Meta-Analysis of Dexmedetomidine on Emergence Agitation and Recovery Profiles in Children after Sevoflurane Anesthesia: Different Administration and Different Dosage

Abstract

The objective of this article is to evaluate the effect of dexmedetomidine on emergence agitation (EA) and recovery profiles in children after sevoflurane anesthesia and its pharmacological mechanisms. Standard bibliographic databases, including MEDLINE, EMBASE, PsycINFP, Springer and ISI Web of Knowledge, were artificially searched to identify all randomized controlled trials (RCTs) comparing the impact of dexmedetomidine with placebo, fentanyl and midazolam on EA and recovery profiles after sevoflurane anesthesia in post-anesthesia care unit (PACU). Two authors assessed the quality of each study independently in accordance with strict inclusion criteria and extracted data. RevMan 5.0 software was applied for performing statistic analysis. The outcomes analyzed included: 1) incidence of EA, 2) emergence time, 3) time to extubation, 4) incidence of post-operation nausea and vomiting, 5) number of patients requiring an analgesic, and 6) time to discharge from PACU. A total of 1364 patients (696 in the dexmedetomidine group and 668 in the placebo, fentanyl and midazolam group) from 20 prospective RCTs were included in the meta-analysis. Compared with placebo, dexmedetomidine decreased the incidence of EA (risk ratio [RR] 0.37; 95% CI 0.30 to 0.46), incidence of nausea and vomiting (RR 0.57; 95% CI 0.38 to 0.85) and number of patients requiring an analgesic (RR 0.43; 95% CI 0.31 to 0.59). However, dexmedetomidine had a significantly delayed effect on the emergence time (weighted mean differences [WMD] 1.16; 95% CI 0.72 to 1.60), time to extubation (WMD 0.61; 95% CI 0.27 to 0.95), and time to discharge from recovery room (WMD 2.67; 95% CI 0.95 to 4.39). Compared with fentanyl (RR 1.39; 95% CI 0.78 to 2.48) and midazolam (RR 1.12; 95% CI 0.54 to 2.35), dexmedetomidine has no significantly difference on the incidence of EA. However, the analgesia effect of dexmedetomidine on postoperation pain has no significantly statistical differences compared with fentanyl (RR 1.12; 95% CI 0.66 to 1.91), which implied that its analgesia effect might play an important role in decreasing the incident of EA. No evidence of publication bias was observed.

Effects of intraoperative dexmedetomidine with intravenous anesthesia on postoperative emergence agitation/delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy

“…Dexmedetomidine (DEX), with its potent and specific affinity of α 2 -adrenergic receptors, [10] has properties of sedation, antianxiety, and analgesic effects, [11–15] and can reduce the incidence of POED in pediatric patients undergoing inhalation anesthesia. [11,12,14,16–18] However, the impact of DEX on the incidence of POED in pediatric patients after intravenous anesthesia is unknown. In the present study, we observed the safety of intraoperative combination of DEX with intravenous anesthesia in pediatric patients undergoing tonsillectomy with or without adenoidectomy, and validity for the prevention of POED.…”

Spots on Prevention of Emergence Delirium and Agitation in Children Using Dexmedetomidine

“…Primary analgesic effects and potentiation of opioid-induced analgesia result from the activation of α2-adrenergic receptors in the dorsal horn of the spinal cord and the inhibition of substance P release [12]. Dexmedetomidine have a unique pharmacologic profile as it can produce stage II non-rapid eye movement sleep through activation of the endogenous sleep promoting pathway, which induce conscious sedation [3]. Zhu M et al (2015), did a meta-analysis which included 20 randomized controlled trials published before October 2014.…”

“…Dexmedetomidine have a unique pharmacologic profile as it can produce stage II non-rapid eye movement sleep through activation of the endogenous sleep promoting pathway, which induce conscious sedation [3]. Zhu M et al (2015), did a meta-analysis which included 20 randomized controlled trials published before October 2014. They studied intervention, premedication, surgery procedures, anesthesia induction and maintenance of anesthesia related to ED.…”

“…More importantly, they showed that dexmedetomidine had identical analgesic effects compared with fentanyl. They used a variety of doses as bolus ranged from 0.15 -1 mcg/kg IV, 2.5 -4 mcg/kg orally, and 1, 2 mcg/kg in caudal, and fascia iliaca blocks respectively [3].…”

“…dissatisfaction and anxiety for the parents and requiring extra nursing care, which further increases associated healthcare costs [3].…”