Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Dental Patients under General Anesthesia: A Randomised Clinical Trial

Wang, Li; Huang, Lili; Zhang, Tiejun; Peng, Wei

doi:10.1155/2020/5142913

Cited by 25 publications

(40 citation statements)

References 23 publications

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“…Twelve trials (18,19,27,28,35,58,60,65,68,71,78,82) Figure 1 PRISMA flow chart depicting study selection criteria. (19,32) or ketofol (24,66), respectively, showed no significant differences between them in EA incidence (P>0.05) (Figure 9).…”

Section: Dex Vs Active Comparatorsmentioning

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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Section: Dex Vs Active Comparatorsmentioning

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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“…The primary outcome was the mask acceptance score. Mask acceptance, as evaluated by an independent observer or/and the attending anesthesiologist, was rated on a scale of 1 to 4 points, with 1 point indicating no fear of the mask and its easy acceptance; 2 points indicating a slight fear of the mask, with the patient being easy to comfort; 3 points indicating moderate fear of the mask, with the patient being di cult to calm; and 4 points indicating fear of the mask, with the patient crying or struggling [10]. Simultaneously, the behavioral score, de ned as the number of distress behaviors, including crying, screaming, nonverbal resistance, and verbal resistance [11], was determined.…”

Section: Methodsmentioning

confidence: 99%

The use of a scented face mask may facilitate the induction of anesthesia in pediatric patients: a randomized controlled trial

Abukawa

Takano

Hobo

et al. 2022

Preprint

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Background: Scented face masks are commonly used during the induction phase of anesthesia. The present study investigated whether the use of a scented mask improved mask acceptance before slow induction of anesthesia in pediatric patients. Methods: This prospective, randomized controlled trial enrolled patients aged 2–10 years who were scheduled to undergo surgery under general anesthesia. Patients were randomly assigned to undergo masking with a scented (experimental group) or unscented (control group) face mask before anesthesia inductionin the presence of a parent. The primary outcome was the mask acceptance score, rated on a validated 4-point from 1 point (not afraid; easily accepts the mask) to 4 points (afraid of a mask; crying or struggling). The secondary outcome was heart rate assessed by pulse oximetry in the pediatric ward before transfer to the operating room (OR), at the entrance to the OR, at the patient notification of mask fitting by the anesthesiologist, and after mask fitting. Results: Seventy-seven patients were accessed for eligibility, with 67 enrolled in the study: 33 in the experimental group and 34 in the control group. Mask acceptance was significantly greater among patients aged 2–3 years in the experimental than in the control group (p < 0.05). Conclusions: Use of scented masks can improve mask acceptance before anesthesia induction with a parental presence in pediatric patients aged 2–3 years.

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“…Just as observed in adults, dexmedetomidine has shown useful in diverse areas in pediatric anesthesia where its sedative properties are useful for premedication, 21 fiberoptic intubation, 22 and radiologic procedures. 23 Its use as an adjunct for balanced anesthesia where it could decrease the use of other drugs, reduce emergence delirium, postoperative shivering, and vomiting, and exhibit neuroprotective effects.…”

Section: Application In Pediatrics/childrenmentioning

confidence: 99%

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

Liu¹,

Li²,

Kang³

et al. 2021

JIR

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Dexmedetomidine, a highly selective α2-adrenoceptor agonist, has sedative, anxiolytic, analgesic, sympatholytic, and opioid-sparing properties and induces a unique sedative response which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Recent studies indicate several emerging clinical applications via different routes. We review recent data on dexmedetomidine studies, particularly exploring the varying routes of administration, experimental implications, clinical effects, and comparative advantages over other drugs. A search was conducted on the PubMed and Web of Science libraries for recent studies using different combinations of the words “dexmedetomidine”, “route of administration”, and pharmacological effect. The current routes, pharmacological effects, and application categories of dexmedetomidine are presented. It functions by stimulating pre- and post-synaptic α2-adrenoreceptors within the central nervous system, leading to hyperpolarization of noradrenergic neurons, induction of an inhibitory feedback loop, and reduction of norepinephrine secretion, causing a sympatholytic effect, in addition to its anti-inflammation, sleep induction, bowel recovery, and sore throat reduction effects. Compared with similar α2-adrenoceptor agonists, dexmedetomidine has both pharmacodynamics advantage of a significantly greater α2:α1-adrenoceptor affinity ratio and a pharmacokinetic advantage of having a significantly shorter elimination half-life. In its clinical application, dexmedetomidine has been reported to present a significant number of benefits including safe sedation for various surgical interventions, improvement of intraoperative and postoperative analgesia, sedation for compromised airways without respiratory depression, nephroprotection and stability of hypotensive hemodynamics, reduction of postoperative nausea and vomiting and postoperative shivering incidence, and decrease of intraoperative blood loss. Although the clinical application of dexmedetomidine is promising, it is still limited and further research is required to enhance understanding of its pharmacological properties, patient selection, dosage, and adverse effects.

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Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Dental Patients under General Anesthesia: A Randomised Clinical Trial

Cited by 25 publications

References 23 publications

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

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

The use of a scented face mask may facilitate the induction of anesthesia in pediatric patients: a randomized controlled trial

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

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