Effect of ancillary drugs on sevoflurane related emergence agitation in children undergoing ophthalmic surgery: a Bayesian network meta-analysis

Tan, Dan; Xia, Haifa; Sun, Shujun; Wang, Fuquan

doi:10.1186/s12871-019-0810-y

Cited by 21 publications

(14 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…More prospective studies comparing the effects of different dosages of dexmedetomidine on EA are required to establish the optimal dose. Dexmedetomidine used in tonsillectomy, adenoidectomy, ophthalmologic, and orthopedic surgeries lower the EA incidence compared with saline, which is consistent with the findings of Cho et al ( 43 ), Jiao et al ( 46 ), and Tan et al ( 42 ). Tonsillectomy with or without adenoidectomy is commonly associated with throat pain and discomfort, and the EA risk associated with this procedure is up to 55.88% and may involve “a sense of suffocation” because of edema, difficulty in swallowing, and nausea.…”

Section: Discussionsupporting

confidence: 88%

Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Yang

Peng

et al. 2020

Front. Pediatr.

View full text Add to dashboard Cite

Background: Emergence agitation (EA) is one of the most common and intractable postoperative complications among children undergoing surgery under general anesthesia. Dexmedetomidine, an α(2)-adrenoceptor agonist, offers an ideal sedation, reduces preoperative anxiety, and facilitates smooth induction of anesthesia, and it is widely used in pediatric surgery. We aimed to evaluate the efficacy of dexmedetomidine for preventing emergence agitation in children after general anesthesia. Methods: We comprehensively reviewed PubMed, Cochrane Library, EMBASE, and Web of Science databases to search all randomized controlled trials, published before April 22, 2020, investigating the efficacy of dexmedetomidine in preventing the emergence agitation in children after general anesthesia. The meta-analysis was performed using Review Manager 5.3. The primary outcome was the incidence of emergence agitation. Secondary outcomes included the number of patients requiring rescue analgesic, number of patients with postoperative nausea and vomiting, emergence time, extubation time, and time to discharge from the post-anesthesia care unit. Results: We included a total of 33 studies, comprising 2,549 patients in this meta-analysis. Compared with saline, dexmedetomidine significantly reduced the emergence agitation incidence [risk ratio (RR) 0.29; 95% confidence interval (CI) 0.22–0.37; p < 0.00001], incidence of postoperative nausea and vomiting (RR 0.46; 95% CI 0.3–0.69; p = 0.0002), and the requirement of rescue analgesic (RR 0.29; 95% CI 0.18–0.44; p < 0.00001). Furthermore, children in the dexmedetomidine group experienced a longer emergence time [mean difference (MD) 2.18; 95% CI 0.81–3.56; p = 0.002] and extubation time (MD 0.77; 95% CI 0.22–1.31; p = 0.006) compared with those in the saline group. However, no significant difference was observed in the time to discharge from the post-anesthesia care unit (MD 2.22; 95% CI −2.29–6.74; p = 0.33) between the two groups. No significant differences were observed between the effects of dexmedetomidine and other drugs like midazolam, propofol, fentanyl, tramadol, and clonidine in terms of the emergence agitation incidence and other parameters, except for the requirement of rescue analgesic (RR 0.45; 95% CI 0.33–0.61; p < 0.00001). Conclusions: Dexmedetomidine can prevent emergence agitation, relieves postoperative pain, decreases the requirement of rescue analgesic, and decreases the postoperative nausea and vomiting events.

show abstract

Section: Discussionsupporting

confidence: 88%

Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Yang

Peng

et al. 2020

Front. Pediatr.

View full text Add to dashboard Cite

show abstract

“…Sevoflurane is generally the preferred anesthetic agent to induce and maintain cardiac general anesthesia in children due to its rapid induction and recovery characteristics, easily controlled anesthetic depth, stable hemodynamics and minor effect on cardiac function [ 18 ] . However, in recent years, it has been shown that one of the main complications after sevoflurane anesthesia in children is emergence delirium upon awakening from general anesthesia, with a reported incidence ranging from 10% to 80%, especially in preschoolers [ 3 , 19 ] . This agitation has a variety of manifestations, including crying, excitement and delirium after awakening.…”

Section: Discussionmentioning

confidence: 99%

“…It has the advantages of rapid analepsia, little airway stimulation, and stable hemodynamics. However, the incidence of emergence delirium is as high as 40%, which affects the postoperative recovery of children, increases the difficulty of postoperative nursing and aggravates the psychological burden on children and their families [ 3 , 4 ] . Sufentanil has a strong analgesic capacity and sedative effect and lasts longer [ 5 ] .…”

Section: Introductionmentioning

confidence: 99%

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

Xu¹,

Chen²,

Huang³

et al. 2020

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

Objective The aim of this study was to evaluate whether sufentanil can reduce emergence delirium in children undergoing transthoracic device closure of ventricular septal defect (VSD) after sevoflurane-based cardiac anesthesia. Methods From February 2019 to May 2019, 68 children who underwent transthoracic device closure of VSD at our center were retrospectively analyzed. All patients were divided into two groups: 36 patients in group S, who were given sufentanil and sevoflurane-based cardiac anesthesia, and 32 patients in group F, who were given fentanyl and sevoflurane-based cardiac anesthesia. The following clinical data were recorded: age, sex, body weight, operation time, and bispectral index (BIS). After the children were sent to the intensive care unit (ICU), pediatric anesthesia emergence delirium (PAED) and face, legs, activity, cry, consolability (FLACC) scale scores were also assessed. The incidence of adverse reactions, such as nausea, vomiting, drowsiness and dizziness, was recorded. Results There was no significant difference in age, sex, body weight, operation time or BIS value between the two groups. Extubation time (min), PEAD score and FLACC scale score in group S were significantly better than those in group F ( P <0.05). No serious anesthesia or drug-related side effects occurred. Conclusions Sufentanil can be safely used in sevoflurane-based fast-track cardiac anesthesia for transthoracic device closure of VSD in children. Compared to fentanyl, sufentanil is more effective in reducing postoperative emergence delirium, with lower analgesia scores and greater comfort.

show abstract

“…Third, insufficient evidence was available in the included studies for comparing the efficacy of dexmedetomidine with that of other active comparators. However, a network meta-analysis indicated that the effects of dexmedetomidine combined with sevoflurane were superior to those of ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil, and clonidine in reducing EA risk in children undergoing ophthalmic surgery [44]. Fourth, the standard postoperative management of PONV and postoperative pain varied among the included studies.…”

Section: Plos Onementioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

Background Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery. Method Five databases were searched for randomized controlled trials published from database inception to April 2020 that compared dexmedetomidine use with placebo or active comparator use and evaluated EA, PONV, or postoperative pain incidence (main outcomes) in patients who had undergone pediatric strabismus surgery. Oculocardiac reflex (OCR) incidence and postanesthesia care unit (PACU) stay duration were considered as safety outcomes. All meta-analyses were performed using a random-effects model. Results In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced EA incidence [risk ratio (RR): 0.

show abstract

Effect of ancillary drugs on sevoflurane related emergence agitation in children undergoing ophthalmic surgery: a Bayesian network meta-analysis

Cited by 21 publications

References 45 publications

Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

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

Contact Info

Product

Resources

About