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

Chiang, Fu Wei; Chang, Jin; Hsu, Shih Chang; Hsu, Kuo Yuan; Chu, Karen Chia Wen; Huang, Chun Jen; Bai, Chyi Huey; Chen, Chiehfeng; Hsu, Yuan Pin

doi:10.1371/journal.pone.0240553

Cited by 15 publications

(28 citation statements)

References 41 publications

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“…Abbreviations: dexmed, dexmedetomidine administered intraoperatively; GI, gastrointestinal; MRI, magnetic resonance imaging; non-dexmed, no dexmedetomidine administered intraoperatively. There is growing evidence that dexmedetomidine is beneficial for reducing postoperative complications, including emergence agitation, 3,4,[14][15][16] pain, 16 opioid requirements, 2,5 and nausea. 16,17 These advantages continue to be demonstrated for common pediatric procedures, such as strabismus repair 17 and adenotonsillectomy, 14,15 and these recent reports have suggested that the reported benefits are realized without delaying recovery.…”

Section: Discussionmentioning

confidence: 99%

“…There is growing evidence that dexmedetomidine is beneficial for reducing postoperative complications, including emergence agitation, 3,4,[14][15][16] pain, 16 opioid requirements, 2,5 and nausea. 16,17 These advantages continue to be demonstrated for common pediatric procedures, such as strabismus repair 17 and adenotonsillectomy, 14,15 and these recent reports have suggested that the reported benefits are realized without delaying recovery. During the present study, dexmedetomidine was typically administered as a bolus dose at the start of the procedure, in the range 0.28 -0.51 µg/kg, but with higher doses in some cases, and the observed delay was relatively short: approximately an additional 5-7 minutes in the PACU.…”

Section: Discussionmentioning

confidence: 99%

“…There is growing evidence that dexmedetomidine is beneficial for reducing postoperative complications, including emergence agitation, 3,4,14‐16 pain, 16 opioid requirements, 2,5 and nausea 16,17 17 and adenotonsillectomy, 14,15 and these recent reports have suggested that the reported benefits are realized without delaying recovery.…”

Section: Discussionmentioning

confidence: 99%

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Association of dexmedetomidine with recovery room and hospital discharge times: A retrospective cohort analysis

West

Görges

Poznikoff

et al. 2021

Pediatric Anesthesia

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Background: Dexmedetomidine is a useful anesthetic adjunct, increasingly popular during pediatric surgery and procedural sedation. Its half-life of 2-3 hours might prolong recovery and discharge times when compared with an un-supplemented propofol anesthetic. This may create an additional burden in a busy post-anesthetic care unit (PACU).Aim: To investigate whether intraoperative adjuvant dexmedetomidine delays PACU discharge in patients undergoing propofol anesthesia for day surgery or procedural investigations with minimal anticipated post-procedural pain. Methods:We conducted a retrospective review of outpatient procedures performed during a six-month period including pediatric patients, ASA physical status I-III, who underwent intravenous anesthesia with propofol and remifentanil for magnetic resonance imaging (MRI), strabismus repair, upper gastrointestinal endoscopy, or combined upper/lower gastrointestinal endoscopy. Patients receiving a sedative premedication, long-acting opioids, or volatile anesthetics for maintenance of anesthesia, were excluded. Duration of PACU stay was compared for patients who did or did not receive intraoperative dexmedetomidine in the four procedure groups.Results: Charts were reviewed for 359 patients; 130 (36%) received dexmedetomidine. Median differences in duration of PACU stay for dexmedetomidine versus nondexmedetomidine cases were: 5 minutes (95%CI 0 to 10, p=0.037) for MRI; 5 minutes (95%CI −3 to 15, p=0.258) for strabismus surgery; 7 minutes (95%CI 3 to 10, p<0.001) for upper endoscopy; and 5 minutes (95%CI 1 to 12, p=0.021) for combined upper/ lower endoscopy. Linear regression (F=61.1, adjusted R 2 =0.40) indicated a significant relationship between dexmedetomidine dose (estimate 14.6 minutes per μg/kg, 95%CI 8.2 to 21.1, p<0.001) and duration of PACU stay. Conclusion:We found evidence for a small association of intraoperative dexmedetomidine with duration of recovery from propofol anesthesia for a set of common outpatient procedures, with a potential dose relationship equivalent to approximately 15 minutes delay per μg/kg dexmedetomidine administered. Future research into the benefits of dexmedetomidine in pediatric anesthesia should further evaluate this relationship.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of dexmedetomidine with recovery room and hospital discharge times: A retrospective cohort analysis

West

Görges

Poznikoff

et al. 2021

Pediatric Anesthesia

View full text Add to dashboard Cite

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“…Strabismus surgery is a typical pediatric procedure that involves general anesthesia. After strabismus surgery, many pediatric patients present with emergence delirium (ED), and the incidence rates are as high as 40-86% (1). ED can lead to various adverse effects, such as increasing risks of suture dehiscence or accidental removal of intravenous catheters, self-injury, prolonged postanesthesia care unit (PACU) length of stay, and even negative postoperative behavior (2,3).…”

Section: Introductionmentioning

confidence: 99%

Intranasal Dexmedetomidine Accompanied by Cartoon Video Preoperation for Reducing Emergence Delirium in Children Undergoing Strabismus Surgery: A Prospective Randomized Trial

Chu

Wang

et al. 2021

Front. Surg.

