analysis of randomized controlled trials. Int J Surg. 2020; 73:57-64.\u003c/li\u003e\n\u003cli\u003eStumpo V, Staartjes VE, Quddusi A, et al. Enhanced Recovery After Surgery strategies for elective craniotomy: a systematic review. \u003cem\u003eJ Neurosurg\u003c/em\u003e. 2021;135(6):1857-1881.\u003c/li\u003e\n\u003cli\u003eBuhl LK, Mueller AL, Boone MD, Nozari A. Risk Factors for Delayed Extubation Following High Posterior Cervical and Occipital Fusion. \u003cem\u003eJ Neurosurg Anesthesiol\u003c/em\u003e. 2022;34(1):64-68. \u003c/li\u003e\n\u003cli\u003eLi X, Liu J, Xu Z, et al. Early identification of delayed extubation following cardiac surgery: Development and validation of a risk prediction model. \u003cem\u003eFront Cardiovasc Med\u003c/em\u003e. 2022;9: 1002768.\u003c/li\u003e\n\u003cli\u003eLi Y, Ma Y, Guo W, et al. Effect of transcutaneous electrical acupoint stimulation on postoperative pain in pediatric orthopedic surgery with the enhanced recovery after surgery protocol: a prospective, randomized controlled trial. \u003cem\u003eAnaesth Crit Care Pain Med\u003c/em\u003e. 2023;42(6):101273.\u003c/li\u003e\n\u003cli\u003eBai WY, Yang YC, Teng XF, et al. Effects of Transcutaneous Electrical Acupoint Stimulation on the Stress Response During Extubation After General Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy: A Prospective Randomized Controlled Trial. \u003cem\u003eJ Neurosurg Anesthesiol\u003c/em\u003e. 2018;30(4):337-346.\u003c/li\u003e\n\u003cli\u003eSun K, Xing T, Zhang F, et al. Perioperative Transcutaneous Electrical Acupoint Stimulation for Postoperative Pain Relief Following Laparoscopic Surgery: A Randomized Controlled Trial. \u003cem\u003eClin J Pain\u003c/em\u003e. 2017;33(4):340-347.\u003c/li\u003e\n\u003cli\u003eHuang S, Peng W, Tian X, et al. Effects of transcutaneous electrical acupoint stimulation at different frequencies on perioperative anesthetic dosage, recovery, complications, and prognosis in video-assisted thoracic surgical lobectomy: a randomized, double-blinded, placebo-controlled trial. \u003cem\u003eJ Anesth\u003c/em\u003e. 2017;31(1):58-65. \u003c/li\u003e\n\u003cli\u003eLu Z, Wang Q, Sun X, et al. Transcutaneous electrical acupoint stimulation before surgery reduces chronic pain after mastectomy: A randomized clinical trial. \u003cem\u003eJ Clin Anesth\u003c/em\u003e. 2021; 74:110453.\u003c/li\u003e\n\u003cli\u003eWang H, Xie Y, Zhang Q, et al. Transcutaneous electric acupoint stimulation reduces intra-operative remifentanil consumption and alleviates postoperative side-effects in patients undergoing sinusotomy: a prospective, randomized, placebo-controlled trial. \u003cem\u003eBr J Anaesth\u003c/em\u003e. 2014;112(6):1075-1082.\u003c/li\u003e\n\u003cli\u003eWu X, Huang J, Zhang Y, et al. Perioperative transcutaneous electrical acupoint stimulation (pTEAS) in pain management in major spinal surgery patients. \u003cem\u003eBMC Anesthesiol\u003c/em\u003e. 2022;22(1):342.\u003c/li\u003e\n\u003cli\u003eXing R, Yang Y, Zhang M, et al. Effect of Transcutaneous Electrical Acupoint Stimulation Combined with Transversus Abdominis Plane Block on Postoperative Recovery in Elderly Patients Undergoing Laparoscopic Gastric Cancer Surgery: A Randomized Controlled Trial. \u003cem\u003ePain Ther\u003c/em\u003e. 2022;11(4):1327-1339. \u003c/li\u003e\n\u003cli\u003ePan Y, Shao Y, Chi Z, Jin S, Wang J. Transcutaneous Electrical Acupoint Stimulation Accelerates the Recovery of Patients Undergoing Laparoscopic Myomectomy: A Randomized Controlled Trial. \u003cem\u003eJ Pain Res\u003c/em\u003e. 2023; 16:809-819.\u003c/li\u003e\n\u003cli\u003eZhang M, Cairen Z, Liu X, et al. Transcutaneous electric acupoint stimulation reduced consumption of profopol in patients undergoing laparoscopic surgery: A randomized clinical trial. \u003cem\u003eMedicine (Baltimore)\u003c/em\u003e. 2024;103(4): e35730.\u003c/li\u003e\n\u003cli\u003eIguidbashian JP, Chang PH, Iguidbashian J, Lines J, Maxwell BG. Enhanced recovery and early extubation after pediatric cardiac surgery using single-dose intravenous methadone. \u003cem\u003eAnn Card Anaesth\u003c/em\u003e. 2020;23(1):70-74. \u003c/li\u003e\n\u003cli\u003eMandell MS, Campsen J, Zimmerman M, Biancofiore G, Tsou MY. The clinical value of early extubation. \u003cem\u003eCurr Opin Organ Transplant\u003c/em\u003e. 2009;14(3):297-302.