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Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

BACKGROUND: Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the...

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Autores principales: Chiang, Fu-Wei, Chang, Jin-Lin, Hsu, Shih-Chang, Hsu, Kuo-Yuan, Chu, Karen Chia-Wen, Huang, Chun-Jen, Bai, Chyi-Huey, Chen, Chiehfeng, Hsu, Chin-Wang, Hsu, Yuan-Pin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549777/
https://www.ncbi.nlm.nih.gov/pubmed/33045022
http://dx.doi.org/10.1371/journal.pone.0240553
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author Chiang, Fu-Wei
Chang, Jin-Lin
Hsu, Shih-Chang
Hsu, Kuo-Yuan
Chu, Karen Chia-Wen
Huang, Chun-Jen
Bai, Chyi-Huey
Chen, Chiehfeng
Hsu, Chin-Wang
Hsu, Yuan-Pin
author_facet Chiang, Fu-Wei
Chang, Jin-Lin
Hsu, Shih-Chang
Hsu, Kuo-Yuan
Chu, Karen Chia-Wen
Huang, Chun-Jen
Bai, Chyi-Huey
Chen, Chiehfeng
Hsu, Chin-Wang
Hsu, Yuan-Pin
author_sort Chiang, Fu-Wei
collection PubMed
description BACKGROUND: Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery. METHOD: Five databases were searched for randomized controlled trials published from database inception to April 2020 that compared dexmedetomidine use with placebo or active comparator use and evaluated EA, PONV, or postoperative pain incidence (main outcomes) in patients who had undergone pediatric strabismus surgery. Oculocardiac reflex (OCR) incidence and postanesthesia care unit (PACU) stay duration were considered as safety outcomes. All meta-analyses were performed using a random-effects model. RESULTS: In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced EA incidence [risk ratio (RR): 0.39; 95% confidence interval (CI): 0.25–0.62, I(2) = 66%], severe EA incidence (RR: 0.27, 95% CI: 0.17–0.43, I(2) = 0%), PONV incidence (RR: 0.33, 95% CI: 0.21–0.54, I(2) = 0%), analgesia requirement (RR: 0.38, 95% CI: 0.25–0.57, I(2) = 0%), and pain scores (standardized mean difference: −1.02, 95% CI: −1.44 to −0.61, I(2) = 75%). Dexmedetomidine also led to lower EA incidence in the sevoflurane group than in the desflurane group (RR: 0.26 for sevoflurane vs. 0.45 for desflurane). Continuous dexmedetomidine infusion (RR: 0.19) led to better EA incidence reduction than did bolus dexmedetomidine infusion at the end of surgery (RR: 0.26) or during the peri-induction period (RR: 0.36). Compared with placebo use, dexmedetomidine use reduced OCR incidence (RR: 0.63; I(2) = 40%). No significant between-group differences were noted for PACU stay duration. CONCLUSION: In patients who have undergone pediatric strabismus surgery, dexmedetomidine use may alleviate EA, PONV, and postoperative pain and reduce OCR incidence. Moreover, dexmedetomidine use does not affect the PACU stay duration.
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spelling pubmed-75497772020-10-20 Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis Chiang, Fu-Wei Chang, Jin-Lin Hsu, Shih-Chang Hsu, Kuo-Yuan Chu, Karen Chia-Wen Huang, Chun-Jen Bai, Chyi-Huey Chen, Chiehfeng Hsu, Chin-Wang Hsu, Yuan-Pin PLoS One Research Article BACKGROUND: Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery. METHOD: Five databases were searched for randomized controlled trials published from database inception to April 2020 that compared dexmedetomidine use with placebo or active comparator use and evaluated EA, PONV, or postoperative pain incidence (main outcomes) in patients who had undergone pediatric strabismus surgery. Oculocardiac reflex (OCR) incidence and postanesthesia care unit (PACU) stay duration were considered as safety outcomes. All meta-analyses were performed using a random-effects model. RESULTS: In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced EA incidence [risk ratio (RR): 0.39; 95% confidence interval (CI): 0.25–0.62, I(2) = 66%], severe EA incidence (RR: 0.27, 95% CI: 0.17–0.43, I(2) = 0%), PONV incidence (RR: 0.33, 95% CI: 0.21–0.54, I(2) = 0%), analgesia requirement (RR: 0.38, 95% CI: 0.25–0.57, I(2) = 0%), and pain scores (standardized mean difference: −1.02, 95% CI: −1.44 to −0.61, I(2) = 75%). Dexmedetomidine also led to lower EA incidence in the sevoflurane group than in the desflurane group (RR: 0.26 for sevoflurane vs. 0.45 for desflurane). Continuous dexmedetomidine infusion (RR: 0.19) led to better EA incidence reduction than did bolus dexmedetomidine infusion at the end of surgery (RR: 0.26) or during the peri-induction period (RR: 0.36). Compared with placebo use, dexmedetomidine use reduced OCR incidence (RR: 0.63; I(2) = 40%). No significant between-group differences were noted for PACU stay duration. CONCLUSION: In patients who have undergone pediatric strabismus surgery, dexmedetomidine use may alleviate EA, PONV, and postoperative pain and reduce OCR incidence. Moreover, dexmedetomidine use does not affect the PACU stay duration. Public Library of Science 2020-10-12 /pmc/articles/PMC7549777/ /pubmed/33045022 http://dx.doi.org/10.1371/journal.pone.0240553 Text en © 2020 Chiang et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Chiang, Fu-Wei
Chang, Jin-Lin
Hsu, Shih-Chang
Hsu, Kuo-Yuan
Chu, Karen Chia-Wen
Huang, Chun-Jen
Bai, Chyi-Huey
Chen, Chiehfeng
Hsu, Chin-Wang
Hsu, Yuan-Pin
Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis
title Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis
title_full Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis
title_fullStr Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis
title_full_unstemmed Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis
title_short Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis
title_sort dexmedetomidine use in pediatric strabismus surgery: a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549777/
https://www.ncbi.nlm.nih.gov/pubmed/33045022
http://dx.doi.org/10.1371/journal.pone.0240553
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