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

Abstract

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.

Effect of different administration and dosage of dexmedetomidine in the reduction of emergence agitation in children: a meta-analysis of randomized controlled trials with sequential trial analysis

“…Our meta-analysis suggested that DEX was superior to midazolam for preventing EA in children, in line with the findings of Lang et al (89) and Rao et al (13). TSA and GRADE results revealed that the level of evidence about the DEX's superiority over midazolam in reducing EA incidence was sufficient.…”

“…The preventive effect of DEX on EA in children has been documented in several meta-analyses (7)(8)(9)(10)(11)(12)(13). Although four relevant meta-analyses (7-10) published during 2014-2015 seemed to confirm the superiority of DEX on EA in children, the limited number of included studies reduced the reliability of outcomes.…”

“…Several systematic reviews and meta-analyses assess using DEX to prevent EA in children (7)(8)(9)(10)(11)(12)(13). However, the results of the existing meta-analyses were prone to bias due to the limited sample size (7)(8)(9)(10)(11)(12), high heterogeneity of included studies (11,13), or including non-randomized case-control studies (13). Moreover, none of these metaanalyses evaluated the evidence quality using either TSA or Grading of recommendation, assessment, development, and evaluation (GRADE) tools, which conclusions would not be dependable.…”

Effect of single-dose dexmedetomidine on the incidence of emergence delirium after sevoflurane-based anesthesia in children undergoing strabismus surgery

“…The correlation between the face, legs, activity, cry, consolability (FLACC) score, duration of anesthesia, and history of previous operation and both Watcha score and pediatric anesthesia emergence delirium (PAED) score. review and metaanalysis support the superiority of dexm edetomidine over placebo, midazolam, or opioid in significantly decreasing the incidence of ED in pediatrics aft er anesthesia for various types of surgeries [23]. The same evidence was also confirmed in a network analysis of ped iatric anesthesia for adenotonsillectomy operation [24].…”

Efficacy of dexmedetomidine on postoperative analgesia &amp; sedation in children undergoing adenotonsillectomy

“…A study by Jun-Li Cao et al stated that objective pain score was lower in dexmedetomidine group at 15, 30, and 45minutes [18] . A study by Yuquan Rao et al stated that compared with placebo, midazolam, and opioids, dexmedetomidine significantly decreased the incidence of post-anesthesia emergence agitation or delirium in pediatric patients [19] . A meta-analysis by Juan Ni et al stated that dexmedetomidine decreased the incidence of severe pain (p<0.001) and need of rescue drug (p<0.001).…”