Preoperative intranasal dexmedetomidine versus intranasal ketamine for prevention of emergence agitation after sevoflurane in myringotomy patients: A randomized clinical trial

Ezz, Hoda Alsaid Ahmed

doi:10.1016/j.egja.2017.03.001

Cited by 10 publications

(18 citation statements)

References 24 publications

(44 reference statements)

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“…Eventually, 63 trials (19-81) including 7,714 patients were identified through our search strategy (Figure 1). All included trials were divided into nine groups based on control drugs: placebo , midazolam (19,(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71), opioids (29,45,(72)(73)(74), propofol (or pentobarbital) (22,25,42,75,76), ketamine (26,60,(77)(78)(79), clonidine (80), chloral hydrate (81), melatonin (59), and ketofol (ketamine and propofol) (23). We assigned propofol and pentobarbital into the same group because both of them produced general anesthetic efficacy through directly activating the γ-aminobutyric acid A receptor of the central nervous system (82).…”

Section: Study Location and Selectionmentioning

confidence: 99%

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: Study Location and Selectionmentioning

confidence: 99%

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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“…Twenty‐five RCTs comprising 1665 patients contributed to the analysis of satisfactory sedation at induction or mask acceptance, including the six studied drugs (placebo, dexmedetomidine, midazolam, ketamine, clonidine, and melatonin) 8,22,23,26–28,30–34,36–40,42,45–52 . Table 1B presents the detailed comparisons of the efficacies of different drugs by RRs and at a corresponding 95% CrIs.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the secondary outcomes, the detailed comparisons of the efficacies of different drugs were as presented in Appendix A7. Table 2 shows the interventions, the number of trials and participants, and the results of the secondary outcomes (incidence of ED, 8,24,26–28,30,31,33,48,49,52–63 incidence of PONV in PACU, 23,28,31,38,41,42,55,59,61–64 need for rescue analgesia in PACU, 31,38,41,53,55,59,62,63,65 length of stay in PACU, 29,31,39,40,52–54,57–59,61–63,65 changes in SBP after interventions, 23,40,50,51,57,66,67 changes in HR after interventions, 8,23,25,26,40,50,51,53–55,57,64,66–68 and changes in SPO 2 after intervention 8,23,40,51,64 ). Individual rank plots and SUCRA for the secondary outcomes were as shown in Appendices A9 and A10.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-five RCTs comprising 1665 patients contributed to the analysis of satisfactory sedation at induction or mask acceptance, including the six studied drugs (placebo, dexmedetomidine, midazolam, ketamine, clonidine, and melatonin). 8,22,23,[26][27][28][30][31][32][33][34][36][37][38][39][40]42,[45][46][47][48][49][50][51][52] Table 1B presents the detailed comparisons of the efficacies of different drugs by RRs and at a corresponding 95% CrIs. The effectiveness of dexmedetomidine, midazolam, ketamine, and clonidine were superior to that of placebo.…”

Section: Risk Of Biasmentioning

confidence: 99%

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Comparison of different sedatives in children before general anaesthesia for selective surgery: A network meta‐analysis

