Effect of different administration and dosage of dexmedetomidine in the reduction of emergence agitation in children: a meta-analysis of randomized controlled trials with sequential trial analysis

Xu, Zhendong; Bai, Yan; Shi, Min; Ming, Shaopeng; Jin, Xiaogao; Xie, Yubo

doi:10.21037/tp-21-105

Cited by 11 publications

(9 citation statements)

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“…This process resembles natural sleep and awakening with anxiolytic sedative effects and without respiratory depression. Previous research [ 19 ] has demonstrated that the application of dorsal penile nerve block combined with dexmedetomidine anesthesia in pediatric circumcision features a fast onset of action, stable vital signs of patients, and less postoperative agitation, which is consistent with the results of the present study.…”

Section: Discussionsupporting

confidence: 93%

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Yao

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To assess the efficacy of dexmedetomidine anesthesia plus dorsal penile nerve block in pediatric circumcision. Methods. In this retrospective study, 80 children receiving circumcision in our hospital from February 2020 to February 2021 were recruited and assigned via different anesthesia methods at a ratio of 1 : 1 to receive dorsal penile nerve block plus dexmedetomidine anesthesia (combined anesthesia group) or only sevoflurane for total inhalational anesthesia (total anesthesia group). Traditional Chinese medicine (TCM) care was introduced to both groups of patients. Outcome measures included vital signs, operative indices, anesthesia effect, adverse reactions, parent satisfaction, and nursing satisfaction. Results. There were no significant differences in the heart rate, oxygen saturation, and mean arterial pressure between the two groups of children before anesthesia, after anesthesia, and during the awakening period ( P > 0.05 ). Patients receiving combined anesthesia showed a shorter time lapse before the disappearance of eyelash reflex, longer time lapse before postoperative analgesic use, faster awakening, and shorter operation time and hospital stay versus those receiving total inhalational anesthesia alone ( P > 0.05 ). The combined anesthesia resulted in a lower Induction Compliance Checklist (ICC) score, McGill score, and Richmond Agitation-Sedation Scale (RASS) score and a higher Ramsay score versus total anesthesia ( P > 0.05 ). Patients receiving combined anesthesia showed a significantly lower incidence of adverse events (5.00% (2/40)) versus total inhalational anesthesia (62.50% (25/40)) (X2 = 29.574, P > 0.05 ). The combined anesthesia group had a higher parent satisfaction (92.50% (37/40)) versus the total anesthesia group (75.00% (30/40)) (X2 = 4.501, P > 0.05 ). A total of 80 questionnaires were distributed, with a 100% return rate and a 100% validity rate, and all 80 questionnaires scored 90 points or above. The families of children in both groups were satisfied with the quality of TCM care. Conclusion. The efficacy of dorsal penile nerve block plus dexmedetomidine anesthesia in pediatric circumcision is better than total inhalational anesthesia with sevoflurane.

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Section: Discussionsupporting

confidence: 93%

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Yao

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Our findings also demonstrate that dexmedetomidine minimizes PONV and the need for rescue analgesia without delaying discharge from the PACU. These findings are consistent with those of earlier meta-analyses [ 33 34 35 ].…”

Section: Discussionsupporting

confidence: 93%

“…In the dexmedetomidine group, all children were calm post-extubation and had significantly lower RASS and CHEOPS scores with no incidence of emergence agitation. Our findings support the high-quality evidence from a recent meta-analysis by Zhang et al [ 33 ], which demonstrated the benefits of maintenance infusion of dexmedetomidine on emergence agitation in children. Our findings also demonstrate that dexmedetomidine minimizes PONV and the need for rescue analgesia without delaying discharge from the PACU.…”

Section: Discussionsupporting

confidence: 91%

Improved postoperative recovery profile in pediatric oral rehabilitation with low-dose dexmedetomidine as an opioid substitute for general anesthesia: a randomized double-blind clinical trial

