Oral trans-mucosal dexmedetomidine for controlling of emergence agitation in children undergoing tonsillectomy: a randomized controlled trial

Abdel‐Ghaffar, Hala Saad; Abdel‐Wahab, Amani H.; Roushdy, M.

doi:10.1016/j.bjane.2019.07.001

Cited by 7 publications

(11 citation statements)

References 26 publications

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“…The patients in 17 trials ( 20 , 22 , 28 – 30 , 32 , 39 , 43 , 49 , 50 , 52 , 54 , 61 , 64 , 72 , 74 , 78 ) underwent otolaryngology surgeries, those in 5 trials ( 36 , 44 , 66 , 67 , 70 ) underwent dental or cleft palate surgeries, those in 9 trials ( 19 , 26 , 38 , 40 , 53 , 55 – 57 , 63 ) underwent ophthalmic surgeries, those in 11 trials ( 21 , 27 , 33 , 34 , 37 , 41 , 42 , 47 , 68 , 69 , 71 ) underwent general or urological surgeries, those in 4 trials ( 23 , 31 , 62 , 73 ) underwent orthopedic surgeries, those in 1 trial ( 65 ) underwent cardiac surgery, those in 8 trials ( 24 , 45 , 46 , 58 – 60 , 75 , 79 ) underwent invasive examination or treatment, those in 5 trials ( 25 , 35 , 76 , 77 , 81 ) underwent non-invasive examination or treatment, and those in 3 trials ( 48 , 51 , 80 ) underwent all kinds of outpatient surgeries. Different routes of drug administration were used: intranasal in 12 trials ( 19 , 24 ...…”

Section: Resultsmentioning

confidence: 99%

“…Different routes of drug administration were used: intranasal in 12 trials ( 19 , 24 , 28 , 40 , 45 , 56 , 58 , 61 , 71 , 78 , 80 , 81 ), oral in 5 trials ( 36 , 66 – 69 ), caudal or nerve block in 5 trials ( 21 , 41 , 47 , 57 , 73 ), inhalation in 1 trial ( 60 ), transmucosal in 1 trial ( 20 ), and intravenous in 39 trials. The strategy of drug administration was also different: (1) intravenous single dose in 20 trials ( 22 , 23 , 25 , 29 , 30 , 32 – 35 , 42 , 48 – 50 , 53 – 55 , 59 , 63 , 64 , 72 ), loading dose plus maintenance infusion in 10 trials ( 26 , 31 , 37 , 43 , 52 , 74 – 77 , 79 ), and only maintenance infusion in 6 trials ( 38 , 39 , 44 , 51 , 62 , 65 ); and (2) administration onset before anesthesia in 29 trials ( 19 , 20 , 24 , 28 , 36 , 40 , 45 , 46 , 49 , 55 , 56 , 58 – …”

Section: Resultsmentioning

confidence: 99%

“…Different dosages of dexmedetomidine administration in each study were presented in nine trials ( 20 , 21 , 33 , 34 , 40 , 43 , 45 , 53 , 56 ). We chose the dexmedetomidine dosage with the highest incidence of EA or ED.…”

Section: Resultsmentioning

confidence: 99%

“…Afterward, the method of one-by-one literature removal was used. Seven trials ( 20 , 23 , 39 , 44 , 46 , 49 , 54 ) were found to be the main sources of heterogeneity in the placebo group ( I 2 dropped from 75 to 36%) and two trials ( 61 , 69 ) in the midazolam group ( I 2 dropped from 57 to 28%). Due to a small number of included trials in the group of propofol (or pentobarbital), the method of one-by-one literature removal was directly used to lower the heterogeneity.…”

Section: Resultsmentioning

confidence: 99%

“…In this meta-analysis, nine trials had different dexmedetomidine groups according to different dosages (20,33,34,40,43,45,53,56) or administration routes of this drug (21). Patients in the control groups of these nine trials were treated with a placebo (20,21,33,34,40,43,45,53,56), and patients in another control group in the study from Pestieau et al received fentanyl treatment (45). We chose the dexmedetomidine group with higher incidence of EA or ED.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Dexmedetomidine on Emergence Agitation or Delirium in Children After Anesthesia—A Systematic Review and Meta-Analysis of Clinical Studies

