Cargando…

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

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 conclusi...

Descripción completa

Detalles Bibliográficos
Autores principales: Tang, Yuanxia, Song, Yun, Tian, Wei, Chen, Gongxue, Gu, Yan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9360810/
https://www.ncbi.nlm.nih.gov/pubmed/35957999
http://dx.doi.org/10.21037/tp-22-172
_version_ 1784764407126949888
author Tang, Yuanxia
Song, Yun
Tian, Wei
Chen, Gongxue
Gu, Yan
author_facet Tang, Yuanxia
Song, Yun
Tian, Wei
Chen, Gongxue
Gu, Yan
author_sort Tang, Yuanxia
collection PubMed
description 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 randomized controlled trials (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 µg/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.
format Online
Article
Text
id pubmed-9360810
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher AME Publishing Company
record_format MEDLINE/PubMed
spelling pubmed-93608102022-08-10 A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children Tang, Yuanxia Song, Yun Tian, Wei Chen, Gongxue Gu, Yan Transl Pediatr Original Article 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 randomized controlled trials (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 µg/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. AME Publishing Company 2022-07 /pmc/articles/PMC9360810/ /pubmed/35957999 http://dx.doi.org/10.21037/tp-22-172 Text en 2022 Translational Pediatrics. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Tang, Yuanxia
Song, Yun
Tian, Wei
Chen, Gongxue
Gu, Yan
A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children
title A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children
title_full A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children
title_fullStr A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children
title_full_unstemmed A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children
title_short A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children
title_sort systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9360810/
https://www.ncbi.nlm.nih.gov/pubmed/35957999
http://dx.doi.org/10.21037/tp-22-172
work_keys_str_mv AT tangyuanxia asystematicreviewandmetaanalysisontheefficacyandsafetyofdexmedetomidinecombinedwithsevofluraneanesthesiaonemergenceagitationinchildren
AT songyun asystematicreviewandmetaanalysisontheefficacyandsafetyofdexmedetomidinecombinedwithsevofluraneanesthesiaonemergenceagitationinchildren
AT tianwei asystematicreviewandmetaanalysisontheefficacyandsafetyofdexmedetomidinecombinedwithsevofluraneanesthesiaonemergenceagitationinchildren
AT chengongxue asystematicreviewandmetaanalysisontheefficacyandsafetyofdexmedetomidinecombinedwithsevofluraneanesthesiaonemergenceagitationinchildren
AT guyan asystematicreviewandmetaanalysisontheefficacyandsafetyofdexmedetomidinecombinedwithsevofluraneanesthesiaonemergenceagitationinchildren
AT tangyuanxia systematicreviewandmetaanalysisontheefficacyandsafetyofdexmedetomidinecombinedwithsevofluraneanesthesiaonemergenceagitationinchildren
AT songyun systematicreviewandmetaanalysisontheefficacyandsafetyofdexmedetomidinecombinedwithsevofluraneanesthesiaonemergenceagitationinchildren
AT tianwei systematicreviewandmetaanalysisontheefficacyandsafetyofdexmedetomidinecombinedwithsevofluraneanesthesiaonemergenceagitationinchildren
AT chengongxue systematicreviewandmetaanalysisontheefficacyandsafetyofdexmedetomidinecombinedwithsevofluraneanesthesiaonemergenceagitationinchildren
AT guyan systematicreviewandmetaanalysisontheefficacyandsafetyofdexmedetomidinecombinedwithsevofluraneanesthesiaonemergenceagitationinchildren