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

Ni J, Wei J, Yao Y, Jiang X, Luo L, Luo D - PLoS ONE (2015)

Bottom Line: 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.Dexmedetomidine was proved effective for preventing EA and for reducing severe pain and the requirement of rescue drugs.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China.

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.

No MeSH data available.


Related in: MedlinePlus

Time to discharge from the postanesthesia care unit (PACU): dexmedetomidine vs. placebo.Forest plot shows that the overall effect of pooled trials was in favor of placebo. Patients given dexmedetomidine stayed longer in the PACU. Heterogeneity was observed when these studies were pooled and the random effects model was chosen for analysis. D, dexmedetomidine; P, placebo
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pone.0128450.g005: Time to discharge from the postanesthesia care unit (PACU): dexmedetomidine vs. placebo.Forest plot shows that the overall effect of pooled trials was in favor of placebo. Patients given dexmedetomidine stayed longer in the PACU. Heterogeneity was observed when these studies were pooled and the random effects model was chosen for analysis. D, dexmedetomidine; P, placebo

Mentions: The incidence of severe pain was evaluated in four trials (251 patients). No statistical heterogeneity was found with a pooled analysis. Subgroup analysis was performed based on surgical procedures with different pain intensities. The results showed that dexmedetomidine significantly reduced the risk of severe pain compared with placebo after tonsillectomy (RR 0.45, 95% CI 0.24–0.86; Fig 3). Two studies, Pestieau 2011 and Saadawy 2009, respectively, showed that dexmedetomidine reduced the risk of severe pain after myringotomy (RR 0.33, 95% CI 0.12–0.91; Fig 3) and after inguinal hernia repair surgery (RR 0.40, 95% CI 0.21–0.76; Fig 3) compared with placebo. The number of patients requiring a rescue drug was evaluated in two trials (Erdil 2009, Guler 2005) that included 120 patients. No heterogeneity was observed in the pooled analysis. It showed that dexmedetomidine significantly reduced the requirement of a rescue drug compared with placebo (RR 0.31, 95% CI 0.18–0.53; P<0.0001). Time to eye-open was observed in eight studies (590 patients). Heterogeneity was observed when these studies were pooled, which was because of the study of Saadawy 2009. Saadawy 2009 administered the study drugs by caudal injection. The pooled analysis (including Saadawy 2009) showed that dexmedetomidine significantly increased time to eye-open by 0.98 min (mean difference 0.98, 95% CI 0.20–1.75; Fig 4). Seven trials (459 patients) evaluated time to extubation. Heterogeneity was observed when these studies were pooled, which could be because of the study of Guler 2005. No significant difference was shown in the pooled analysis (P = 0.05). Time to discharge from the PACU was evaluated in six trials (429 patients). Heterogeneity was observed when these studies were pooled owing to the study of Chen 2013. With the random effects model, dexmedetomidine significantly increased time to discharge from the PACU by 4.63 min (mean difference 4.63, 95% CI 0.66–8.59; Fig 5).


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

Ni J, Wei J, Yao Y, Jiang X, Luo L, Luo D - PLoS ONE (2015)

Time to discharge from the postanesthesia care unit (PACU): dexmedetomidine vs. placebo.Forest plot shows that the overall effect of pooled trials was in favor of placebo. Patients given dexmedetomidine stayed longer in the PACU. Heterogeneity was observed when these studies were pooled and the random effects model was chosen for analysis. D, dexmedetomidine; P, placebo
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4440759&req=5

pone.0128450.g005: Time to discharge from the postanesthesia care unit (PACU): dexmedetomidine vs. placebo.Forest plot shows that the overall effect of pooled trials was in favor of placebo. Patients given dexmedetomidine stayed longer in the PACU. Heterogeneity was observed when these studies were pooled and the random effects model was chosen for analysis. D, dexmedetomidine; P, placebo
Mentions: The incidence of severe pain was evaluated in four trials (251 patients). No statistical heterogeneity was found with a pooled analysis. Subgroup analysis was performed based on surgical procedures with different pain intensities. The results showed that dexmedetomidine significantly reduced the risk of severe pain compared with placebo after tonsillectomy (RR 0.45, 95% CI 0.24–0.86; Fig 3). Two studies, Pestieau 2011 and Saadawy 2009, respectively, showed that dexmedetomidine reduced the risk of severe pain after myringotomy (RR 0.33, 95% CI 0.12–0.91; Fig 3) and after inguinal hernia repair surgery (RR 0.40, 95% CI 0.21–0.76; Fig 3) compared with placebo. The number of patients requiring a rescue drug was evaluated in two trials (Erdil 2009, Guler 2005) that included 120 patients. No heterogeneity was observed in the pooled analysis. It showed that dexmedetomidine significantly reduced the requirement of a rescue drug compared with placebo (RR 0.31, 95% CI 0.18–0.53; P<0.0001). Time to eye-open was observed in eight studies (590 patients). Heterogeneity was observed when these studies were pooled, which was because of the study of Saadawy 2009. Saadawy 2009 administered the study drugs by caudal injection. The pooled analysis (including Saadawy 2009) showed that dexmedetomidine significantly increased time to eye-open by 0.98 min (mean difference 0.98, 95% CI 0.20–1.75; Fig 4). Seven trials (459 patients) evaluated time to extubation. Heterogeneity was observed when these studies were pooled, which could be because of the study of Guler 2005. No significant difference was shown in the pooled analysis (P = 0.05). Time to discharge from the PACU was evaluated in six trials (429 patients). Heterogeneity was observed when these studies were pooled owing to the study of Chen 2013. With the random effects model, dexmedetomidine significantly increased time to discharge from the PACU by 4.63 min (mean difference 4.63, 95% CI 0.66–8.59; Fig 5).

Bottom Line: 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.Dexmedetomidine was proved effective for preventing EA and for reducing severe pain and the requirement of rescue drugs.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China.

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.

No MeSH data available.


Related in: MedlinePlus