Abstract
Objective: We aim to evaluate whether dexmedetomidine can reduce incidence caused by sevoflurane anesthesia in pediatric patients systematically. Methods: We have searched the Cochrane Library, PubMed, EBSCO, Springer, Chinese Journal Full-text Database (CNKI), Chinese Biomedical Literature Database (CBM) and WanFang Data (all the materials selected from these databases range from the date of establishment of the databases to April 2013). Reference lists of all studies have also been checked. Two valuators performed the process of RCT, quality assessment, and data extraction with inclusion and exclusion criteria, and conduct the Meta-analysis with the software RevMan5.2. Results: The meta-analysis which including 27 randomized trials and 1882 children showed that dexmedetomidine extended the incidence of the children’s recovery time [MD=2.39, 95% CI (1.27, 3.51)] and discharge time [MD=6.09, 95% CI (3.42, 8.77)] compared with placebo. Nevertheless, there were no obvious differences in extubation time [MD=0.75, 95% CI (0.45, 1.05)]. While reducing the incidence of early emergence agitation, dexmedetomidine showed a large advantage [RR=0.31, 95% CI (0.26, 0.38)] and could reduce agitation score [MD=-0.89, 95% CI (-1.04, -0.74)], also could reduce pain score [MD=-2.66, 95% CI (-3.81, -1.51)], as well as the need for painkillers [RR=0.34, 95% CI (0.22, 0.52)]. What’s more, on reducing occurrence of nausea and vomiting [RR=0.59, 95% CI (0.36, 0.97)], occurrence of bucking [RR=0.39, 95% CI (0.23, 0.68)], dexmedetomidine also showed some preventive effects. There were no serious side effects on respiratory and circulatory system in all included studies. Conclusion: Dexmedetomidine can be used safely in children and improve the awakening quality after sevoflurane anesthesia.
Highlights
Sevoflurane is a popular inhalational anesthetic for general anesthesia in children
According to the methods of the Cochrane systematic review, we reviewed the Randomized Controlled Trials (RCTs) about dexmedetomidine for prevention of emergence agitation and other side effects in pediatric patients after sevoflurane anesthesia
The heterogeneity test showed a severe heterogeneity among the trials, a random-effects model was applied, the results showed that compared with placebo, dexmedetomidine extended the recovery time [Mean Difference (MD)=2.39, 95% CI (1.27, 3.51)], [4,5,9,10,11,15,16,17,18,19,22,23,24,25,26,27,28] (Figure1)
Summary
Sevoflurane is a popular inhalational anesthetic for general anesthesia in children It is especially characterized by a lower blood/ gas partition coefficient, less irritation to the airway, less cardio depressive effect, lower hepatotoxicity and easier to obtain with children as compared with other volatile anesthetics. According to the methods of the Cochrane systematic review, we reviewed the Randomized Controlled Trials (RCTs) about dexmedetomidine for prevention of emergence agitation and other side effects in pediatric patients after sevoflurane anesthesia These data are either in English or non-English language publications, and the main purpose of this meta-analysis is to evaluate whether dexmedetomidine can reduce postoperative agitation and other adverse reactions in children, thereby improve the quality of awakening, and provide an important basis for the clinical application and further research
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