Abstract
Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery. Five databases were searched for randomized controlled trials published from database inception to April 2020 that compared dexmedetomidine use with placebo or active comparator use and evaluated EA, PONV, or postoperative pain incidence (main outcomes) in patients who had undergone pediatric strabismus surgery. Oculocardiac reflex (OCR) incidence and postanesthesia care unit (PACU) stay duration were considered as safety outcomes. All meta-analyses were performed using a random-effects model. In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced EA incidence [risk ratio (RR): 0.39; 95% confidence interval (CI): 0.25-0.62, I2 = 66%], severe EA incidence (RR: 0.27, 95% CI: 0.17-0.43, I2 = 0%), PONV incidence (RR: 0.33, 95% CI: 0.21-0.54, I2 = 0%), analgesia requirement (RR: 0.38, 95% CI: 0.25-0.57, I2 = 0%), and pain scores (standardized mean difference: -1.02, 95% CI: -1.44 to -0.61, I2 = 75%). Dexmedetomidine also led to lower EA incidence in the sevoflurane group than in the desflurane group (RR: 0.26 for sevoflurane vs. 0.45 for desflurane). Continuous dexmedetomidine infusion (RR: 0.19) led to better EA incidence reduction than did bolus dexmedetomidine infusion at the end of surgery (RR: 0.26) or during the peri-induction period (RR: 0.36). Compared with placebo use, dexmedetomidine use reduced OCR incidence (RR: 0.63; I2 = 40%). No significant between-group differences were noted for PACU stay duration. In patients who have undergone pediatric strabismus surgery, dexmedetomidine use may alleviate EA, PONV, and postoperative pain and reduce OCR incidence. Moreover, dexmedetomidine use does not affect the PACU stay duration.
Highlights
Pediatric strabismus surgery is one of the most common ophthalmic procedures performed under general anesthesia
In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced emergence agitation (EA) incidence [risk ratio (RR): 0.39; 95% confidence interval (CI): 0.25– 0.62, I2 = 66%], severe EA incidence (RR: 0.27, 95% CI: 0.17–0.43, I2 = 0%), postoperative nausea and vomiting (PONV) incidence (RR: 0.33, 95% CI: 0.21–0.54, I2 = 0%), analgesia requirement (RR: 0.38, 95% CI: 0.25–0.57, I2 = 0%), and pain scores
After strabismus surgery, many pediatric patients present with emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain [1], whose incidence rates are as high as 40%–86% [1], 37%–80% [2], and 65% [3], respectively
Summary
Pediatric strabismus surgery is one of the most common ophthalmic procedures performed under general anesthesia. After strabismus surgery, many pediatric patients present with emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain [1], whose incidence rates are as high as 40%–86% [1], 37%–80% [2], and 65% [3], respectively. In a meta-analysis, dexmedetomidine premedication was found to reduce PONV incidence in children undergoing different types of surgery [10]. Whether dexmedetomidine can reduce EA, PONV, and postoperative pain incidence in pediatric patients undergoing strabismus surgery remains unclear. Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery
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