A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children

被引:11
作者
Tang, Yuanxia [1 ]
Song, Yun [1 ]
Tian, Wei [2 ]
Chen, Gongxue [3 ]
Gu, Yan [1 ]
机构
[1] Chongqing Maternal & Child Hlth Hosp, Dept Anesthesiol, 120 Longshan Rd, Chongqing, Peoples R China
[2] Bozhou Dist Peoples Hosp, Dept Anesthesiol, Zunyi, Guizhou, Peoples R China
[3] Chongqing Maternal & Child Hlth Hosp, Dept Pediat, Chongqing, Peoples R China
关键词
Dexmedetomidine; sevoflurane; anesthetics; children; emergence agitation; INTRANASAL DEXMEDETOMIDINE; STRABISMUS SURGERY; PEDIATRIC-PATIENTS; REDUCES AGITATION; DOUBLE-BLIND; PREVENTION; KETAMINE; PREMEDICATION; TONSILLECTOMY; MIDAZOLAM;
D O I
10.21037/tp-22-172
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background: The incidence of restlessness in the wake-up period of sevoflurane inhalation anesthesia is high. Although many studies have explored the relationship between dexmedetomidine and restlessness in the wake-up period of sevoflurane anesthesia in children, they can't keep consistent conclusions and lack evidence-based medical evidence. Meta-analysis was conducted to explore the efficacy and safety of dexmedetomidine in the treatment of restlessness during the recovery period of sevoflurane anesthesia in children, and to provide reference for clinic. Methods: Relevant articles were retrieved from PubMed, Embase, MEDLINE, Science Direct, The Cochrane Library, the Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, the Chinese Science and Technology Periodical Database, and the Chinese Biomedical Literature Database (CBM). The Chinese and English search keywords included "dexmedetomidine", "children", "sevoflurane", and "emergence agitation". The articles included were independently evaluated and cross-checked by 2 professionals in strict accordance with the 5 evaluation criteria for RCTs in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.0.1). Results: A total of 16 articles were included in this meta-analysis. Of the 16 RCTs, 14 described the generation of random sequences in detail, 8 described allocation concealment in detail, no patient blinding was described due to different surgical methods, 8 articles used operator blinding, and all 16 articles had complete outcome measures. The incidence of emergence agitation in the 0.5 mu g/kg dexmedetomidine group was significantly lower than that in the control group, and the difference was statistically significant [odds ratio (OR) =0.22, 95% CI: 0.13, 0.40, P<0.00001]. The incidence of analgesic rescue in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (OR =0.29, 95% CI: 0.13, 0.63, Z =3.13, P=0.002). The incidence of postoperative nausea and vomiting in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (OR =0.33, 95% CI: 0.20, 0.55, Z =4.29, P<0.0001). Discussion: The results of this meta-analysis confirmed that dexmedetomidine could reduce the incidence of emergence agitation, postoperative analgesic rescue, and nausea and vomiting in children after sevoflurane anesthesia.
引用
收藏
页码:1156 / 1170
页数:15
相关论文
共 39 条
[21]   Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane [J].
Lin, Yiquan ;
Chen, Ying ;
Huang, Jingxia ;
Chen, Hongbin ;
Shen, Weihua ;
Guo, Wenjun ;
Chen, Qianru ;
Ling, Hongfeng ;
Gan, Xiaoliang .
JOURNAL OF CLINICAL ANESTHESIA, 2016, 33 :289-295
[22]   Comparison of Low-Dose Sevoflurane Inhalation With Intranasal Ketamine as Rescue Sedation After Intranasal Dexmedetomidine Failure in Outpatient Children Undergoing MRI: A Randomized Control Trial [J].
Liu, Wei ;
Yu, Qian ;
Jiang, Rui ;
Liu, Fengzhi ;
Dong, Yanfu ;
Tang, Wen .
JOURNAL OF PERIANESTHESIA NURSING, 2021, 36 (05) :492-498
[23]   Dexmedetomidine Infusion for Analgesia and Prevention of Emergence Agitation in Children with Obstructive Sleep Apnea Syndrome Undergoing Tonsillectomy and Adenoidectomy [J].
Patel, Anuradha ;
Davidson, Melissa ;
Tran, Minh C. J. ;
Quraishi, Huma ;
Schoenberg, Catherine ;
Sant, Manasee ;
Lin, Albert ;
Sun, Xiuru .
ANESTHESIA AND ANALGESIA, 2010, 111 (04) :1004-1010
[24]   The effect of dexmedetomidine during myringotomy and pressure-equalizing tube placement in children [J].
Pestieau, Sophie R. ;
Quezado, Zenaide M. N. ;
Johnson, Yewande J. ;
Anderson, Jennifer L. ;
Cheng, Yao I. ;
McCarter, Robert J. ;
Pena, Maria T. ;
Finkel, Julia C. .
PEDIATRIC ANESTHESIA, 2011, 21 (11) :1128-1135
[25]   Effect of single-dose dexmedetomidine on emergence agitation and recovery profiles after sevoflurane anesthesia in pediatric ambulatory surgery [J].
Sato, Masami ;
Shirakami, Gotaro ;
Tazuke-Nishimura, Misako ;
Matsuura, Shogo ;
Tanimoto, Keiji ;
Fukuda, Kazuhiko .
JOURNAL OF ANESTHESIA, 2010, 24 (05) :675-682
[26]   Dexmedetomidine Injection during Strabismus Surgery Reduces Emergence Agitation without Increasing the Oculocardiac Reflex in Children: A Randomized Controlled Trial [J].
Song, In-Ae ;
Seo, Kwang-Suk ;
Oh, Ah-Young ;
Baik, Ji-Seok ;
Kim, Jin Hee ;
Hwang, Jung-Won ;
Jeon, Young-Tae .
PLOS ONE, 2016, 11 (09)
[27]   Dexmedetomidine for preventing sevoflurane-related emergence agitation in children: a meta-analysis of randomized controlled trials [J].
Sun, L. ;
Guo, R. ;
Sun, L. .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2014, 58 (06) :642-650
[28]   Dexmedetomidine and Clonidine Attenuate Sevoflurane-Induced Tau Phosphorylation and Cognitive Impairment in Young Mice via α-2 Adrenergic Receptor [J].
Sun, Mingyang ;
Dong, Yuanlin ;
Li, Mengzhu ;
Zhang, Yiying ;
Liang, Feng ;
Zhang, Jiaqiang ;
Soriano, Sulpicio G. ;
Xie, Zhongcong .
ANESTHESIA AND ANALGESIA, 2021, 132 (03) :878-889
[29]   Dexmedetomidine Effect on Emergence Agitation and Delirium in Children Undergoing Laparoscopic Hernia Repair: a Preliminary Study [J].
Sun, Yingying ;
Li, Yuanhai ;
Sun, Yajuan ;
Wang, Xing ;
Ye, Hongwu ;
Yuan, Xianren .
JOURNAL OF INTERNATIONAL MEDICAL RESEARCH, 2017, 45 (03) :973-983
[30]   Effect of ancillary drugs on sevoflurane related emergence agitation in children undergoing ophthalmic surgery: a Bayesian network meta-analysis [J].
Tan, Dan ;
Xia, Haifa ;
Sun, Shujun ;
Wang, Fuquan .
BMC ANESTHESIOLOGY, 2019, 19 (1)