Oral Melatonin, Dexmedetomidine, and Midazolam for Prevention of Postoperative Agitation in Children

Özcengiz, Dilek; Güneş, Yılmaz; Özmete, Özlem

doi:10.1097/01.sa.0000410707.23984.00

Cited by 11 publications

(25 citation statements)

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“…A majority of references were excluded according to inclusion criteria. Finally, 15 independent studies were included in our meta‐analysis . The detailed steps of our literature search and the study selection are described in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of the 15 RCTs are presented in Table . As for the methodological quality, two studies were of low risk of bias, and the other 13 studies were of moderate risk of bias. The meta‐analysis included 15 articles (518 patients in the dexmedetomidine group and 413 in the placebo group).…”

Section: Resultsmentioning

confidence: 99%

“…The meta‐analysis included 15 articles (518 patients in the dexmedetomidine group and 413 in the placebo group). Among these studies, three studies reported the incidence of severe sevoflurane‐related EA (EA‐severe), and 13 studies focused on EA‐not classified (the severity of EA was not classified).…”

Section: Resultsmentioning

confidence: 99%

“…Another choice is to use dexmedetomidine, an α 2 ‐adrenoceptor (α 2 ‐AR) agonist with sedative, analgesic and anxiolytic actions, which has been widely used in pediatric and adult populations . Dexmedetomidine was approved by the Food and Drug Administration in 1999 for the sedation of adults receiving mechanical ventilation in an intensive care setting, and it has been an authorized drug in Europe since September 2011; there have been numerous studies evaluating dexmedetomidine's impact on EA. However, its efficacy remains controversial.…”

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confidence: 99%

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Dexmedetomidine for preventing sevoflurane‐related emergence agitation in children: a meta‐analysis of randomized controlled trials

Guo

2014

Acta Anaesthesiol Scand

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Emergence agitation (EA) is a common problem after sevoflurane anesthesia in children. Prophylactic dexmedetomidine has been directed at this issue; however, the efficacy remains controversial. We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effectiveness of dexmedetomidine on the incidence of sevoflurane-related EA. A comprehensive literature search was performed to identify RCTs that compared dexmedetomidine with placebo about the reduction in the incidence of sevoflurane-related EA for children. Heterogeneity between studies was anticipated; therefore, random effects models were chosen to calculate the pooled risk ratio (RR) and 95% confidence interval (CI), and I(2) statistics were used to assess statistical heterogeneity. The funnel plot and Egger test were used to assess potential publication bias. Subgroup analysis was run to explore the possible effects of age, surgical procedure, regional block/local anesthetics, supplemental analgesic, propofol, N2O, pre-medication and methodological quality on the incidence of EA using dexemedetomidine. Totally, 15 RCTs were included (518 patients received dexmedetomidine and 413 had placebo). Dexmedetomidine reduced the incidence of sevofurane-related EA (pooled RR = 0.351; 95% CI: 0.275-0.449; P = 0.965; heterogeneity test, I(2) = 0.0%), and it also resulted in a lower incidence of severe EA (pooled RR = 0.119; 95% CI: 0.033-0.422; P = 0.962; heterogeneity test, I(2) = 0.0%). All subgroup analyses for potential sources of heterogeneity showed a lower incidence of sevoflurane-related EA after dexmedetomidine administration. This meta-analysis demonstrated that dexemedetomidine was effective in reducing the incidence of sevoflurane-induced EA in children as compared with placebo.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Dexmedetomidine for preventing sevoflurane‐related emergence agitation in children: a meta‐analysis of randomized controlled trials

Guo

2014

Acta Anaesthesiol Scand

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“…Seven studies adopt "mean ± SD" pattern to provide data on agitation score, statistical analysis shows: DEX can reduce the patients' agitation score [MD=-0.89, 95% CI (-1.04, -0.74)] ( Figure 10) [3,10,11,17,18,25,29].…”

Section: Agitation Scorementioning

confidence: 99%

Effects of Dexmedetomidine on Postoperative Recovery Profile after Sevoflurane Anesthesia in Pediatric Patients: A Meta-analysis