\u003c/li\u003e\n\u003cli\u003evan Lemmen M, Florian J, Li Z, et al. Opioid Overdose: Limitations in Naloxone Reversal of Respiratory Depression and Prevention of Cardiac Arrest [published correction appears in Anesthesiology. 2023 Dec 1;139(6):920]. \u003cem\u003eAnesthesiology\u003c/em\u003e. 2023;139(3):342-353.\u003c/li\u003e\n\u003cli\u003eYuan CS, Attele AS, Dey L, Lynch JP, Guan X. Transcutaneous electrical acupoint stimulation potentiates analgesic effect of morphine. \u003cem\u003eJ Clin Pharmacol\u003c/em\u003e. 2002;42(8):899-903.\u003c/li\u003e\n\u003cli\u003eThille AW, Gacouin A, Coudroy R, et al. Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece. \u003cem\u003eN Engl J Med\u003c/em\u003e. 2022;387(20):1843-1854.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"transcutaneous electrical acupoint stimulation, extubation, anesthesia, adverse event","lastPublishedDoi":"10.21203/rs.3.rs-4282264/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4282264/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe delayed extubation time after often accompany with many adverse events. The purpose of the study was to evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on the extubation time and adverse events after surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe randomized controlled trials related to apply TEAS during perioperative period were searched in the database of Cochrane Library, PubMed, Web of Science, Embase, CNKI from the inception to Apil 2024. The main outcome was the extubation time after surgery, and the secondary outcomes were the consumption of analgesics, adverse events during extubation, time of surgery and anesthesia. Data were pooled and analyzed by RevMan 5.3 software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study enrolled 9 studies, including 1039 participants. The current results indicated that the application of TEAS effectively shortened the extubation time after surgery (SMD \u0026minus;\u0026thinsp;0.55 95%-CI [-0.84; -0.26], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0002), as well as time to recall after surgery (SMD \u0026minus;\u0026thinsp;0.18 95%-CI [-0.32; -0.03], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). TEAS also reduced the consumption of remifentanail during surgery (SMD \u0026minus;\u0026thinsp;1.15 95%-CI [-1.72, -0.59], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.00001). In addition, TEAS reduced the incidence of PONV (RR 0.49, 95%-CI [0.32, 0.74], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007), cough (RR 0.53, 95%-CI [0.31, 0.90], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02) and agitation (RR 0.31, 95%-CI [0.14, 0.67], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) during extubation period. While TEAS have no effects on surgical (SMD 0.12, 95%-CI [-0.01, 0.26], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.07) and anesthesia time (SMD 0.15, 95%-CI [-0.15, 0.45], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.32).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe study suggested that application of TEAS effectively shortened the time to extubation and recall after surgery. TEAS also reduce the consumption of analgesics, and adverse events after surgery, but have no effects on surgical and anesthesia time. Which may positively improve the enhanced recovery of patients after surgery.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eCRD42018099275\u003c/p\u003e","manuscriptTitle":"Transcutaneous electrical acupoint stimulation shortens the time to extubation after surgery: a systemic review and meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-02 20:05:38","doi":"10.21203/rs.3.rs-4282264/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14b0e4a4-1c8c-453e-abbf-3eaa4d87e6f2","owner":[],"postedDate":"May 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-21T06:41:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-02 20:05:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4282264","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4282264","identity":"rs-4282264","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}