Comparative efficacy of ancillary drugs in sevoflurane‐related emergence agitation after paediatric adenotonsillectomy: A Bayesian network meta‐analysis

Jiao, Hongmei; Wang, Hongwei; Jiang, Zi-Ru; Hu, Jingli

doi:10.1111/jcpt.13133

Cited by 13 publications

(12 citation statements)

References 44 publications

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“…More prospective studies comparing the effects of different dosages of dexmedetomidine on EA are required to establish the optimal dose. Dexmedetomidine used in tonsillectomy, adenoidectomy, ophthalmologic, and orthopedic surgeries lower the EA incidence compared with saline, which is consistent with the findings of Cho et al (43), Jiao et al (46), and Tan et al (42). Tonsillectomy with or without adenoidectomy is commonly associated with throat pain and discomfort, and the EA risk associated with this procedure is up to 55.88% and may involve "a sense of suffocation" because of edema, difficulty in swallowing, and nausea.…”

Section: Discussionsupporting

confidence: 89%

Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Yang

Peng

et al. 2020

Front. Pediatr.

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Background: Emergence agitation (EA) is one of the most common and intractable postoperative complications among children undergoing surgery under general anesthesia. Dexmedetomidine, an α(2)-adrenoceptor agonist, offers an ideal sedation, reduces preoperative anxiety, and facilitates smooth induction of anesthesia, and it is widely used in pediatric surgery. We aimed to evaluate the efficacy of dexmedetomidine for preventing emergence agitation in children after general anesthesia. Methods: We comprehensively reviewed PubMed, Cochrane Library, EMBASE, and Web of Science databases to search all randomized controlled trials, published before April 22, 2020, investigating the efficacy of dexmedetomidine in preventing the emergence agitation in children after general anesthesia. The meta-analysis was performed using Review Manager 5.3. The primary outcome was the incidence of emergence agitation. Secondary outcomes included the number of patients requiring rescue analgesic, number of patients with postoperative nausea and vomiting, emergence time, extubation time, and time to discharge from the post-anesthesia care unit. Results: We included a total of 33 studies, comprising 2,549 patients in this meta-analysis. Compared with saline, dexmedetomidine significantly reduced the emergence agitation incidence [risk ratio (RR) 0.29; 95% confidence interval (CI) 0.22–0.37; p < 0.00001], incidence of postoperative nausea and vomiting (RR 0.46; 95% CI 0.3–0.69; p = 0.0002), and the requirement of rescue analgesic (RR 0.29; 95% CI 0.18–0.44; p < 0.00001). Furthermore, children in the dexmedetomidine group experienced a longer emergence time [mean difference (MD) 2.18; 95% CI 0.81–3.56; p = 0.002] and extubation time (MD 0.77; 95% CI 0.22–1.31; p = 0.006) compared with those in the saline group. However, no significant difference was observed in the time to discharge from the post-anesthesia care unit (MD 2.22; 95% CI −2.29–6.74; p = 0.33) between the two groups. No significant differences were observed between the effects of dexmedetomidine and other drugs like midazolam, propofol, fentanyl, tramadol, and clonidine in terms of the emergence agitation incidence and other parameters, except for the requirement of rescue analgesic (RR 0.45; 95% CI 0.33–0.61; p < 0.00001). Conclusions: Dexmedetomidine can prevent emergence agitation, relieves postoperative pain, decreases the requirement of rescue analgesic, and decreases the postoperative nausea and vomiting events.

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Section: Discussionsupporting

confidence: 89%

Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Yang

Peng

et al. 2020

Front. Pediatr.

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“…Although our study found intraoperative use of benzodiazepines is a possible risk factor for adult EA, many studies 23,24 reported benzodiazepine (eg, midazolam) administration reduced pediatric EA. Thus, whether benzodiazepine administration increase or decrease adult EA needs well‐designed randomized controlled studies.…”

Section: Discussioncontrasting

confidence: 63%

Risk factors for emergence agitation in adults after general anesthesia: A systematic review and meta‐analysis

Wei

Feng

Chen

et al. 2021

Acta Anaesthesiol Scand

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Background Emergence agitation (EA) is an adverse post‐operative complication that increases the risk for injury, self‐extubation, hemorrhages, and prolonged hospitalization. This meta‐analysis aims to define the risk factors for adult EA after general anesthesia and provide recommendations for clinical practice. Methods Embase, PubMed, Medline, and the Cochrane Library databases were comprehensive retrieved. Observational studies that reported the risk factors for adult EA were enrolled. Review Manager 5.4 was used to analyze the extracted data. Results Eighteen observational studies involving 16, 678 adult patients were enrolled in this study. Eighteen pre‐operative and nineteen intraoperative factors with unadjusted data, and five pre‐operative and five intraoperative factors with adjusted data were meta‐analyzed separately. Among them, seven factors (age, male, smoking, history of substance misuse, inhalational anesthesia, urinary catheter, complain of pain, or need analgesic drug use in post‐anesthetic care unit) were the risk factors no matter meta‐analyzed by unadjusted data or adjusted data. Intraoperative use of benzodiazepines was the risk factor when meta‐analyzed by adjusted data, but not unadjusted data. Moreover, age and inhalational anesthesia were not the risk factors when omitted one study for sensitivity analysis, and history of substance misuse could not do sensitivity analysis. Conclusion Based on this meta‐analysis, male, smoking, urinary catheter, and post‐operative pain are the risk factors, while age, inhalational anesthesia, history of substance misuse, and intraoperative use of benzodiazepines are the possible risk factors for adult EA. Editorial Comment This systematic review and meta‐analysis identify risk factors associated with the occurrence of agitation during emergence from general anesthesia. As might be expected, the strongest factors are generally things which are irritating or painful for patients, but cannot necessarily be avoided.

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“…review and metaanalysis support the superiority of dexm edetomidine over placebo, midazolam, or opioid in significantly decreasing the incidence of ED in pediatrics aft er anesthesia for various types of surgeries [23]. The same evidence was also confirmed in a network analysis of ped iatric anesthesia for adenotonsillectomy operation [24]. In our trial, dexmedetomidine was given as a single IV dose (0.3 μg/kg).…”

Section: Discussionsupporting

confidence: 68%

Effect of single-dose dexmedetomidine on the incidence of emergence delirium after sevoflurane-based anesthesia in children undergoing strabismus surgery

Elghamry

Elkeblawy

2020

Egyptian Journal of Anaesthesia

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Comparative efficacy of ancillary drugs in sevoflurane‐related emergence agitation after paediatric adenotonsillectomy: A Bayesian network meta‐analysis

Cited by 13 publications

References 44 publications

Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Risk factors for emergence agitation in adults after general anesthesia: A systematic review and meta‐analysis

Effect of single-dose dexmedetomidine on the incidence of emergence delirium after sevoflurane-based anesthesia in children undergoing strabismus surgery

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