The Safety and Efficacy Evaluation of Dexmedetomidine for Procedural Sedation and Postoperative Behaviors in Pediatric Populations: A Systematic Review and Meta-analysis

Abstract

Background: This study systematically evaluated the safety and efficacy of dexmedetomidine for procedural sedation and postoperative behaviors in a pediatric population as well as whether the results met the information required to draw conclusions. Objective: To evaluate the safety and efficacy evaluation of dexmedetomidine for procedural sedation and postoperative behaviors in a pediatric population. Methods: PubMed, Cochrane library, Web of Science and Ovid MEDLINE were searched to obtain randomized controlled trials (RCTs) comparing dexmedetomidine with control medicine and comparing different doses of dexmedetomidine. Results: There were a total of 16 RCTs for a total of 3240 patients. Dexmedetomidine slowed down the heart rate (HR; mean difference: −13.27; 95% CI: −16.41 to 10.14; P < 0.001) and reduced postoperative delirium (risk ratio [RR]: 0.31; 95% CI: 0.20-0.50; P < 0.001), the number of pain patients (RR: 0.48; 95% CI: 0.30-0.75; P = 0.002), and desaturation (RR: 0.34; 95% CI: 0.13-0.89; P = 0.03) compared with the control group. The limitation was that it was difficult to determine the range of low- and high-dose dexmedetomidine. Conclusion and Relevance: Dexmedetomidine slowed down intraoperative HR within the normal range, which might reduce myocardial oxygen consumption. It reduced postoperative pain and postoperative complications: delirium and desaturation. Dexmedetomidine showed no dose-dependent increase in the procedural sedation time of pediatric patients. Clinically, dexmedetomidine can improve pediatric procedural sedation and postoperative behavior, and it can be considered as a related medicine for safety in pediatric surgery.

Dream of the Endless

“…The selection of agents for PSAA is primarily guided by considerations of ease and familiarity, along with the desired pharmacokinetic profile (Table 2) (Baker & Weant, 2011; Baumgartner, Groff, Yaeger, & Fuller, 2023; Beers, Calimlim, Uddoh, Esposito, & Camporesi, 2000; Bellolio et al, 2016, 2016; Gan, Zhao, & Chen, 2022; Hara et al, 2023; Kern, Guinn, & Mehta, 2022; Kisilewicz, Rosenberg, & Vaillancourt, 2017; Miller, Andolfatto, Miner, Burton, & Krauss, 2019; Sener, Eken, Schultz, Serinken, & Ozsarac, 2011; Strayer & Nelson, 2008; Vuyk, Schnider, & Engbers, 2000). Typically, a combination of opioid analgesics and sedatives is preferred, as this approach tends to offer comprehensive pain management and procedural comfort.…”

“…Dexmedetomidine (Precedex), a centrally acting alpha-2 receptor agonist, exerts its sedative effects by inhibiting the release of excitatory neurotransmitters (Baumgartner et al, 2023; Gan et al, 2022). In terms of versatility both within and outside the ED, dexmedetomidine shares similarities with midazolam, making it a valuable option for various clinical settings.…”