Chen¹,

Yu²,

Hui-jun³

et al. 2013

J Anesth Clin Res

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Objective: We aim to evaluate whether dexmedetomidine can reduce incidence caused by sevoflurane anesthesia in pediatric patients systematically. Methods: We have searched the Cochrane Library, PubMed, EBSCO, Springer, Chinese Journal Full-text Database (CNKI), Chinese Biomedical Literature Database (CBM) and WanFang Data (all the materials selected from these databases range from the date of establishment of the databases to April 2013). Reference lists of all studies have also been checked. Two valuators performed the process of RCT, quality assessment, and data extraction with inclusion and exclusion criteria, and conduct the Meta-analysis with the software RevMan5.2. Results: The meta-analysis which including 27 randomized trials and 1882 children showed that dexmedetomidine extended the incidence of the children's recovery time [MD=2.39, 95% CI (1.27, 3.51)] and discharge time [MD=6.09, 95% CI (3.42, 8.77)] compared with placebo. Nevertheless, there were no obvious differences in extubation time [MD=0.75, 95% CI (0.45, 1.05)]. While reducing the incidence of early emergence agitation, dexmedetomidine showed a large advantage [RR=0.31, 95% CI (0.26, 0.38)] and could reduce agitation score [MD=-0.89, 95% CI (-1.04,-0.74)], also could reduce pain score [MD=-2.66, 95% CI (-3.81,-1.51)], as well as the need for painkillers [RR=0.34, 95% CI (0.22, 0.52)]. What's more, on reducing occurrence of nausea and vomiting [RR=0.59, 95% CI (0.36, 0.97)], occurrence of bucking [RR=0.39, 95% CI (0.23, 0.68)], dexmedetomidine also showed some preventive effects. There were no serious side effects on respiratory and circulatory system in all included studies. Conclusion: Dexmedetomidine can be used safely in children and improve the awakening quality after sevoflurane anesthesia. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h

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Atomised intranasal dexmedetomidine versus oral melatonin in prevention of emergence delirium in children undergoing ophthalmic surgery with sevoflurane

Jangra¹,

Ashok²,

Sethi³

et al. 2022

European Journal of Anaesthesiology

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BACKGROUND Melatonin and dexmedetomidine have both been used as a premedication to decrease emergence delirium in children. The effectiveness of oral melatonin, compared with atomised intranasal dexmedetomidine, in this role is not well studied. OBJECTIVETo study the efficacy of pre-operative atomised intranasal dexmedetomidine versus oral melatonin in children scheduled for ophthalmic surgery under sevoflurane.DESIGN A prospective, randomised, double-blind trial.SETTING Ophthalmic surgery in a university teaching hospital, April 2021 to October 2021.PATIENTS A total of 120 children undergoing ophthalmic surgery with sevoflurane anaesthesia.INTERVENTION Children were randomised to receive preoperative intranasal dexmedetomidine 2 mg/kg via an atomiser device (dexmedetomidine group) or oral melatonin 0.5 mg kg À1 (melatonin group), 45 min before surgery.OUTCOMES MEASURED The primary outcome was the incidence of emergence delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included pre-operative sedation, quality of inhalational induction, postoperative sedation and pain. RESULTSThe incidence of emergence delirium was lower in the dexmedetomidine group than in the melatonin group (17 versus 37%, relative risk 0.45, 95% CI: 0.24 to 0.88; P ¼ 0.01). Children in the dexmedetomidine group were more sedated following premedication and in the postanaesthesia care unit (P < 0.05). Postoperative pain scores were lower in the dexmedetomidine group than in the melatonin group: 0 [0 to 3] versus 2.5 [0-4], (P ¼ 0.01). The requirement for and dose of rescue fentanyl analgesia postoperatively was comparable between the two groups.CONCLUSION Atomised intranasal dexmedetomidine significantly reduced emergence delirium in paediatric opthalmic procedures under sevoflurane anaesthesia compared to oral melatonin.TRIAL REGISTRATION Clinical Trials Registry of India CTRI/2021/03/032388 (www.ctri.nic.in)

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Oral Melatonin, Dexmedetomidine, and Midazolam for Prevention of Postoperative Agitation in Children

Cited by 11 publications

References 3 publications

Dexmedetomidine for preventing sevoflurane‐related emergence agitation in children: a meta‐analysis of randomized controlled trials

Dexmedetomidine for preventing sevoflurane‐related emergence agitation in children: a meta‐analysis of randomized controlled trials

Effects of Dexmedetomidine on Postoperative Recovery Profile after Sevoflurane Anesthesia in Pediatric Patients: A Meta-analysis

Atomised intranasal dexmedetomidine versus oral melatonin in prevention of emergence delirium in children undergoing ophthalmic surgery with sevoflurane

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