Abstract
The objective of this article is to evaluate the effect of dexmedetomidine on emergence agitation (EA) and recovery profiles in children after sevoflurane anesthesia and its pharmacological mechanisms. Standard bibliographic databases, including MEDLINE, EMBASE, PsycINFP, Springer and ISI Web of Knowledge, were artificially searched to identify all randomized controlled trials (RCTs) comparing the impact of dexmedetomidine with placebo, fentanyl and midazolam on EA and recovery profiles after sevoflurane anesthesia in post-anesthesia care unit (PACU). Two authors assessed the quality of each study independently in accordance with strict inclusion criteria and extracted data. RevMan 5.0 software was applied for performing statistic analysis. The outcomes analyzed included: 1) incidence of EA, 2) emergence time, 3) time to extubation, 4) incidence of post-operation nausea and vomiting, 5) number of patients requiring an analgesic, and 6) time to discharge from PACU. A total of 1364 patients (696 in the dexmedetomidine group and 668 in the placebo, fentanyl and midazolam group) from 20 prospective RCTs were included in the meta-analysis. Compared with placebo, dexmedetomidine decreased the incidence of EA (risk ratio [RR] 0.37; 95% CI 0.30 to 0.46), incidence of nausea and vomiting (RR 0.57; 95% CI 0.38 to 0.85) and number of patients requiring an analgesic (RR 0.43; 95% CI 0.31 to 0.59). However, dexmedetomidine had a significantly delayed effect on the emergence time (weighted mean differences [WMD] 1.16; 95% CI 0.72 to 1.60), time to extubation (WMD 0.61; 95% CI 0.27 to 0.95), and time to discharge from recovery room (WMD 2.67; 95% CI 0.95 to 4.39). Compared with fentanyl (RR 1.39; 95% CI 0.78 to 2.48) and midazolam (RR 1.12; 95% CI 0.54 to 2.35), dexmedetomidine has no significantly difference on the incidence of EA. However, the analgesia effect of dexmedetomidine on postoperation pain has no significantly statistical differences compared with fentanyl (RR 1.12; 95% CI 0.66 to 1.91), which implied that its analgesia effect might play an important role in decreasing the incident of EA. No evidence of publication bias was observed.
Highlights
Children undergoing elective surgeries such as strabismus, tonsillectomy and outpatient surgeries, especially under sevoflurane anesthesia, often experience emergency agitation (EA) and other uncomfortable symptoms [1,2]
We found that dexmedetomidine significantly decreased the incidence of occurrence of PONV in children undergoing sevoflurane anesthesia (RR 0.57; 95% CI 0.38 to 0.85)
Our analysis suggests that compared with midazolam, dexmedetomidine has no significant effect on the incidence of EA, this conclusion is limited by the small number of studies (n = 3) (RR 1.12; 95% CI 0.54 to 2.35) and further research is required for confirmation
Summary
Children undergoing elective surgeries such as strabismus, tonsillectomy and outpatient surgeries, especially under sevoflurane anesthesia, often experience emergency agitation (EA) and other uncomfortable symptoms [1,2]. It is a troublesome phenomenon that can result in injury to the children themselves or damage to the surgical site, leading to dissatisfaction and anxiety for the parents and requiring extra nursing care, which further increases associated healthcare costs [2]. Some studies found that EA was closely associated with various etiologies such as anxiety, pain, physiologic compromise and anesthetics [4]. Nausea and vomiting, severe pain, eye opening time and extubation time are the main factors for discharge from the post-anesthesia care unit (PACU) or hospital, affecting the children’s recovery [5]. Anesthesiologists aim to reduce the incidence of EA and improve the quality of children’s postoperative condition with the help of various drugs and techniques
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