Yang

Huang

et al. 2022

Clinical Pharmacy Therapeu

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What is known and Objective It is estimated that 60% of children undergoing anaesthesia develop severe preoperative anxiety. The anxiety is associated with adverse reactions. Sedatives such as dexmedetomidine, midazolam, clonidine, ketamine, and melatonin can be used as premedication against preoperative anxiety. However, no consensus has been reached on the choice of pre‐anaesthetic sedatives in children before selective surgery. Therefore, the current network meta‐analysis (NMA) was carried out to evaluate different sedatives in children aged between 1 and 7 before general anaesthesia for selective surgery. Methods Randomized clinical trials (RCTs) were retrieved from Pubmed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases from inception to October 22, 2021. Primary outcomes showed satisfactory sedation at parent separation and also at induction or mask acceptance. Secondary outcomes were those related to added benefits and side effects. The present NMA was conducted using the R software. Results of the study were reported as Relative Risk (RR) or Mean Difference (MD) at a 95% credible intervals (CrIs). Results and Discussion A total of 48 trials were included in the present study. It was found that the effectiveness of dexmedetomidine, midazolam, clonidine, and ketamine were superior to that of placebo in satisfactory sedation at parent separation and induction or mask acceptance. There was no significant difference between melatonin and placebo in satisfactory sedation at induction or mask acceptance. Dexmedetomidine, ketamine, clonidine, and melatonin were superior to placebo in reducing emergence delirium (ED). In addition, midazolam prolonged the length of stay in the post anaesthesia care unit (PACU) as compared with placebo. Dexmedetomidine caused a significant reduction in systolic blood pressure (SBP) and heart rate (HR). Nevertheless, it was noted that the hemodynamic changes were roughly within safety limits. What is New and Conclusion It was evident that the studied drugs can provide effective sedation with exception of melatonin and placebo. However, it was found that midazolam, ketamine, and clonidine lead to several side effects. The findings of the present study supported that dexmedetomidine, especially intranasal administration, has potential in the optimal selection of the sedatives for premedication in children. This is because the drug has effective sedation, reduced incidence of ED, side effects, and onset time.

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“…[37,38] Intranasal dexmedetomidine can induce sedation within 30 min in pediatric patients. [2, 5, 6, 9, 11, 12, 14-22, 24, 26-28, 31,35,36,38,39] A recent study reported that intranasal dexmedetomidine 4 μg/kg enabled magnetic resonance imaging (MRI) examination without apnea and hypoxemia in infants; [27] however, 30.7% (16/52) of the patients developed bradycardia (<80% of the baseline heart rate), and 3.8% (2/52) developed hypotension (<80% of the baseline mean arterial pressure). As such, intranasal dexmedetomidine alone can be associated with slow onset time, bradycardia, or hypotension.…”

Section: Introduction Background and Rationale {6a}mentioning

confidence: 99%

Multicenter Randomized Controlled Trial comparing Oral Chloral Hydrate and Intranasal combination of Dexmedetomidine and Ketamine for Procedural Sedation in Children: study protocol

Jang

Joo

Lee

et al. 2022

Preprint

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Background Oral chloral hydrate is widely used in pediatric sedation. Intranasal dexmedetomidine has been increasingly used for pediatric sedation; however, its improvement is warranted. The combination of dexmedetomidine with ketamine can improve onset and hemodynamic stability while maintaining sedative efficacy. This study aims to determine the efficacy and safety of intranasal combination of dexmedetomidine and ketamine compared to oral chloral hydrate. Methods This is a prospective, parallel-arm, single-blinded, multi-center, randomized controlled trial with 1:1 allocation, designed to compare the effects of intranasal combination of dexmedetomidine and ketamine with those of oral chloral hydrate. We shall enrol 136 patients aged < 7 years old in this study. Prior to the procedure, we shall randomise each patient into the control group (oral chloral hydrate 50 mg/kg) or study group (intranasal dexmedetomidine 2 µg/kg and ketamine 3 mg/kg). The primary outcome will be the rate of achieving an adequate sedation level (6-point Pediatric Sedation State Scale 1, 2, or 3) within 15 min. In addition, we shall measure the sedation time, sedation failure rate, completion of procedure, adverse events, patient acceptance, and physician satisfaction. Discussion This study will provide evidence of the efficacy and safety of the intranasal combination of dexmedetomidine and ketamine in comparison with oral chloral hydrate. Trial registration : ClinicalTrials.gov, NCT04820205. Registered on 19th March 2021

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Preoperative intranasal dexmedetomidine versus intranasal ketamine for prevention of emergence agitation after sevoflurane in myringotomy patients: A randomized clinical trial

Cited by 10 publications

References 24 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

Comparison of different sedatives in children before general anaesthesia for selective surgery: A network meta‐analysis

Multicenter Randomized Controlled Trial comparing Oral Chloral Hydrate and Intranasal combination of Dexmedetomidine and Ketamine for Procedural Sedation in Children: study protocol

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