Dexmedetomidine and perioperative analgesia in children

Rebollar, Ramón Eizaga; Palacios, M.V. García; Riobó, M C Fernández; Morera, Luis Miguel Torres

doi:10.1016/j.redare.2022.08.003

Cited by 7 publications

(9 citation statements)

References 59 publications

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“…Loading doses are not commonly used, even though a loading dose of 0.5–1.0 μg/kg has been used in several clinical trials 14,25 . Because the analgesic effects of dexmedetomidine are limited, it is typically used in combination with opiates due to its ability to potentiate their analgesic effects 2,9 . Compared to Carney's study with patients aged 0–17.7 years, 23 the study population in the present study was younger (<6 months).…”

Section: Discussionmentioning

confidence: 82%

“…14,25 Because the analgesic effects of dexmedetomidine are limited, it is typically used in combination with opiates due to its ability to potentiate their analgesic effects. 2,9 Compared to Carney's study with patients aged 0-17.7 years, 23 the study population in the present study was younger (<6 months). Neonates may suffer a greater number of adverse cardiovascular events because they metabolise dexmedetomidine more slowly and have higher plasma concentrations with the same dosages compared to older infants.…”

Section: Discussionmentioning

confidence: 99%

“…Sedatives are used to reduce anxiety and pain, allowing healthcare staff to carry out therapeutic and diagnostic procedures when providing paediatric and neonatal intensive care 1 . Dexmedetomidine is a selective α‐receptor agonist that has sedative, anxiolytic and analgesic effects 2 . It acts in the locus coeruleus in the central nervous system and leads to sedation that resembles physiological sleep 3 .…”

Section: Introductionmentioning

confidence: 99%

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Adverse cardiovascular events are common during dexmedetomidine administration in neonates and infants during intensive care

et al. 2023

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AimThis study aimed to assess the safety of a commonly used sedative, dexmedetomidine in neonates and infants during intensive care.MethodsA retrospective cohort study was conducted in the paediatric intensive care unit at Oulu University Hospital. The study population consisted of all children from birth up to six months of age who received dexmedetomidine during 2010–2016. Adverse cardiovascular outcomes were defined as abnormal heart rates or blood pressure values according to the Pediatric Early Warning Score.ResultsOf the 172 infants, 56% had congenital malformation, and 48% had undergone surgery. Neonates and 1–3‐month‐olds experienced bradycardia (86% vs. 73% in 1–3‐month‐olds and 50% in 3–6‐month‐olds, p = 0.001) and severe bradycardia (17% vs. 14% in 1–3‐month‐olds and 0% in 3–6‐month‐olds, p = 0.005) more often than older patients. The median maximum rate of dexmedetomidine infusion was 0.86 μg/kg/h (IQR = 0.60–1.71 μg/kg/h). A dose‐dependent increase in bradycardia and severe hypotension was found. Adverse cardiovascular events were managed with additional fluid boluses and discontinuation of the infusion.ConclusionAdverse cardiovascular events were common during dexmedetomidine administration in neonates and infants. Lower dexmedetomidine doses may be required in sedating neonates.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adverse cardiovascular events are common during dexmedetomidine administration in neonates and infants during intensive care

et al. 2023

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“…Among the various pharmacological approaches for preventing EA/ED, intranasal administration of dexmedetomidine has been suggested to be beneficial 4,5 . Dexmedetomidine is a highly selective and potent α 2 adrenoreceptor agonist with various properties, including anxiolysis, sedation, analgesia, and sympatholysis with minimal respiratory depression 6 . Increasing evidence supports the use of dexmedetomidine for EA management in the pediatric age group 7,8 .…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Dexmedetomidine is a highly selective and potent α 2 adrenoreceptor agonist with various properties, including anxiolysis, sedation, analgesia, and sympatholysis with minimal respiratory depression. 6 Increasing evidence supports the use of dexmedetomidine for EA management in the pediatric age group. 7,8 However, several reports have shown no superior effect of intranasal dexmedetomidine compared with other agents.…”

Section: Introductionmentioning

confidence: 99%

The effect of intranasal dexmedetomidine administration on emergence agitation or delirium in pediatric patients after general anesthesia: A meta‐analysis of randomized controlled trials

