The Effects of Anesthetic Agents on Emergence Delirium in Pediatric Strabismus Surgery

Lee, Seung Cheol; Chung, Chan Jong; Chin, Young Jhoon; Lee, Soo Il; Lee, Jong Hwan

doi:10.4097/kjae.2007.52.2.138

Cited by 3 publications

(4 citation statements)

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“…The search strategy yielded 3816 records which, following deduplication and title, abstract and full-text screening, were reduced to 30 studies comparing the effects of sevoflurane alone vs. sevoflurane with the addition of intra-operative adjuvant dexmedetomidine 16–45 and 36 studies comparing sevoflurane alone vs. TIVA 10,46–80 . The PRISMA flow diagram is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The details of individual included studies are shown in Supplementary Tables S1 and S2, http://links.lww.com/EJA/A522. Reasons for study exclusion following the full-text screening are shown in Supplementary Table S3, http://links.lww.com/EJA/A522 10,16–80 . Risk of bias analyses for individual studies are included in Supplementary Tables S4 and S5, http://links.lww.com/EJA/A522.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 57 studies comprising 4638 patients 10,16,18,20–46,48–52,55–61,63,65–73,77–80 were found investigating the incidence of emergence delirium using sevoflurane alone vs. either TIVA or sevoflurane with adjuvant dexmedetomidine (median [IQR] incidence of emergence delirium in the sevoflurane group 40% [24.8]; median incidence of emergence delirium in the TIVA group 9.1% [21.0]; median incidence of emergence delirium in the dexmedetomidine group 12.8% [IQR 11.7]). Pairwise meta-analyses showed that both TIVA [RR 0.43, 95% CI 0.33 to 0.56, I 2 = 49%, GRADE high quality of evidence] and adjuvant intra-operative dexmedetomidine (RR 0.34, 95% CI 0.27 to 0.42, I 2 = 54%, GRADE moderate quality of evidence) are associated with lower likelihood of emergence delirium than sevoflurane alone (see Supplementary Figs.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, midazolam premedication 17,27,30,36,37,39,42,45,46,54,58,62,64,70,74–76,78,79 did not affect the effect size (Supplementary Table S6, http://links.lww.com/EJA/A522). In the sensitivity analysis, following exclusion of studies that were considered to have a high risk of bias, 10,30,36,40,46,47,49,51–54,56,60,62,66–68,70,73,76,79,80 there was no significant change in the results of the NMA comparing adjuvant dexmedetomidine and TIVA (Supplementary Table S6, http://links.lww.com/EJA/A522; see Supplementary Fig. S12 for network diagrams for the subgroup and sensitivity analyses, http://links.lww.com/EJA/A522).…”

Section: Resultsmentioning

confidence: 99%

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Dexmedetomidine vs. total intravenous anaesthesia in paediatric emergence delirium

Petre

Levin

Englesakis

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Emergence delirium is a common complication in paediatric anaesthesia associated with significant morbidity. Total intravenous anaesthesia (TIVA) and intra-operative dexmedetomidine as an adjuvant to sevoflurane anaesthesia can both reduce the incidence of emergence delirium compared with sevoflurane alone, but no studies have directly compared their relative efficacy. OBJECTIVE The study objective was to compare the effects of TIVA and dexmedetomidine on the incidence of paediatric emergence delirium. STUDY DESIGN The current study is a systematic review and network meta-analysis (NMA) of randomised controlled trials. DATA SOURCES We conducted a systematic search of 12 databases including Medline (Ovid) and Web of Science (Clarivate Analytics) from their respective inception to December 2020. ELIGIBILITY Inclusion criteria were randomised controlled trials of paediatric patients undergoing general anaesthesia using sevoflurane, sevoflurane with dexmedetomidine or TIVA. Data were extracted by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and analysed using NMA methodology. Risk ratios and 95% credible intervals (CrI) were calculated for all outcomes [emergence delirium, postoperative nausea and vomiting (PONV), and time to emergence and extubation]. The protocol was registered with PROSPERO (CRD42018091237). RESULTS The systematic review returned 66 eligible studies comprising 5257 patients with crude median emergence delirium incidences of 12.8, 9.1 and 40% in the dexmedetomidine with sevoflurane, TIVA and sevoflurane alone groups, respectively. NMA indicated that compared with TIVA, sevoflurane with adjuvant dexmedetomidine decreased the incidence of emergence delirium without statistical difference (risk ratio 0.88, 95% CrI 0.61 to 1.20, low quality of evidence), but resulted in a higher incidence of PONV (risk ratio: 2.3, 95% CrI 1.1 to 5.6, low quality of evidence). CONCLUSION Clinical judgement, considering the patient's risk factors for the development of clinically significant outcomes such as emergence delirium and PONV, should be used when choosing between TIVA and sevoflurane with adjuvant dexmedetomidine. These findings are limited by the low quality of evidence (conditional recommendation).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Dexmedetomidine vs. total intravenous anaesthesia in paediatric emergence delirium

Petre

Levin

Englesakis

et al. 2021

European Journal of Anaesthesiology

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The Effects of Pre-operative Visual Information and Parental Presence Intervention on Anxiety, Delirium, and Pain of Post-Operative Pediatric Patients in PACU

et al. 2012

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Effects of Family Presence Intervention on Anxiety, Delirium, Pain and Length of Time in Recovery Room of Post-operative Elderly Patients in Post-anesthesia Care Units

Kim¹,

Lee²

2015

J Korean Acad Fundam Nurs

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The objectives of this study were to assess the influence of family presence in the PACU (Post Anesthesia Care Unit) on anxiety, emergency delirium, pain and length of stay in the recovery room for elderly patients undergoing surgery for which general anesthesia has been used. Methods: The study was a nonequivalent control group pre-post test design. Eighty elderly patients over 65 years who underwent surgery under general anesthesia were recruited. Forty were assigned to the experiment group, patients together with a family member and 40 to the control group, with no family member present. Patients' anxiety, emergency delirium, pain and length of time in the recovery room were evaluated at 10 minute and 30 minute after arrival in the PACU. Results: Patients with family members in the PACU showed significantly decreased levels of anxiety at 10 and 30 minutes and significantly lower levels of emergency delirium and pain at 30 minutes. However there was no difference between the 2 groups for length of time in the recovery room. Conclusion: The results of this study indicate that being with family members in the PACU after surgery under general anesthesia is effective for reducing elderly patients' anxiety, delirium and pain during time in the recovery room.

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The Effects of Anesthetic Agents on Emergence Delirium in Pediatric Strabismus Surgery

Cited by 3 publications

References 30 publications

Dexmedetomidine vs. total intravenous anaesthesia in paediatric emergence delirium

Dexmedetomidine vs. total intravenous anaesthesia in paediatric emergence delirium

The Effects of Pre-operative Visual Information and Parental Presence Intervention on Anxiety, Delirium, and Pain of Post-Operative Pediatric Patients in PACU

Effects of Family Presence Intervention on Anxiety, Delirium, Pain and Length of Time in Recovery Room of Post-operative Elderly Patients in Post-anesthesia Care Units

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