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Background: After general anesthesia, many pediatric patients present with emergence delirium (ED). The aim of this study was to determine whether dexmedetomidine intranasal premedication accompanied by a cartoon video 30 min before general anesthesia would have an effect on reducing emergence delirium in preschool children.Methods: One hundred and forty children aged 3–6 year undergoing elective strabismus surgery were randomly to be premedicated with 2 μg kg−1 intranasal dexmedetomidine accompanied by the viewing of a cartoon video (Group DV) or without any premedication as usual (Group C). The primary outcome was the incidence of emergence delirium at the postanesthesia care unit (PACU), evaluated by the Pediatric Anesthesia Emergence Delirium (PAED) scale. The secondary outcomes included: the Modified Yale Preoperative Anxiety Scale (mYPAS) upon separation from parents; the Induction Compliance Checklist score (ICC); the PACU discharge time; the parental satisfaction score; the incidences of the side effects and the Post-Hospital Behavior Questionnaire (PHBQ) score during the first day after surgery.Results: The incidence of emergence agitation (PAED score ≥ 10) was reduced in Group DV compared with Group C [8 (11.4%) vs. 24 (34.3%); P = 0.001]. None of the patients in the DV group experienced severe emergence agitation (PAED score ≥ 15), as compared with the C group (P = 0.006). The mYPAS score upon separation from parents (P < 0.001) and the incidence of poor coordination (ICC ≥ 4) during induction (P < 0.001) were significantly lower in Group DV than in Group C. In Group DV, the PACU discharge time was longer (P < 0.001), and the parental satisfaction score was higher (P < 0.001). However, during the first day after surgery, the PHBQ score was lower in Group DV compared with Group C (P = 0.001).Conclusions: Premedication with 2 μg kg−1 intranasal dexmedetomidine accompanied by cartoon video viewing can dramatically reduce emergence delirium in preschool children undergoing strabismus surgery, relieve preoperative anxiety and improve the parental satisfaction and the postoperative behavior changes during the first day after surgery.Clinical Trial Registration: ChiCTR2000030678.

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“…In this study, vitamin A palmitate (VAP) eye gel is applied for the treatment of dry eye in children after strabismus surgery, as surgery will cause adverse effects on the physiological structure of the ocular surface, and destroy the stability of the tear film, which will aggravate the postoperative discomfort because of the lack of tear lubrication (10). Compared with other dry eye drugs, such as sodium hyaluronate and Carbomer, VAP eye gel can not only play a role of replenishing water and lubricating the eyeball, but vitamin A supplementation can improve the dehydration symptoms of corneal and conjunctival epithelial cells, and promote the normal differentiation and proliferation of corneal epithelium and conjunctival epithelium (11).…”

Section: Introductionmentioning

confidence: 99%

Application of vitamin A palmitate eye gel and nurse value of Watson’s theory of caring in children with dry eye after strabismus surgery: a randomized trial

Yang¹,

Guo²,

Gong³

et al. 2021

Transl Pediatr

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Background: After strabismus surgery, the local swelling of conjunctival wound will affect the uniform distribution of tears on the ocular surface, and the inflammatory reaction will affect the stability of tear film, which will easily lead to iatrogenic dry eye. This study aimed to investigate the effect of vitamin A palmitate (VAP) eye gel application in dry eye and the advantages of Watson's theory of caring.Methods: Two hundred and forty children with dry eye after strabismus surgery treated in our hospital from September 2018 to September 2020 were selected as the study subjects, and were randomly divided into control group and observation group according to the allocation ratio of 1:1. Watson's theory of care nursing was applied in the observation group, and VAP eye gel was additionally dropped into the eye. Mouse conjunctival goblet cells (GCs) were used to detect the effect of VAP on the growth of GCs. Treatment compliance, improvement of dry eye symptoms [Schirmer I test (SIT), tear film break-up time (BUT), and fluorescent staining (FL) score], inflammatory factor levels in tears, clinical efficacy, and parents' satisfaction were compared.Results: It was found that VAP eye gel could better promote the proliferation of GCs. After nursing and clinical treatment, the dry eye symptoms were improved in all included children, and improvements in the SIT, BUT, and FL scores were more obvious in the observation group. Watson's theory of care nursing could effectively improve the children's treatment compliance and parents' satisfaction.Conclusions: As a result, the application of VAP eye gel and Watson's theory of care nursing could effectively reduce the occurrence of dry eye after strabismus surgery, and were of great importance for improving the relationship between nurses and patients and building a harmonious hospital.

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

Cited by 15 publications

References 41 publications

Association of dexmedetomidine with recovery room and hospital discharge times: A retrospective cohort analysis

Association of dexmedetomidine with recovery room and hospital discharge times: A retrospective cohort analysis

Intranasal Dexmedetomidine Accompanied by Cartoon Video Preoperation for Reducing Emergence Delirium in Children Undergoing Strabismus Surgery: A Prospective Randomized Trial

Application of vitamin A palmitate eye gel and nurse value of Watson’s theory of caring in children with dry eye after strabismus surgery: a randomized trial

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