Abstract
ObjectiveEmergence agitation (EA) is a common complication in children under sevoflurane anesthesia. The aim of this meta-analysis was to evaluate the effects of intravenous dexmedetomidine on EA in children under sevoflurane anesthesia.MethodsA comprehensive literature search was conducted to identify clinical trials that evaluated the effects of intravenous dexmedetomidine and placebo on EA in children under sevoflurane anesthesia. The search collected trials from MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science. Analysis was conducted using STATA version 12.0. Data from each trial were pooled using relative ratio (RR) for dichotomous data or weighted mean difference (WMD) for continuous data and corresponding 95% confidence interval (95% CI). Heterogeneity assessment, sensitivity analysis, and publication bias were performed.ResultsTwelve trials, in which 459 patients received dexmedetomidine and 353 patients received placebo, were included in this analysis. We found that intravenous dexmedetomidine decreased the incidences of EA (RR = 0.346, 95% CI 0.263 to 0.453, P<0.001), and postoperative pain (RR = 0.405, 95% CI 0.253 to 0.649, P<0.001). Intravenous dexmedetomidine also prolonged extubation time (WMD = 0.617, 95% CI 0.276 to 958, P<0.001), and emergence time (WMD = 0.997, 95% CI 0.392 to 1.561, P = 0.001). Further evidences are required to evaluate the incidence of postoperative nausea and vomiting (PONV). Sensitivity analysis strengthened evidences for lower incidences of EA, pain, and prolonged extubation time, and emergence time. Funnel plots did not detect any significant publication bias.ConclusionMeta-analysis demonstrated that dexmedetomidine decreased the incidence of EA in children under sevoflurane anesthesia.
Highlights
Sevoflurane is a widely used inhalational anesthetic for pediatric anesthesia because of its low pungency, low blood–gas partition coefficient, rapid onset, fast recovery properties, minimal cardiac depressive effect, and low toxicity [1,2]
For trials that comparison between control group and multiple intervention groups using different dexmedetomidine dose, we combined intervention groups to create a single pair-wise comparison. Both the sample sizes and the numbers of people with events were summed across groups
The pooled result showed that dexmedetomidine significantly decreased the incidence of postoperative nausea and vomiting (PONV) in children under sevoflurane anesthesia (RR = 0.593, 95% confidence interval (95% CI) 0.391 to 0.901, P = 0.014, Figure 5)
Summary
Sevoflurane is a widely used inhalational anesthetic for pediatric anesthesia because of its low pungency, low blood–gas partition coefficient, rapid onset, fast recovery properties, minimal cardiac depressive effect, and low toxicity [1,2]. Sevoflurane anesthesia is associated with a high incidence (10%–80%) of emergence agitation (EA) in children [3,4,5,6]. EA is associated with complications such as selfinjury, anxiety, and increased costs for additional medical care. Drugs such as the a2-adrenoceptor agonist dexmedetomidine may improve EA after sevoflurane anesthesia. Dexmedetomidine is highly specific for the a2-adrenoceptor and has an 8-fold higher affinity than clonidine [7]. It has sedative, analgesic, and anxiolytic properties with few adverse effects [8]. Several clinical trials have shown that intravenous dexmedetomidine significantly reduces the incidence of EA in children under sevoflurane anesthesia [9,10,11]
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