Effect of two different doses of dexmedetomidine on the incidence of emergence agitation after strabismus surgery: a randomized clinical trial

Abdelrahman, Khaled A; Abd‐Elshafy, Sayed Kaoud; Sayed, Jehan Ahmed

doi:10.1016/j.bjane.2018.05.001

Cited by 9 publications

(26 citation statements)

References 21 publications

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“…Basic characteristics of the publications and risk of bias assessment results are shown in Table 1 and Figures 2 and 3. Two of the trials comprised four-arm tests, 6,9 each of which was split into three lots of two-arm tests, and four of the trials comprised three-arm tests, 7,23 , 24 , 27 each of which was split into two lots of two-arm tests for the purpose of the present analyses. In addition, there were four 5,14 , 18 , 28 three-arm trials comparing the efficacy of Dex, other drugs and saline.…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen RCTs reported the duration of PACU stay, 6 , 7 , 9 , 15 , 16 , 21 , 22 , 24 , 25 , 27 , 29 , 31 I 2 =76.1% ( P < 0.001), which were combined by using a random-effects model. Dex was found to be associated with reduced duration of PACU stay versus placebo (SMD 0.29, 95% CI 0.08, 0.51; P = 0.008; Figure 10 and Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 24 RCTs were included in the present meta-analysis. [4][5][6][7][8][9][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The results showed that, compared with placebo, Dex was associated with positive effects on recovery quality in children undergoing general anaesthesia with sevoflurane, reducing nausea and vomiting and shortening the eye-opening time, extubation time, and duration of PACU stay. Unlike the present study, Amorim et al 10 reported that Dex reduced the incidence of emergence agitation while prolonging the duration of PACU stay and eye-opening time.…”

Section: Discussionmentioning

confidence: 99%

“…Subgroup analysis revealed that sample size was the main source of heterogeneity (Table 3). Thirteen RCTs reported the eye-opening time, 5,7,9,14,15,18,19,24,25,28,29 I 2 ¼ 79.9% (P < 0.001), and these were combined using a random-effects model. Dex was found to be associated with reduced eyeopening time versus placebo (SMD 0.72, 95% CI 0.41, 1.03; P < 0.001; Figure 6 and Table 2).…”

Section: Quantitative Synthesismentioning

confidence: 99%

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Effect of Dexmedetomidine in children undergoing general anaesthesia with sevoflurane: a meta-analysis and systematic review

Wen

Liu

2020

J Int Med Res

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Objective The sedative effects of dexmedetomidine (Dex) are similar to natural sleep, with easy wakening following Dex administration, and Dex has minor effects on breathing, reducing emergence agitation in children. The aim of this study was to systematically evaluate the effects of Dex on recovery quality in children following general anaesthesia with sevoflurane, to aid clinical decision making. Methods Relevant randomized controlled trials published before August 2019 were searched and selected from databases. Two researchers independently screened the literature, extracted data, and assessed included studies for bias risk. Meta-analysis was performed using Stata 14.0 software. Results The study included 24 publications. Following general anaesthesia by sevoflurane, Dex was associated with reduced occurrence of emergence agitation (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.11, 0.25) and nausea and vomiting (OR 0.40, 95% CI 0.24, 0.60), along with shortened eye-opening time (standardized mean difference [SMD] 0.72, 95% CI 0.41, 1.03), shortened extubation time (SMD 0.54, 95% CI 0.28, 0.81), and reduced duration of post-anaesthesia care unit (PACU) stay (SMD 0.29, 95% CI 0.08, 0.51) versus placebo. Conclusion Dexmedetomidine has positive effects on recovery quality in children undergoing general anaesthesia with sevoflurane.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Quantitative Synthesismentioning

confidence: 99%

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Effect of Dexmedetomidine in children undergoing general anaesthesia with sevoflurane: a meta-analysis and systematic review

Wen

Liu

2020

J Int Med Res

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“…Nine studies reported the incidence of EA according to the different dose of DEX compared to placebo (22,30,33,43,44,56,75,76,79). We conducted a metaregression analysis to show the relationship between the dose of DEX and EA incidence, which revealed statistically significant evidence for an association between the log risk ratio for EA and the dose of DEX (P=0.013) (Figure 11).…”

Section: Relationship Between the Dose Of Dex And Incidence Of Eamentioning

confidence: 99%

Effect of different administration and dosage of dexmedetomidine in the reduction of emergence agitation in children: a meta-analysis of randomized controlled trials with sequential trial analysis

