Dataset Information

Effect of dexmedetomidine on preventing postoperative agitation in children: a meta-analysis.

ABSTRACT:

Background

Emergence agitation (EA) is one of the most common postoperative complications in children. The purpose of this meta-analysis is to assess the effect of dexmedetomidine for preventing postoperative agitation in children.

Methods

We searched the Cochrane Central Register of Controlled Trails, MEDLINE, and EMBASE. Randomized controlled trials were included. The following outcome measures were evaluated: incidence of EA, number of patients requiring rescue, time to eye-open, time to extubation, time to discharge from the postanesthesia care unit (PACU).

Results

We analyzed 19 trials (1608 patients) that met the inclusion criteria. Compared with placebo, intravenous dexmedetomidine significantly reduced the incidence of EA [risk ratio (RR) 0.34, 95% confidence interval (CI) 0.25-0.44, P<0.00001). Dexmedetomidine also decreased the incidence of severe pain (RR 0.41, 95% CI 0.27-0.62, P<0.0001) and requirement of a rescue drug (RR 0.31, 95% CI 0.18-0.53, P<0.0001). However, compared with placebo, dexmedetomidine increased the time to eye-open by 0.98 min (P = 0.01) and the time to PACU discharge by 4.63 min (P = 0.02). Dexmedetomidine was also compared with midazolam, propofol, ketamine, and fentanyl, among others. No significant difference was found in the incidence of EA for most of these comparisons, with the exception of fentanyl and propofol, where dexmedetomidine was more beneficial.

Conclusions

Dexmedetomidine was proved effective for preventing EA and for reducing severe pain and the requirement of rescue drugs. It slightly increased the time to eye-open and the time to PACU discharge. Dexmedetomidine was also more beneficial than propofol or fentanyl in preventing EA.

SUBMITTER: Ni J

PROVIDER: S-EPMC4440759 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Publications

Effect of dexmedetomidine on preventing postoperative agitation in children: a meta-analysis.

Ni Juan J Wei Jiafu J Yao Yusheng Y Jiang Xiaoqin X Luo Linli L Luo Dong D

PloS one 20150521 5

<h4>Background</h4>Emergence agitation (EA) is one of the most common postoperative complications in children. The purpose of this meta-analysis is to assess the effect of dexmedetomidine for preventing postoperative agitation in children.<h4>Methods</h4>We searched the Cochrane Central Register of Controlled Trails, MEDLINE, and EMBASE. Randomized controlled trials were included. The following outcome measures were evaluated: incidence of EA, number of patients requiring rescue, time to eye-ope ...[more]

PMID: 25997021

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Project description:The aim of the present study was to observe whether dexmedetomidine (DEX) combined with sufentanil decreased emergence agitation (EA) in children receiving sevoflurane anesthesia for cleft palate repair surgery. Children undergoing elective cleft palate repair surgery were randomly allocated into the DEX + sufentanil group (group DS; n=50) and the normal saline + fentanyl group (group SF; n=50). Patients in group DS were treated with 0.5 µg/kg DEX prior to induction of anesthesia, whereas patients in group SF received an equal volume of normal saline. Sufentanil (0.2 µg/kg) was administered to induce anesthesia, and 30 min before the end of surgery for patients in group DS. Fentanyl (2 µg/kg) was administered at the same time point for patients in group SF. Mean arterial pressure (MAP), heart rate (HR), duration of surgery and anesthesia, and the dosage of remifentanil were assessed. EA score, Pediatric Anesthesia Emergence Delirium (PAED) score and the Children and Infants Postoperative Pain Scale (CHIPPS) score were documented every 15 min in the post-anesthesia care unit (PACU). The number of cases requiring fentanyl (1 µg/kg) and the recovery profile data were analyzed. Compared with group DS (P<0.05) and the baseline (P<0.05), HR and MAP were significantly increased in group SF immediately following tracheal intubation and extubation. Mean values of maximum EA, PAED and CHIPPS scores were significantly reduced in group DS compared with group SF at 0 (P<0.01), 15 (P<0.05), and 30 min (P<0.05) after arrival at PACU. The incidence of EA in group SF was significantly increased compared with group DS (P<0.05). The dosage of remifentanil during the surgery and the number of cases requiring fentanyl (1 µg/kg) in group DS were significantly decreased compared with group SF (P<0.05). The findings of the present study suggested that DEX combined with sufentanil was able to effectively decrease the incidence of EA in children receiving sevoflurane anesthesia for cleft palate repair surgery.

