Premedication with dexmedetomidine in pediatric patients: a systematic review and meta-analysis

Abstract

Premedication is important in pediatric anesthesia. This meta-analysis aimed to investigate the role of dexmedetomidine as a premedicant for pediatric patients.A systematic literature search was conducted to identify randomized controlled trials comparing dexmedetomidine premedication with midazolam or ketamine premedication or placebo in children. Two reviewers independently performed the study selection, quality assessment and data extraction. The original data were pooled for the meta-analysis with Review Manager 5. The main parameters investigated included satisfactory separation from parents, satisfactory mask induction, postoperative rescue analgesia, emergence agitation and postoperative nausea and vomiting.Thirteen randomized controlled trials involving 1190 patients were included. When compared with midazolam, premedication with dexmedetomidine resulted in an increase in satisfactory separation from parents (RD = 0.18, 95% CI: 0.06 to 0.30, p = 0.003) and a decrease in the use of postoperative rescue analgesia (RD = -0.19, 95% CI: -0.29 to -0.09, p = 0.0003). Children treated with dexmedetomidine had a lower heart rate before induction. The incidence of satisfactory mask induction, emergence agitation and PONV did not differ between the groups. Dexmedetomidine was superior in providing satisfactory intravenous cannulation compared to placebo.This meta-analysis suggests that dexmedetomidine is superior to midazolam premedication because it resulted in enhanced preoperative sedation and decreased postoperative pain. Additional studies are needed to evaluate the dosing schemes and long-term outcomes of dexmedetomidine premedication in pediatric anesthesia.

Intranasal deksmedetomidin er gunstig som premedikasjon til barn – sett fra anestesisykepleieres perspektiv

“…Ulike vitenskapelige artikler indikerer at deksmedetomidin er velegnet som premedikasjon og sedasjon til barn ned til ett års alderen. Forskning viser også at bruk av deksmedetomidin har positive effekter i postoperativ fase, slik som roligere og mindre smertefulle oppvåkninger (1,3,8).…”

“…Tidligere studier indikerer at deksmedetomidin kan redusere behovet for anestesimedikamenter peroperativt og forlenge effekten av opioider, noe som medfører redusert behov for smertestillende postoperativt. Studiene indikerer også at deksmedetomidin som premedikasjon beskytter bedre mot postoperativ uro enn midazolam (3,8,29).…”

“…Midazolams bivirkninger som vond smak, svie ved intranasal implisering, respirasjonsdepresjon og i noen tilfeller økt uro gjør det likevel til et suboptimalt valg (1,3,8). Det er behov for alternativ premedikasjon til barn for å forbedre behandlingstilbudet i pre-, per-og postoperativ fase (9).…”

“…Forskning estimerer at 40-70 prosent av barn i førskolealder opplever angst i forbindelse med kirurgiske inngrep (1,3,8). Angst kan føre til vanskelige anestesiinnledninger, som er krevende for barnet, foreldre og anestesiteamet.…”

Radiation Therapy for Children: Periprocedural Anaesthetic Concerns

“…EMLA cream is a good option if time permits and can be applied one hour prior to the expected time for start. There are studies stating the use of intranasal dexmedetomidine, midazolam, and ketamine for preprocedural sedation, before intravenous cannulation is attempted [6][7][8][9]. Usually an intravenous line is started on the first day and maintained till the next five days since radiations is delivered in 30 fractions for the subsequent six weeks.…”