Xu¹,

Bai²,

Shi³

et al. 2021

Transl Pediatr

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Background: Beneficial effects of dexmedetomidine (DEX) against emergence agitation (EA) in children remain controversial. We performed a more comprehensive meta-analysis to evaluate the protective effect of different administration routes, timing, patterns, and doses of DEX on EA in children. Methods:The randomized controlled trials about DEX preventing EA in children were searched in PubMed, Cochrane Library, Embase, and Web of Sciences up to October 7, 2020. The traditional meta-analysis and subgroup analysis were performed to study the influence of DEX on EA in children. The sequential trial analysis (TSA) further analyzed the pooled results to evaluate meta-analyses' robustness. Grading of recommendation, assessment, development, and evaluation (GRADE) was used to assess evidence quality.Results: Sixty-seven studies with 5,688 pediatric patients were included. DEX significantly decreased EA in children compared to placebo [RR 0.29, 95% confidence intervals (CI): 0.25-0.34] and midazolam (RR 0.34, 95% CI: 0.25-0.45), with firm evidence from TSA. Notably, using DEX significantly reduced severe EA incidence (RR 0.23, 95% CI: 0.16-0.32), with firm evidence by TSA and high quality of GRADE. Pre-specified subgroup analyses revealed firm and high-quality evidence for a reduction of EA, only if the perineural route administers DEX (RR 0.24, 95% CI: 0.14-0.41), as premedication (RR 0.27, 95% CI: 0.20-0.36), as continuous dosage (RR 0.25, 95% CI: 0.18-0.33), at high dose (RR 0.24, 95% CI: 0.18-0.31). The pooled results also showed that DEX reduced the incidence of PONV compared to placebo (RR 0.43, 95% CI: 0.33-0.55). Evidence for DEX's influence on other secondary outcomes (emergence time, time in PACU, rescue analgesia, hypotension, and bradycardia) is insufficient to draw any conclusion.Conclusions: Our findings confirm the beneficial effects of DEX on EA, severe EA, and PONV in children. There was firm and high-quality evidence for the efficacy of DEX in preventing EA in children when perineural routes administered DEX, as premedication, as continuous dosage, and at a high dose. The best dose, route, patterns, and timing of DEX and influence on other outcomes call for further studies.

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Dexmedetomidine vs. total intravenous anaesthesia in paediatric emergence delirium

Petre

Levin

Englesakis

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Emergence delirium is a common complication in paediatric anaesthesia associated with significant morbidity. Total intravenous anaesthesia (TIVA) and intra-operative dexmedetomidine as an adjuvant to sevoflurane anaesthesia can both reduce the incidence of emergence delirium compared with sevoflurane alone, but no studies have directly compared their relative efficacy. OBJECTIVE The study objective was to compare the effects of TIVA and dexmedetomidine on the incidence of paediatric emergence delirium. STUDY DESIGN The current study is a systematic review and network meta-analysis (NMA) of randomised controlled trials. DATA SOURCES We conducted a systematic search of 12 databases including Medline (Ovid) and Web of Science (Clarivate Analytics) from their respective inception to December 2020. ELIGIBILITY Inclusion criteria were randomised controlled trials of paediatric patients undergoing general anaesthesia using sevoflurane, sevoflurane with dexmedetomidine or TIVA. Data were extracted by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and analysed using NMA methodology. Risk ratios and 95% credible intervals (CrI) were calculated for all outcomes [emergence delirium, postoperative nausea and vomiting (PONV), and time to emergence and extubation]. The protocol was registered with PROSPERO (CRD42018091237). RESULTS The systematic review returned 66 eligible studies comprising 5257 patients with crude median emergence delirium incidences of 12.8, 9.1 and 40% in the dexmedetomidine with sevoflurane, TIVA and sevoflurane alone groups, respectively. NMA indicated that compared with TIVA, sevoflurane with adjuvant dexmedetomidine decreased the incidence of emergence delirium without statistical difference (risk ratio 0.88, 95% CrI 0.61 to 1.20, low quality of evidence), but resulted in a higher incidence of PONV (risk ratio: 2.3, 95% CrI 1.1 to 5.6, low quality of evidence). CONCLUSION Clinical judgement, considering the patient's risk factors for the development of clinically significant outcomes such as emergence delirium and PONV, should be used when choosing between TIVA and sevoflurane with adjuvant dexmedetomidine. These findings are limited by the low quality of evidence (conditional recommendation).

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Effect of two different doses of dexmedetomidine on the incidence of emergence agitation after strabismus surgery: a randomized clinical trial

Cited by 9 publications

References 21 publications

Effect of Dexmedetomidine in children undergoing general anaesthesia with sevoflurane: a meta-analysis and systematic review

Effect of Dexmedetomidine in children undergoing general anaesthesia with sevoflurane: a meta-analysis and systematic review

Effect of different administration and dosage of dexmedetomidine in the reduction of emergence agitation in children: a meta-analysis of randomized controlled trials with sequential trial analysis

Dexmedetomidine vs. total intravenous anaesthesia in paediatric emergence delirium

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