et al. 2020

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Background: We conducted this systematic review and meta-analysis to investigate the clinical effect of dexmedetomidine in preventing pediatric emergence agitation (EA) or delirium (ED) following anesthesia compared with placebo or other sedatives. Methods: The databases of Pubmed, Embase, and Cochrane Library were searched until 8th January 2020. Inclusion criteria were participants with age<18 years and studies of comparison between dexmedetomidine and placebo or other sedatives. Exclusion criteria included adult studies; duplicate publications; management with dexmedetomidine alone; review or meta-analysis; basic research; article published as abstract, letter, case report, editorial, note, method, or protocol; and article presented in non-English language. Results: Fifty-eight randomized controlled trials (RCTs) and five case-control trials (CCTs) including 7,714 patients were included. The results showed that dexmedetomidine significantly decreased the incidence of post-anesthesia EA or ED compared with placebo [OR = 0.22, 95% CI: (0.16, 0.32), I 2 = 75, P < 0.00001], midazolam [OR = 0.36, 95% CI: (0.21, 0.63), I 2 = 57, P = 0.0003], and opioids [OR = 0.55, 95% CI: (0.33, 0.91), I 2 = 0, P = 0.02], whereas the significant difference was not exhibited compared with propofol (or pentobarbital) [OR = 0.56, 95% CI: (0.15, 2.14), I 2 = 58, P = 0.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Effect of Dexmedetomidine on Emergence Agitation or Delirium in Children After Anesthesia—A Systematic Review and Meta-Analysis of Clinical Studies

et al. 2020

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PROSPECT guideline for tonsillectomy: systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Tonsillectomy is one of the most frequently performed surgical procedures; however, pain management remains challenging. Procedure-specific efficacy as well as specific risks of treatment options should guide selection of pain management protocols based on evidence and should optimise analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal pain management after tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta-analysis guidelines with procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Out of the 719 potentially eligible studies identified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre-operative and intra-operative interventions that improved postoperative pain were paracetamol; non-steroidal anti-inflammatory drugs; intravenous dexamethasone; ketamine (only assessed in children); gabapentinoids; dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infiltration; antibiotics; and magnesium sulphate. Limited evidence was found for clonidine. The analgesic regimen for tonsillectomy should include paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone, with opioids as rescue analgesics. Analgesic adjuncts such as intra-operative and postoperative acupuncture as well as postoperative honey are also recommended. Ketamine (only for children); dexmedetomidine; or gabapentinoids may be considered when some of the first-line analgesics are contra-indicated. Further randomised controlled trials are required to define risk and combination of drugs most effective for postoperative pain relief after tonsillectomy.

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Determination of the Median Effective Dose of Dexmedetomidine for the Prevention of Emergence Agitation in Geriatric Patients Undergoing Major Open Surgery With General Anesthesia: A Prospective, Double-Blinded, Dose-Response Trial

et al. 2021

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Dexmedetomidine can effectively decrease the incidences of emergence agitation (EA) in adult patients, but there are major side effects related to increased dose of dexmedetomidine. The purpose of this study was to determine the median effective dose of dexmedetomidine in the prevention of EA among geriatric patients undergoing major open surgery with general anesthesia. A total of 50 geriatric patients were enrolled in this study. Dexmedetomidine 0.5 μg·kg−1·h−1 continuous intravenous infusion was administered to the first patient. The next dose was increased or decreased by .05 depending on the response of the previous patient, according to the Dixon up-and-down method. An “effective” or “ineffective” response was determined based on the Riker sedation-agitation score (RSAS), we defined “effective” as RSAS<5, and “ineffective” as RSAS≥5. The ED50 of dexmedetomidine in prevention of EA was .30 μg·kg−1·h−1 (95% CI, .27–.33) and the predicted ED95 was .42 μg·kg−1·h−1 (95% CI, .38–.51). The incidence of bradycardia was significantly increased in the group without EA compared to the group with EA (57.1% vs 13.6%, P = .002). The ED50 of dexmedetomidine in prevention of EA was .30 μg·kg−1·h−1 (95% CI, .27–.33) and the predicted ED95 was .42 μg·kg−1·h−1 (95% CI, .38–.51). Bradycardia was the main complication.

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Oral trans-mucosal dexmedetomidine for controlling of emergence agitation in children undergoing tonsillectomy: a randomized controlled trial

Cited by 7 publications

References 26 publications

The Effect of Dexmedetomidine on Emergence Agitation or Delirium in Children After Anesthesia—A Systematic Review and Meta-Analysis of Clinical Studies

The Effect of Dexmedetomidine on Emergence Agitation or Delirium in Children After Anesthesia—A Systematic Review and Meta-Analysis of Clinical Studies

PROSPECT guideline for tonsillectomy: systematic review and procedure‐specific postoperative pain management recommendations

Determination of the Median Effective Dose of Dexmedetomidine for the Prevention of Emergence Agitation in Geriatric Patients Undergoing Major Open Surgery With General Anesthesia: A Prospective, Double-Blinded, Dose-Response Trial

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