Abstract
BackgroundThe comparative efficacy of ancillary drugs on sevoflurane related emergence agitation (EA) in children undergoing ophthalmic surgery remains controversial.MethodsThe databases were retrieved in an orderly manner from the dates of their establishment to October, 2018, including PubMed, The Cochrane Library and Web of Science, to collect randomized controlled trials (RCT) of different anesthetic drugs combined with sevoflurane for ophthalmic surgery. Then a network meta-analysis was conducted using R and Stata 12.0 softwares.ResultsThe meta-analysis showed that, in reducing sevoflurane related EA, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil and clonidine were superior to placebo (P < 0.05). The network meta-analysis showed that the effects of ancillary drugs combine with sevoflurane in reducing risk of EA in children undergoing ophthalmic surgery was superior to placebo: dexmedetomidine (OR = 0.17, 95% CrI 0.12–0.22), ketamine (OR = 0.30, 95% CrI 0.11–0.49), propofol (OR = 0.24, 95% CrI 0.09–0.63), fentanyl (OR = 0.16, 95% CrI 0.08–0.56), midazolam (OR = 0.20, 95% CrI 0.09–0.40), sufentanil (OR = 0.27, 95% CrI 0.14–0.41), remifentanil (OR = 0.18, 95% CrI 0.08–0.54) and clonidine (OR = 0.14, 95% CrI 0.07–0.41). The SUCRA of placebo, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil, clonidine were respectively 0.26, 77.93, 27.71, 42.8, 69.43, 52.89, 59.83, 57.62 and 61.53%.ConclusionsThe effects of dexmedetomidine combine with sevoflurane in reducing risk of emergence agitation in children undergoing ophthalmic surgery was superior to other drugs.
Highlights
The comparative efficacy of ancillary drugs on sevoflurane related emergence agitation (EA) in children undergoing ophthalmic surgery remains controversial
The meta-analysis showed that, in reducing sevoflurane related EA, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil and clonidine were superior to placebo (P < 0.05)
The network metaanalysis showed that the effects of ancillary drugs combine with sevoflurane in reducing risk of EA in children undergoing ophthalmic surgery was superior to placebo: dexmedetomidine (OR = 0.17, 95% CrI 0.12–0.22), ketamine (OR = 0.30, 95% CrI 0.11–0.49), propofol (OR = 0.24, 95% CrI 0.09–0.63), fentanyl (OR = 0.16, 95% CrI 0.08– 0.56), midazolam (OR = 0.20, 95% CrI 0.09–0.40), sufentanil (OR = 0.27, 95% CrI 0.14–0.41), remifentanil (OR = 0.18, 95% CrI 0.08–0.54) and clonidine (OR = 0.14, 95% CrI 0.07–0.41)
Summary
The comparative efficacy of ancillary drugs on sevoflurane related emergence agitation (EA) in children undergoing ophthalmic surgery remains controversial. Especially in children’s ophthalmology, the operation time is short, and the patient’s self-control ability is weak, so the quality of anesthesia is required to be high [2] It is a necessary condition for the operation to effectively inhibit the stress response and oculocardiac reflex caused by the Sevoflurane is the most commonly used inhalation anesthetic in pediatric anesthesia [5]. When it is used as the only anesthetic, it is associated with a high incidence of emergence agitation (EA) and may be harmful to patients [7,8,9] Anesthetic adjuvants such as metomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil, clonidine and other drugs have been effectively used to prevent EA. It can maintain the analgesic effect for a long time after operation, and effectively reduce the EA, crying and other adverse reactions in children [12]
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