Dexmedetomidine during carotid endarterectomy: A review or a commentary?

Sir,

I am a regular reader of your journal, which during the last decade has greatly improved in its presentation. It is now an indexed journal that is easily accessible online. The quality of an editorial and review article reflects the standard of a journal. I read the review article, “Benefit of using dexmedetomidine during carotid artery endartrectomy (CEA): A review” recently published in your journal[1] I am quite disappointed to read this for the reasons, which I mention below.

A review article is defined as an attempt by one or more writers to sum up the current state of the research on a particular topic.[2] On the PubMed and Google, authors searched the carotid endartrectomies done under general and loco-regional anesthesia during which dexamedetomidine was used. Using the keywords: Anesthesia, carotid endartectomy, they found only few studies. Whereas, when I searched on the Google, I found a huge list of related articles. I then further advanced the search by adding the third key word “dexamedetomidine,” which authors did not include in their search! To this, screen displayed more than 80,000 results. From such a huge list I am sure one can get dozens of articles of interest related to the relevant issue.

Furthermore, studies they highlighted in their review were not relevant to the topic of their review article. In the GALA trial[3] and Rerkasem's systematic review,[4] dexamedetomidine was not the component of anesthesia, (local or general) administered for the operation. Authors should have mentioned the criteria and methodology they used to construct the review article. A review article is constructed from several primary literature papers to produce a coherent argument about a topic and should focus on the topic. Under the heading of literature review, authors did not mention a single study where dexamedetomidine was used as a component of general anesthesia for CEA. Yet they concluded that dexamedetomidine is an ideal drug for CEA done under general anesthesia. The discussion was mostly about studies, where dexamedetomidine was used for surgeries other than CEA, such as, gastric bypass, coronary artery bypass graft, mitral valve replacement and craniotomy. Finally I would like to mention that peer reviewing is fundamental to high quality research. In this process, methods and findings are scrutinized by experts in the same field. If the SJA claims to be a peer reviewed journal, then a more robust system most certainly needs to be employed immediately.