Dexmedetomidine versus other sedatives for non-painful pediatric examinations: A systematic review and meta-analysis of randomized controlled trials

Lin, Yuanyuan; Zhang, Rui; Shen, Weihua; Chen, Qianru; Zhu, Yanling; Li, Jinfei; Chi, Wei; Gan, Xiaoliang

doi:10.1016/j.jclinane.2020.109736

Cited by 20 publications

(12 citation statements)

References 35 publications

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“…The findings of this meta‐analysis were similar to those of a meta‐analysis by Lin et al, which was published in 2020 and compared dexmedetomidine with other sedatives during nonpainful paediatric procedures 39 . However, our aim was to evaluate the safety and efficacy of dexmedetomidine administered solely by the intranasal route, as it does not require much co‐operation and is less invasive than the intravenous route.…”

Section: Discussionsupporting

confidence: 83%

“…The findings of this meta-analysis were similar to those of a metaanalysis by Lin et al, which was published in 2020 and compared dexmedetomidine with other sedatives during nonpainful paediatric procedures. 39 However, our aim was to evaluate the safety and efficacy of dexmedetomidine administered solely by the intranasal route, as it does not require much co-operation and is less invasive than the intravenous route. Lin et al also included studies where dexmedetomidine was administered orally or intravenously, thereby adding heterogeneity as intravenous, intranasal and oral routes have different pharmacokinetic, safety and efficacy profiles.…”

Section: Relationship To Other Reviewsmentioning

confidence: 99%

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Systematic review and meta‐analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation

et al. 2020

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Aim This systematic review and meta‐analysis evaluated the effectiveness of intranasal dexmedetomidine as a sole sedative during paediatric procedural sedation outside the operating room. Methods Relevant literature identified by PubMed, Scopus, ClinicalTrials.gov, ScienceDirect and Cochrane Library up to 31 December 2019 was systematically reviewed. Randomised controlled trials that compared intranasal dexmedetomidine with another sedative or placebo during paediatric procedural sedation were included. Trials that studied intranasal dexmedetomidine as a premedication before anaesthesia were excluded. The primary outcome was the success of the planned procedure. Results We analysed seven randomised controlled trials of 730 patients: four trials with 570 patients compared dexmedetomidine with chloral hydrate and three trials with 160 patients compared dexmedetomidine with midazolam. The incidence of successfully completing the procedure did not differ between dexmedetomidine and chloral hydrate, but dexmedetomidine had a higher success rate than midazolam. The incidence of hypotension, bradycardia or respiratory complications did not differ between the sedatives used. Nausea and vomiting were more common in children treated with chloral hydrate than in those treated with other sedatives. Conclusion Intranasal dexmedetomidine was a safe and effective sedative for minor paediatric procedures.

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Section: Discussionsupporting

confidence: 83%

Section: Relationship To Other Reviewsmentioning

confidence: 99%

Systematic review and meta‐analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation

et al. 2020

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“…4,5 Several studies have shown that dexmedetomidine premedication provides satisfactory preoperative sedation, alleviates parental separation anxiety, promotes the acceptance of facemask induction, and decreases the incidence of emergence delirium. 6,7 When used as premedication in pediatric patients, intranasal dexmedetomidine has been shown to confer an advantage over oral midazolam (the most commonly used premedication). 8 Nonetheless, attempts at mask inhalation induction or intravenous cannulation have been reported to arouse children from sedation and result in challenges for the installation of anesthesia.…”

Section: Introductionmentioning

confidence: 99%

<p>Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial</p>

Zheng¹,

Shi²,

Chen³

et al. 2020

DDDT

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Purpose: To compare the efficacy of intranasal dexmedetomidine and dexmedetomidineketamine premedication in preschool children undergoing tonsillectomy. Patients and Methods: We enrolled 66 children with American Society of Anesthesiologists physical status I or II, aged 3-7 years undergoing tonsillectomy. Patients were randomly allocated to receive intranasal premedication with either dexmedetomidine 2 μg kg −1 (Group D) or dexmedetomidine 2 μg kg −1 and ketamine 2 mg kg −1 (Group DK). The primary outcome was the sedation level assessed by the Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) 30 min after intervention. The minimal clinically relevant difference in the MOAA/S score was 0.5. Secondary outcomes included sedation onset time, parental separation anxiety, acceptance of mask induction, emergence time, emergence delirium, postoperative pain intensity, length of stay in the post-anesthesia care unit (PACU), and adverse effects. Results: At 30 min after premedication, the MOAA/S score was lower in Group DK than in Group D patients (median: 1.0, interquartile range [IQR]: 1.0-2.0 vs median: 3.0, IQR: 2.0-3.0; P<0.001), with a median difference of 1.0 (95% confidence interval [CI]: 1.0-2.0, P<0.001). Patients in Group DK showed considerably faster onset of sedation (15 min, 95% CI: 14.2-15.8 min) than Group D (24 min, 95% CI: 23.2-24.8 min), with a median difference of 8.0 min (95% CI: 7.0-9.0 min, P<0.001). Both parental separation and facemask acceptance scores were lower in Group DK than in Group D patients (P=0.012 and P=0.001, respectively). There was no significant difference in emergence time, incidence of emergence delirium, postoperative pain scores, and length of stay in the PACU between the two groups. Conclusion: Intranasal premedication with a combination of dexmedetomidine and ketamine produced better sedation for pediatric tonsillectomy than dexmedetomidine alone.

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“…Dexmedetomidine is a highly selective α 2 -agonist with sedative and analgesic effects and minimal respiratory depression. These favorable characteristics make it potentially useful for anesthesia in pediatric surgeries ( 10 , 11 ). In our case, 1 µg/kg dexmedetomidine administered intravenously before induction made the hemodynamic status more favorable when combined with sevoflurane 1%–2% intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a child with congenital insensitivity to pain with anhidrosis: A case report

Zhang

Geng

2022

Front. Surg.

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Congenital insensitivity to pain with anhidrosis (CIPA) is a rare, autosomal recessive disease classified as hereditary sensory and autonomic neuropathy type VI. Patients with CIPA are characterized by insensitivity to pain, episodes of unexplained fever, anhidrosis, self-mutilating behavior, intellectual disability, and autonomic nervous system abnormalities. The clinical features may intrinsically pose anesthetic challenges. We present a case of a patient with CIPA who underwent tumor biopsy under general anesthesia using a Supreme laryngeal mask airway without any complications. The anesthetic management of this condition is discussed.

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Dexmedetomidine versus other sedatives for non-painful pediatric examinations: A systematic review and meta-analysis of randomized controlled trials

Cited by 20 publications

References 35 publications

Systematic review and meta‐analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation

Systematic review and meta‐analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation

<p>Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial</p>

Anesthetic management of a child with congenital insensitivity to pain with anhidrosis: A case report

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