Efficacy of propofol for the prevention of emergence agitation after sevoflurane anaesthesia in children: A meta-analysis

Xiao, Yinggang; Jin, Xuening; Zhang, Yang; Huang, Tianfeng; Zhou, Lingjun; Gao, Ju

doi:10.3389/fsurg.2022.1031010

Cited by 11 publications

(3 citation statements)

References 40 publications

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“…Sub-anesthetic dosages of propofol administered through intravenous conscious sedation infusion have eased dental procedures for apprehensive children. Moreover, it can be injected toward the conclusion of an examination or procedure to mitigate the occurrence and intensity of emergence agitation ( 83 ). However, intravenous propofol induction remains problematic due to the challenges involved in obtaining vascular access in distressed and alert children ( 84 ).…”

Section: Medicationsmentioning

confidence: 99%

Procedural sedation in pediatric dentistry: a narrative review

Gao

2023

Front. Med.

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Procedural sedation and analgesia are now considered standard care for managing pain and anxiety in pediatric dental patients undergoing diagnostic and therapeutic procedures outside of the operating room. Anxiolysis, which combines both pharmacologic and non-pharmacologic approaches, plays a significant role in procedural sedation. Non-pharmacologic interventions such as Behavior Management Technology can help reduce preprocedural agitation, ease the transition to sedation, reduce the required amount of medication for effective sedation, and decrease the occurrence of adverse events. As the introduction of novel sedative regimen and methods in pediatric dentistry, the potential role of mainstay sedatives administered by new routes, for new indications, and with new delivery techniques, should be considered. The purpose of this paper is to examine and discuss the current state of sedation techniques in pediatric dentistry.

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Section: Medicationsmentioning

confidence: 99%

Procedural sedation in pediatric dentistry: a narrative review

Gao

2023

Front. Med.

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“…In a dose–response study with 0.5 μg/kg up to 2.0 μg/kg of nasal dexmedetomidine, the highest dose worked best [24 ▪ ]. Propofol given as a bolus at the end of a sevoflurane anaesthetic is a well established practice [25].…”

Section: Postoperative Agitationmentioning

confidence: 99%

A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing

Jöhr¹

2023

Current Opinion in Anaesthesiology

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Purpose of reviewThe aim of this review is to discuss recent developments in paediatric anaesthesia, which have evolved in an undulating fashion.Recent findingsThe role and efficacy of pharmacological premedication is reevaluated. The anxiolytic and sedative properties of midazolam and α2-agonists have now been defined more precisely. Both classes of drugs have their unique profile, and there is no reason to condemn one or the other. Midazolam is an excellent anxiolytic, whereas dexmedetomidine is superior in the postoperative period and for sedation during diagnostic imaging.A total intravenous technique with propofol is often considered to be the standard for the prevention of emergence agitation; but alternatives do exist, such as a co-medication with dexmedetomidine or opioids. In clinical reality, a multimodal approach may often be advisable.The theoretical basis for propofol dosing has recently been adapted. In contrast to previous beliefs, the context-sensitive half-life of propofol seems to be quite short beyond the first year of life.SummaryMidazolam and dexmedetomidine are not interchangeable; each compound has its pros and cons. As an anxiolytic drug, midazolam indisputably deserves its place, whereas dexmedetomidine is a better sedative and particularly beneficial in the postoperative period. New data will allow more precise age-adapted dosing of propofol.

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“…Emergence delirium (ED) represents a behavioral disorder in children characterized by crying, fear, instability, and disorientation in the early stages of anesthesia recovery. Improper anesthesia techniques and postoperative airway obstruction and pain significantly contribute to the occurrence of these complications [5,6]. Therefore, the use of effective interventions to promote cooperation, ensure clinical safety, enhance overall comfort, and reduce postoperative adverse reactions has become a focal point in anesthesia research and efforts.…”

Section: Introductionmentioning

confidence: 99%

Effects of different doses of intranasal dexmedetomidine on related complications and parents’ satisfaction in anesthetized children: a systematic review

Hu,

Wang,

Sun

2024

BMC Pediatr

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Background Agitation/delirium is commonly seen in children after anesthesia, and a proper dose of dexmedetomidine can prevent this complication. This study aimed to investigate the effects of different doses of Dexmedetomidine (DEX) on agitation/delirium and other complications in anesthetized children, providing clinical evidence for dose recommendations of DEX. Methods This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search was conducted in the Cochrane Library, PubMed, Web of Science, and EMBASE. Two independent researchers performed literature screening, data extraction, and assessed the methodological quality. Data analysis was conducted using R and STATA 16.0. Results In the final analysis, 20 randomized controlled trials (RCTs) involving 2521 children were included. The results showed that in comparison to normal saline, 1 µg/kg, 1.5 µg/kg, and 2 µg/kg intranasal DEX significantly reduced the incidence of post-anesthetic emergence agitation in children with the most effective dose being 2 µg/kg (SUCRA = 0.91). Compared with normal saline, 1 µg/kg, 1.5 µg/kg, and 2 µg/kg intranasal DEX reduced patient’s need for postoperative analgesia, with the most effective dose being 1.5 µg/kg (SUCRA = 0.78). However, 1 µg/kg DEX performed the best in reducing Pediatric Anaesthesia Emergence Delirium (PAED) Scale score (SUCRA = 0.88). Conclusion Compared with normal saline, intranasal administration of 2 µg/kg DEX and 1.5 µg/kg DEX are the optimal doses to reduce the incidence of agitation and the need for postoperative pain relief in children under general anesthesia. Given effectiveness and safety, intranasal use of 1 µg/kg DEX appears to be the most effective dosage for anesthetized children.

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Efficacy of propofol for the prevention of emergence agitation after sevoflurane anaesthesia in children: A meta-analysis

Cited by 11 publications

References 40 publications

Procedural sedation in pediatric dentistry: a narrative review

Procedural sedation in pediatric dentistry: a narrative review

A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing

Effects of different doses of intranasal dexmedetomidine on related complications and parents’ satisfaction in anesthetized children: a systematic review

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