Project description:Dexmedetomidine (DEX) has been used extensively for patients during surgery. Some studies found that DEX could reduce the incidence of postoperative side effects in laparoscopic surgical patients. However, no firm conclusions were made about it.The authors searched for randomized controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials testing DEX administrated in laparoscopic surgical patients and reporting on postoperative nausea, vomiting, shivering, heart rate, mean arterial pressure (MAP), or extubation time after surgery or within 1 hour in postoperative care unit. Trial sequential analysis (TSA) was used for RCTs comparing DEX with placebo or no treatment in laparoscopic surgery patients. A protocol for this meta-analysis has been registered on PROSPERO (http://www.crd.york.ac.uk/prospero) and the registration number is CRD42015020226.Fifteen studies (899 patients) were included. DEX could significantly reduce the incidence of postoperative nausea (risk ratio [RR] and 95% confidence interval [CI], 0.43 [0.28, 0.66], P?<?0.0001), vomiting (RR and 95% CI, 0.36 [0.18, 0.72], P?=?0.004), shivering (RR and 95% CI, 0.19 [0.11, 0.35], P?<?0.00001), rescue antiemetic (RR and 95% CI, 0.18 [0.07, 0.47], P?=?0.0006), and increase the incidence of dry mouth (RR and 95% CI, 7.40 [2.07, 26.48], P?=?0.002) comparing with the control group. In addition, firm conclusions can be made on the results of postoperative nausea according to the TSA. Meta-analysis showed that DEX group had a significantly lower heart rate (mean difference [MD] and 95% CI, -14.21 [-18.85, -9.57], P?<?0.00001) and MAP (MD and 95% CI, -12.35 [-15.28, -9.42], P?<?0.00001) than the control group, and firm conclusions can be made according to the TSA. No significance was observed on extubation time between 2 groups (MD and 95% CI, 0.70 [-0.89, 2.28], P?=?0.39).The results from this meta-analysis indicated that perioperative DEX decreased postoperative nausea and shivering in laparoscopic surgical patients. However, common adverse effects were lower heart rate and MAP. Firm conclusions cannot be made on postoperative shivering, rescue antiemetic, and dry mouth until more RCTs were included.

Project description:The objective of this article is to evaluate the effect of dexmedetomidine on emergence agitation (EA) and recovery profiles in children after sevoflurane anesthesia and its pharmacological mechanisms. Standard bibliographic databases, including MEDLINE, EMBASE, PsycINFP, Springer and ISI Web of Knowledge, were artificially searched to identify all randomized controlled trials (RCTs) comparing the impact of dexmedetomidine with placebo, fentanyl and midazolam on EA and recovery profiles after sevoflurane anesthesia in post-anesthesia care unit (PACU). Two authors assessed the quality of each study independently in accordance with strict inclusion criteria and extracted data. RevMan 5.0 software was applied for performing statistic analysis. The outcomes analyzed included: 1) incidence of EA, 2) emergence time, 3) time to extubation, 4) incidence of post-operation nausea and vomiting, 5) number of patients requiring an analgesic, and 6) time to discharge from PACU. A total of 1364 patients (696 in the dexmedetomidine group and 668 in the placebo, fentanyl and midazolam group) from 20 prospective RCTs were included in the meta-analysis. Compared with placebo, dexmedetomidine decreased the incidence of EA (risk ratio [RR] 0.37; 95% CI 0.30 to 0.46), incidence of nausea and vomiting (RR 0.57; 95% CI 0.38 to 0.85) and number of patients requiring an analgesic (RR 0.43; 95% CI 0.31 to 0.59). However, dexmedetomidine had a significantly delayed effect on the emergence time (weighted mean differences [WMD] 1.16; 95% CI 0.72 to 1.60), time to extubation (WMD 0.61; 95% CI 0.27 to 0.95), and time to discharge from recovery room (WMD 2.67; 95% CI 0.95 to 4.39). Compared with fentanyl (RR 1.39; 95% CI 0.78 to 2.48) and midazolam (RR 1.12; 95% CI 0.54 to 2.35), dexmedetomidine has no significantly difference on the incidence of EA. However, the analgesia effect of dexmedetomidine on postoperation pain has no significantly statistical differences compared with fentanyl (RR 1.12; 95% CI 0.66 to 1.91), which implied that its analgesia effect might play an important role in decreasing the incident of EA. No evidence of publication bias was observed.

Project description:Pain, autonomic distress, and emergence agitation occur commonly in children undergoing general anesthesia. While acupuncture therapy has been reported to effectively reduce such pain and autonomic distress in children, its effect in preventing emergence agitation remains unclear. Therefore, we will conduct a systematic review and meta-analysis with trial sequential analysis to evaluate the effect of acupuncture therapy in preventing emergence agitation in children undergoing general anesthesia. Methods and analysis This protocol was prepared according to the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Protocols guidelines. We will conduct a search for randomized controlled trials that evaluated the effect of acupuncture therapy in preventing emergence agitation. The following databases will be searched for relevant articles: MEDLINE, CENTRAL, Embase, and Web of Science; four pre-registration sites will be accessed from inception to April 1, 2021. No language restrictions will be applied. Two authors will independently scan and select eligible studies, extract the data, and assess the risk of bias. The incidence of emergence agitation will be combined as a risk ratio with a 95% confidence interval using a random-effect model. The I2 statistics will be used to assess heterogeneity. We will evaluate the quality of the clinical trials using the Cochrane methodology and assess the quality of evidence using the Grading of Recommendation Assessment, Development, and Evaluation approach. If appropriate, a trial sequential analysis will be performed. Expected outcomes This meta-analysis will be the first to evaluate the effect of acupuncture therapy in preventing emergence agitation in children. The findings from this meta-analysis have the potential to reveal pivotal factors that affect the clinical effect of acupuncture therapy, thereby supporting the optimization of acupuncture therapy for emergence agitation. Protocol registration University Hospital Medical Information Network Clinical Trials Registry (UMIN000040775).

