Preoperative Melatonin and Its Effects on Induction and Emergence in Children Undergoing Anesthesia and Surgery

Kain, Zeev N.; MacLaren, Jill E.; Herrmann, Leslie; Mayes, Linda C.; Rosenbaum, Abraham; Hata, Justin; Lerman, Jerrold

doi:10.1097/aln.0b013e3181a91870

Cited by 89 publications

(114 citation statements)

References 36 publications

(27 reference statements)

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“…Three RCTs (n = 353) studied the effect of melatonin on behaviour in children emerging from anaesthesia compared with placebo [22,29], dexmedetomidine [29] and midazolam [21,22,29]. Behaviour was assessed using the Keegan score [21], a discomfort scale [22] and an agitation scale [29].…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies (n = 1146) investigated anxiety before, during and after surgery using four different scales: VAS [4, 12, 14, 17-19, 23, 24]; NRS [20]; statetrait anxiety inventory [5,6,15]; Yale pre-operative anxiety scale [21,22]. Melatonin reduced pre-operative anxiety, but the meta-analysis was very heterogeneous, which was partly resolved by exclusion of RCTs for which we had converted median (IQR or range) to mean (SD) values (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…One study included a control group in which patients did not receive a placebo [23]. Participants had various operations: abdominal [15][16][17]25, Full-text studies excluded (n = 17) -10 studies did not investigate surgical patients -3 studies were protocol studies -2 studies were not randomised -2 studies used melatonin only in combination with other drug interventions 32]; dental [27]; gynaecological [5,6,18,19,30]; ophthalmological [4,14]; orthopaedic [12]; thoracic [28,29]; urological [13]; vascular [26]; and mixed [20][21][22][23][24]31]. The anaesthetic techniques included: general anaesthesia [13,[15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32]; intravenous regional anaesthesia [12]; neuraxial block [5,6,20,…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of peri‐operative melatonin

Andersen

Werner²,

Rosenberg

et al. 2014

Anaesthesia

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SummaryWe systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction; and safety. Compared with placebo, melatonin reduced the standardised mean difference (95% CI) pre-operative anxiety score by 0.88 (0.44-1.33) and postoperative pain score by 1.06 (0.23-1.88). The magnitude of effect was unreliable due to substantial statistical heterogeneity, with I 2 87% and 94%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review of peri‐operative melatonin

Andersen

Werner²,

Rosenberg

et al. 2014

Anaesthesia

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“…These drugs include propofol, midazolam, ketamine, opioids and alpha 2 agonists including clonidine and dexmedetomidine. [12][13][14][15][16] The administration of such drugs for premedication or at the end of surgery significantly reduces the incidence of EA. Fentanyl (2.5 mcg/kg) was effective whereas smaller doses were ineffective.…”

Section: Discussionmentioning

confidence: 99%

Emergence agitation in paediatric patients using sevoflurane and isoflurane anaesthesia: a randomised controlled study

Pradeep

Manissery

Upadya

2017

Southern African Journal of Anaesthesia and Analgesia

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Background: Emergence agitation (EA) is a well-recognised phenomenon often observed in children following general anaesthesia. The aim of this study was to compare the incidence and severity of EA in the paediatric age group under sevoflurane or isoflurane anaesthesia using the PAED Scale (Pediatric Anaesthesia Emergence Delirium Scale) (the primary outcome) and its correlation with preinduction agitation as well as its association with pain using the FLACC (Face Legs Activity Cry Consolability) score (the secondary outcome). Method: In this randomised controlled trial, 60 children aged between 2 and 6 years were enrolled and randomly divided into two groups. All patients were induced with sevoflurane, relaxed with atracurium and the airway secured with an appropriate device. Anaesthesia was maintained with O 2 , N 2 O and sevoflurane or isoflurane. Adequate analgesia was ensured. Post-procedure, they were observed in the post-anaesthesia care unit (PACU) for development of EA. The statistical package SPSS® version 17 was used and data were analysed using Student's unpaired t-test and a chi-square test. Statistical significance was accepted at p < 0.05. Results: The mean PAED scale was 12.9 in the sevoflurane group and 9.4 in the isoflurane group (p < 0.001). The incidence of EA was significantly related to preinduction agitation (p = 0.00). Higher FLACC scores were observed only within the initial 10 min in the sevoflurane group (p = 0.009). Conclusions: An increased incidence of EA was observed with sevoflurane maintenance anaesthesia, particularly during the initial 10-20 min of the postoperative period. EA was strongly associated with preinduction agitation, but it was poorly correlated to pain, i.e. not all patients who developed EA had a high FLACC score.

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“…19 Melatonin generally has minimal side effects and may decrease emergence delirium in children postoperatively. 53 Agents such as dexmedetomidine and clonidine may help with agitation. 7,27 In critically ill children, a continuous infusion blocks dopamine receptors in the brain, countering overstimulation of higher cortical pathways; it can alleviate hallucinations and unstructured thoughts, provide anxiolysis or sedation, and restore attention.…”

Section: Pharmacological Management Of Deliriummentioning

confidence: 99%

Delirium in Children: Identification, Prevention, and Management

Bettencourt

Mullen

2017

Critical Care Nurse

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Delirium in children is an often underrecognized but serious complication of hospitalization. Delirium in this age group has been described as behaviors such as refractory agitation and restlessness, visual or auditory hallucinations, children being "not themselves," and a lethargic state. Often, children with delirium are at risk for harming themselves by dislodging tubes, falling, or refusing care. Pediatric nurses must recognize and intervene to prevent and treat delirium in hospitalized children because the delirium may be an indicator of worsening clinical status and is associated with high mortality and morbidity in children of all ages and with posttraumatic stress disorder. Pediatric nurses are uniquely positioned to design care interventions to both reduce risk for delirium and treat active delirium. Many treatment recommendations are nonpharmacological and are part of excellent nursing care. (Critical Care Nurse. 2017; 37[3]:e9-e18)

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Preoperative Melatonin and Its Effects on Induction and Emergence in Children Undergoing Anesthesia and Surgery

Abstract: Midazolam is more effective than melatonin in reducing children's anxiety at induction of anesthesia. Melatonin showed a direct dose-dependent effect on emergence delirium.

Cited by 89 publications

References 36 publications

A systematic review of peri‐operative melatonin

A systematic review of peri‐operative melatonin

Emergence agitation in paediatric patients using sevoflurane and isoflurane anaesthesia: a randomised controlled study

Delirium in Children: Identification, Prevention, and Management

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