Kim

Park

et al. 2023

Pediatric Anesthesia

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Background: Emergence agitation or delirium can occur in pediatric patients after anesthesia. Dexmedetomidine is known to reduce the impairment of postoperative cognitive function.Aims: This study aimed to identify the role of intranasal administration of dexmedetomidine in lowering the development of emergence agitation or emergence delirium in pediatric patients after general anesthesia.Methods: Electronic databases, including PubMed, EMBASE, CENTRAL, Scopus, and Web of Science, were searched to identify studies. The primary outcome was the proportion of patients who underwent emergence agitation or emergence delirium after the surgery. Secondary outcomes included emergence time and incidence of postoperative nausea and/or vomiting. We estimated the odds ratio and mean difference with 95% confidence intervals for the determination of effect size using a random-effects model. Results:In total, 2103 pediatric patients from 20 randomized controlled trials were included in the final analysis. The incidence of emergence agitation or emergence delirium was 13.6% in the dexmedetomidine group and 33.2% in the control group.The pooled effect size revealed that intranasal dexmedetomidine administration significantly reduced the incidence of postoperative emergence agitation or emergence delirium in pediatric patients undergoing surgery under general anesthesia (odds ratio 0.25, 95% confidence interval 0.18-0.34; p = .0000; I 2 = 37.74%). Additionally, significant difference was observed in emergence time between the two groups (mean difference 2.42, 95% confidence interval 0.37-4.46; p = .021; I 2 = 98.40%). Children in the dexmedetomidine group had a significantly lower incidence of postoperative nausea and/or vomiting than those in the control group (odds ratio 0.39, 95% confidence interval 0.24-0.64; p = .0002; I 2 = 0.00%).

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The preventive effect of dexmedetomidine on anesthesia complications in strabismus surgery: a systematic review and meta-analysis

Chen

Li²,

Zheng

et al. 2023

BMC Anesthesiol

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Objective Dexmedetomidine is a medication that has analgesic, sedative, and anti-anxiety properties. In the clinical, it is often used to prevent common complications associated with strabismus surgery, including postoperative delirium, postoperative nausea and vomiting, postoperative pain, and oculocardiac reflex. However, its effectiveness and side effects of the present studies are different. The sample sizes of the present studies on the prevention of complications of dexmedetomidine are small. Therefore, this study evaluates the efficacy of dexmedetomidine in preventing anesthesia-related complications in strabismus surgery through a systematic review and meta-analysis. Methods Literature was retrieved from 10 commonly used databases and randomized controlled trials published up to May 2022 were sought. The included studies compared the intervention effects of dexmedetomidine versus placebo on anesthesia-related complications in surgery. The occurrence rates of postoperative delirium, postoperative nausea and vomiting, postoperative pain, and oculocardiac reflex in patients undergoing strabismus surgery were evaluated. Statistical analyses and forest plots were generated using Review Manager and STATA software. Binary outcomes were measured using relative risk (RR) with a 95% confidence interval for each outcome. The Cochrane risk of bias tool was used to assess the bias and risk in the studies that met the inclusion criteria. Results A total of 13 articles were ultimately included in the analysis, comprising 1,018 patients who underwent strabismus surgery. The dexmedetomidine group, compared to the placebo group, demonstrated significant reductions in the incidence of postoperative delirium (RR = 0.73, P = 0.001), severe postoperative delirium (RR = 0.45, P = 0.005), postoperative nausea and vomiting (RR = 0.48, P < 0.0001), and the need for supplemental analgesia postoperatively (RR = 0.60, P = 0.004). Additionally, subgroup analysis revealed that intravenous administration of dexmedetomidine significantly reduced the incidence of oculocardiac reflex (RR = 0.50, P = 0.001). In contrast, intranasal administration of dexmedetomidine did not have a significant effect on the incidence of oculocardiac reflex (RR = 1.22, P = 0.15). There was a significant difference between the subgroups (P = 0.0005, I2 = 91.7%). Conclusion Among patients undergoing strabismus surgery, the use of dexmedetomidine can alleviate postoperative delirium and reduce the incidence of postoperative nausea and vomiting, as well as postoperative pain. Moreover, intravenous administration of dexmedetomidine can lower the occurrence rate of the oculocardiac reflex.

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Dexmedetomidine and perioperative analgesia in children

Cited by 7 publications

References 59 publications

Adverse cardiovascular events are common during dexmedetomidine administration in neonates and infants during intensive care

Adverse cardiovascular events are common during dexmedetomidine administration in neonates and infants during intensive care

The effect of intranasal dexmedetomidine administration on emergence agitation or delirium in pediatric patients after general anesthesia: A meta‐analysis of randomized controlled trials

The preventive effect of dexmedetomidine on anesthesia complications in strabismus surgery: a systematic review and meta-analysis

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