Project description:Background: Emergence agitation (EA) is one of the most common and intractable postoperative complications among children undergoing surgery under general anesthesia. Dexmedetomidine, an α(2)-adrenoceptor agonist, offers an ideal sedation, reduces preoperative anxiety, and facilitates smooth induction of anesthesia, and it is widely used in pediatric surgery. We aimed to evaluate the efficacy of dexmedetomidine for preventing emergence agitation in children after general anesthesia. Methods: We comprehensively reviewed PubMed, Cochrane Library, EMBASE, and Web of Science databases to search all randomized controlled trials, published before April 22, 2020, investigating the efficacy of dexmedetomidine in preventing the emergence agitation in children after general anesthesia. The meta-analysis was performed using Review Manager 5.3. The primary outcome was the incidence of emergence agitation. Secondary outcomes included the number of patients requiring rescue analgesic, number of patients with postoperative nausea and vomiting, emergence time, extubation time, and time to discharge from the post-anesthesia care unit. Results: We included a total of 33 studies, comprising 2,549 patients in this meta-analysis. Compared with saline, dexmedetomidine significantly reduced the emergence agitation incidence [risk ratio (RR) 0.29; 95% confidence interval (CI) 0.22-0.37; p < 0.00001], incidence of postoperative nausea and vomiting (RR 0.46; 95% CI 0.3-0.69; p = 0.0002), and the requirement of rescue analgesic (RR 0.29; 95% CI 0.18-0.44; p < 0.00001). Furthermore, children in the dexmedetomidine group experienced a longer emergence time [mean difference (MD) 2.18; 95% CI 0.81-3.56; p = 0.002] and extubation time (MD 0.77; 95% CI 0.22-1.31; p = 0.006) compared with those in the saline group. However, no significant difference was observed in the time to discharge from the post-anesthesia care unit (MD 2.22; 95% CI -2.29-6.74; p = 0.33) between the two groups. No significant differences were observed between the effects of dexmedetomidine and other drugs like midazolam, propofol, fentanyl, tramadol, and clonidine in terms of the emergence agitation incidence and other parameters, except for the requirement of rescue analgesic (RR 0.45; 95% CI 0.33-0.61; p < 0.00001). Conclusions: Dexmedetomidine can prevent emergence agitation, relieves postoperative pain, decreases the requirement of rescue analgesic, and decreases the postoperative nausea and vomiting events.

Project description:ObjectiveThe aim of this study was to report preliminary data on the use of intranasal dexmedetomidine to treat postoperative restlessness, agitation, and pain in 23 patients aged > 70 years and undergoing orthopedic surgery.BackgroundPostoperative agitation and delirium are common among older adult patients undergoing orthopedic surgery. Most preparations used to treat agitation and delirium carry a risk for adverse events such as respiratory failure. Moreover, mere opioid therapy may be insufficient in treatment of pain. Dexmedetomidine, an α2-adrenoreceptor agonist with sedative and analgesic properties, has been shown to reduce opioid requirement and reduce postoperative delirium in older adults.MethodsWe studied the use of post-operative intranasal dexmedetomidine in a retrospective study cohort of geriatric patients undergoing orthopedic surgery. Primary outcomes included alterations in heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peripheral oxygen saturation (SpO2), Modified Richmond Agitation and Sedation Score (mRASS), and opioid consumption following dexmedetomidine administration.ResultsWe identified 23 patients with a mean (SD) age of 79.9 (7.5) years who received dexmedetomidine 100 µg intranasally postoperatively. After dexmedetomidine administration, HR decreased by 10.4 (3.7) beats/min (95% CI 2.9-17.8; p = 0.004) and MAP by 16.2 (4.4) mmHg (95% CI 7.3-25.1; p < 0.001). HR decrease was significant at 2 h and MAP decrease at 1, 2, and 3 h following dexmedetomidine administration. Dexmedetomidine administration was associated with significant reductions in opioid consumption (p < 0.001) and mRASS score (p < 0.001). SpO2 and RR remained unchanged.ConclusionsThese preliminary findings suggest that intranasal dexmedetomidine reduces opioid consumption without causing respiratory depression and may be used to treat postoperative restlessness, agitation, and pain in geriatric patients. However, hemodynamic effects of dexmedetomidine may require close observation for 3 hours following administration in older adult patients.

Dataset Information

Effect of dexmedetomidine on preventing postoperative agitation in children: a meta-analysis.

Background

Methods

Results

Conclusions

Publications

Effect of dexmedetomidine on preventing postoperative agitation in children: a meta-analysis.

Similar Datasets

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