The effect of KETODEX on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane based-anesthesia

Hadi, Sally M.; Saleh, Amin J.; Tang, Yong; Daoud, Ahmed; Mei, Xi; Ouyang, Wen

doi:10.1016/j.ijporl.2015.02.012

Cited by 31 publications

(34 citation statements)

References 41 publications

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“… 35 Some trials have shown that premedication with DEX in children clearly reduces the incidence of EA, improves sedation and parental separation, and shortens the stay in the post-anaesthesia care unit compared with other sedatives such as midazolam or propofol. 9 , 35 – 37 Our results are in accordance with their findings.…”

Section: Discussionsupporting

confidence: 93%

Effects of dexmedetomidine versus midazolam for premedication in paediatric anaesthesia with sevoflurane: A meta-analysis

Feng

Wang

et al. 2017

J Int Med Res

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BackgroundDexmedetomidine (DEX), an α2-adrenergic receptor agonist, produces ideal sedation and early postoperative recovery for premedication in paediatric surgery, reducing preoperative anxiety and facilitating smooth induction of anaesthesia. We performed a meta-analysis to compare the effects of DEX and midazolam (MDZ) in paediatric anaesthesia with sevoflurane.MethodsPubMed, Ovid, Web of Science, and Public Health Management Corporation were searched through December 2016 for randomized controlled trials (RCTs) that compared DEX and MDZ in children undergoing sevoflurane anaesthesia. The risk ratio (RR) with 95% incidence interval (95%CI) was used for dichotomous variables.ResultsTwelve RCTs involving 422 patients in the DEX group and 448 patients in the MDZ group were included. Patients in the DEX group had a significantly lower incidence of unsatisfactory sedation (RR [95%CI] = 0.71 [0.57–0.89]), unsatisfactory parental separation (RR [95%CI] = 0.56 [0.35–0.87]), and rescue analgesia (RR [95%CI] = 0.52 [0.35–0.77]) than patients in the MDZ group. However, both groups had a similar incidence of unsatisfactory mask acceptance, emergence agitation, and postoperative nausea and vomiting.ConclusionCompared with MDZ, DEX is beneficial in paediatric anaesthesia with sevoflurane because of its lower incidence of unsatisfactory sedation, parental separation, and rescue analgesia.

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Section: Discussionsupporting

confidence: 93%

Effects of dexmedetomidine versus midazolam for premedication in paediatric anaesthesia with sevoflurane: A meta-analysis

Feng

Wang

et al. 2017

J Int Med Res

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“…A total of 1086 related articles were obtained with the initial inspection. After screening layers, 25 RCTs were finally included . Figure 1 presents the flow chart of the literature search.…”

Section: Resultsmentioning

confidence: 99%

Comparative efficacy of ancillary drugs in sevoflurane‐related emergence agitation after paediatric adenotonsillectomy: A Bayesian network meta‐analysis

et al. 2020

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What is known and objective The comparative efficacy of ancillary drugs on sevoflurane‐related emergence agitation (EA) in paediatric anaesthesia for adenotonsillectomy remains unclear. The purpose of this Bayesian network meta‐analysis was to investigate the efficacy of ancillary drugs on sevoflurane‐related EA in paediatric anaesthesia for adenotonsillectomy. Methods MEDLINE, Embase, the Cochrane Library and Web of Science databases were electronically searched to identify randomized controlled trials (RCTs) of different ancillary drugs used in adenotonsillectomy from inception to April 2019. Two reviewers independently screened the literature, extracted data and assessed the risk of bias in included studies. Subsequently, a network meta‐analysis was performed using the R software and RevMan 5.3 software. Results and discussion We included 25 RCTs, involving 2151 participants. The proportion of patients with sevoflurane‐related EA was significantly lower in the dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil and clonidine groups than in the placebo group (P < .05). Fentanyl was superior to sufentanil (P < .05), whereas dexmedetomidine was superior to fentanyl (P < .05). Among ancillary drugs, dexmedetomidine (90.04%) showed the highest possibility of reducing the risk of EA, followed by fentanyl (87.45%), remifentanil (63.85%), ketamine (52.07%), midazolam (51.27%), clonidine (49.94%), propofol (29.89%), sufentanil (21.38%) and placebo (4.09%). What is new and conclusion Evidence suggests that the effects of dexmedetomidine in reducing the risk of sevoflurane‐related EA in paediatric anaesthesia for adenotonsillectomy were better than the effects of other drugs. However, large, high‐quality RCTs are required to further confirm this.

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“…However, only a few studies have evaluated the effects of multimodal analgesic regimens on EA. In a prospective randomized double-blind controlled study, administration of low-dose ketamine (0.15 mg/kg) followed by dexmedetomidine (0.3 μg/kg), both administered intravenously approximately 10 minutes before the end of surgery, was found to reduce the incidence and severity of EA in pediatric patients undergoing adenotonsillectomy using sevoflurane anesthesia, compared to the administration of volume-matched saline [131]. Notably, ketamine administration at the end of the operation in children undergoing sevoflurane anesthesia (after performing caudal block prior to surgery) could not further reduce EA, compared to the placebo group [132].…”

Section: Multimodal Analgesiamentioning

confidence: 99%

Emergence agitation: current knowledge and unresolved questions

Lee

Sung

2020

Korean J Anesthesiol

100

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This article is protected by copyright of Korean Journal of Anesthesiology. All rights reserved. Emergence agitation (EA), which is also referred to as emergence delirium, can lead to clinically significant consequences. The mechanism of EA remains unclear. Proposed contributors to EA include age, male sex, type of surgery, emergency operation, use of inhalational anesthetics with low blood-gas partition coefficients, long duration of surgery, anticholinergics, premedication with benzodiazepines, voiding urgency, postoperative pain, and the presence of invasive devices. If preor intraoperative objective monitoring could predict the occurrence of agitation during emergence, this would help to reduce the adverse consequences of EA. Several tools are available for assessing EA; however, its incidence varies considerably according to the assessment tool and definition of EA used, due to the absence of standardized clinical research practice guidelines. Total intravenous anesthesia, propofol, μ-opioid agonists, N-methyl-D-aspartate receptor antagonists, nefopam, α2adrenoreceptor agonists, regional analgesia, multimodal analgesia, parent-present induction, and preoperative education for surgery may contribute to prevention of EA. However, it is difficult to identify patients at high risk for EA and to properly apply EA prevention methods in various clinical situations, because both risk factors and preventive strategies often show inconsistent results depending on the methodology of the study and the patients assessed. This review discusses the most important research topics related to EA and directions for future research.

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The effect of KETODEX on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane based-anesthesia

Cited by 31 publications

References 41 publications

Effects of dexmedetomidine versus midazolam for premedication in paediatric anaesthesia with sevoflurane: A meta-analysis

Effects of dexmedetomidine versus midazolam for premedication in paediatric anaesthesia with sevoflurane: A meta-analysis

Comparative efficacy of ancillary drugs in sevoflurane‐related emergence agitation after paediatric adenotonsillectomy: A Bayesian network meta‐analysis

Emergence agitation: current knowledge and unresolved questions

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