Effect of Dexmedetomidine on Preventing Postoperative Agitation in Children: A Meta-Analysis

Abstract

BackgroundEmergence agitation (EA) is one of the most common postoperative complications in children. The purpose of this meta-analysis is to assess the effect of dexmedetomidine for preventing postoperative agitation in children.MethodsWe searched the Cochrane Central Register of Controlled Trails, MEDLINE, and EMBASE. Randomized controlled trials were included. The following outcome measures were evaluated: incidence of EA, number of patients requiring rescue, time to eye-open, time to extubation, time to discharge from the postanesthesia care unit (PACU).ResultsWe analyzed 19 trials (1608 patients) that met the inclusion criteria. Compared with placebo, intravenous dexmedetomidine significantly reduced the incidence of EA [risk ratio (RR) 0.34, 95% confidence interval (CI) 0.25–0.44, P<0.00001). Dexmedetomidine also decreased the incidence of severe pain (RR 0.41, 95% CI 0.27–0.62, P<0.0001) and requirement of a rescue drug (RR 0.31, 95% CI 0.18–0.53, P<0.0001). However, compared with placebo, dexmedetomidine increased the time to eye-open by 0.98 min (P = 0.01) and the time to PACU discharge by 4.63 min (P = 0.02). Dexmedetomidine was also compared with midazolam, propofol, ketamine, and fentanyl, among others. No significant difference was found in the incidence of EA for most of these comparisons, with the exception of fentanyl and propofol, where dexmedetomidine was more beneficial.ConclusionsDexmedetomidine was proved effective for preventing EA and for reducing severe pain and the requirement of rescue drugs. It slightly increased the time to eye-open and the time to PACU discharge. Dexmedetomidine was also more beneficial than propofol or fentanyl in preventing EA.

Effects of intravenous fentanyl around the end of surgery on emergence agitation in children: Systematic review and meta‐analysis

“…According to the type of medication and when it is administered, various prophylactic interventions have been proposed to reduce the incidence and severity of EA . Among these interventions, the use of pharmacological agents before emergence or at the end of surgery is regarded as a reasonable method in clinical situations, as it does not depend on the duration of surgery or anesthesia or the characteristics of the anesthetic drugs administered during induction and maintenance .…”

“…1,4,5 According to the type of medication and when it is administered, various prophylactic interventions have been proposed to reduce the incidence and severity of EA. 2,3,5,6 Among these interventions, the use of pharmacological agents before emergence or at the end of surgery is regarded as a reasonable method in clinical situations, as it does not depend on the duration of surgery or anesthesia or the characteristics of the anesthetic drugs administered during induction and maintenance. 5,7,8 From this viewpoint, relatively low doses of propofol (1 mg/kg) or fentanyl (1 mcg/kg) administered around the end of surgery have been rigorously investigated using different assessment tools to determine whether they can successfully decrease EA under various conditions.…”

Pain during intravenous Propofol injection and its prevention in the pediatric population. A randomized controlled trial.

“…In the pediatric population, it is tantamount to appease the psychological state of the patient thus reducing anxiety which reduces the subjective sensation of pain. 24 In our study we tried to appease the patient as much as possible however there were no fixed criteria. Anesthesiologists have adopted administration of a combination of drugs to reduce the pain of propofol injection.…”

Monitoring boreal forest biomass and carbon storage change by integrating airborne laser scanning, biometry and eddy covariance data

“…(Note, NEP and NPP are parallel but distinct concepts, as NPP does not account for heterotrophic respiration C losses). Above and below-ground biomass measurements can be destructive, limited in spatial extent and temporal frequency because they are labour intensive (Curtis et al, 2002;Gower et al, 1997;Lambert et al, 2005;Peichl & Arain, 2007, Zha et al, 2013, and may not fully account for spatial variability (Kristensen, Naesset, Ohlson, Bolstad, & Kolka, 2015). Despite such limitations, in situ observations of temporal change in C stocks provide a cumulative assessment of biomass C growth and loss (Barford et al, 2001), which may allow for more direct partitioning of changes in C pool quantities associated with climatic, disturbance and land management drivers.…”

“…invasive root measurements, trampling of understory, litter traps), the observer might alter the growth trajectory of the plot or surrounding area (Cahill, Castelli, & Casper, 2001;Semboli, Beina, Closset-Kopp, Gourlet-Fleury, & Decocq, 2014). Such concerns provide justification for refining and integrating non-invasive C assessment techniques such as eddy covariance and remote sensing (He, Chen, Pan, Birdsey, & Kattge, 2012;Kristensen et al, 2015). To this end, airborne laser scanning (ALS) provides a noninvasive spatially-and structurally-explicit scaling mechanism between field-plot data and EC-based estimates of NEP within forest ecosystems.…”