Naik

Jaiswal

Ganesh

et al. 2022

J Dent Anesth Pain Med

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Background Low-dose dexmedetomidine may be a suitable alternative to opioids for pediatric ambulatory procedures under general anesthesia (GA). However, the recovery profile remains unclear. Herein, we aimed to evaluate the effects of low-dose dexmedetomidine on the recovery profile of children. Methods Seventy-two children undergoing ambulatory oral rehabilitation under GA were randomly and equally distributed into two groups (D and F). Group D received an infusion of dexmedetomidine 0.25 µg/kg for 4 min for induction, followed by maintenance of 0.4 µg/kg/h. Group F received an infusion of fentanyl 1 µg/kg over 4 min for induction, followed by maintenance at 1 µg/kg/h. The primary outcome was the extubation time. The secondary outcomes were awakening time, end-tidal sevoflurane (ET-Sevo) requirement, change in hemodynamic parameters, Richmond Agitation–Sedation Scale (RASS), Children's Hospital of Eastern Ontario pain scale (CHEOPS) score, length of PACU stay, and incidence of adverse events. Results Statistically significant differences were observed in the recovery profile between the groups: the median time for extubation was 3.65 (3.44–6.2) vs. 6.25 (4.21–7) minutes in groups D vs. F (P = 0.001), respectively, while the corresponding awakening times were 19 (18.75–21) and 22.5 (22–24) minutes, respectively (P < 0.001). The mean ET-Sevo was low in group D (1.1 vs. 1.2; P < 0.001). The heart rate was significantly low across all time points in group D, without resulting in bradycardia. The median RASS and CHEOPS scores were also significantly lower in group D. No significant differences were observed in the mean arterial pressure, incidence of adverse events, or length of PACU stay. Conclusion Low-dose dexmedetomidine was more effective than fentanyl as an opioid substitute at providing a better recovery profile in pediatric ambulatory oral rehabilitation under GA. Dexmedetomidine also significantly reduced sevoflurane consumption without causing adverse events or prolonging hospital stay.

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“…Compared with intravenous administration, intranasal administration of dexmedetomidine has a longer absorption process, and this results in a longer duration of action, more satisfactory sedation and less postoperative agitation 8,12 . Several studies have reported intranasal dexmedetomidine to be associated with a decrease in the incidence of emergence agitation after paediatric inhalational anaesthesia, but various doses were used and the optimal dose was uncertain 13–15 . Yao et al 14 reported the incidence of emergence agitation as 16.7 and 3.3% with 1 and 2 μg kg −1 intranasal dexmedetomidine, respectively, in children aged 3 to 7 years after sevoflurane anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of different doses of intranasal dexmedetomidine in preventing emergence agitation in children with inhalational anaesthesia

Lei¹,

Wu²,

Wu³

et al. 2022

European Journal of Anaesthesiology

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BACKGROUND Emergence agitation is a common paediatric complication after inhalational anaesthesia. Intranasal dexmedetomidine can prevent emergence agitation effectively, but the optimal dose is uncertain.OBJECTIVE The aim of our study was to investigate the 95% effective dose (ED 95 ) of intranasal dexmedetomidine for the prevention of emergence agitation after inhalational anaesthesia for paediatric ambulatory surgery.DESIGN A prospective, randomised, placebo-controlled, double-blind, clinical trial. SETTINGThe study was conducted in Guangzhou Women and Children's Medical Center in China from August 2017 to December 2018.PATIENTS Three hundred and eighteen children scheduled for ambulatory surgery were enrolled into two age groups of less than 3 years and at least 3 years. INTERVENTIONSThe children in each age group were randomised into five equal subgroups to receive either intranasal dexmedetomidine 0.5, 1.0, 1.5 or 2.0 mg kg À1 (Groups D 0.5 , D 1.0 , D 1.5 and D 2.0 ), or intranasal isotonic saline (group C) after induction.MAIN OUTCOME MEASURES The primary outcome was the ED 95 dose of intranasal dexmedetomidine for preventing emergence agitation after inhalational anaesthesia for paediatric ambulatory surgery. RESULTSThe incidences of emergence agitation for Groups C, D 0.5 , D 1.0 , D 1.5 and D 2.0 were 63, 40, 23, 13 and 3% in children less than 3 years, and 43, 27, 17, 7 and 3% in children at least 3 years. The ED 95 of intranasal dexmedetomidine for preventing emergence agitation was 1.99 mg kg À1 [95% confidence interval (CI), 1.83 to 3.80 mg kg À1 ] in children less than 3 years, and 1.78 mg kg À1 (95% CI, 0.93 to 4.29 mg kg À1 ) in children at least 3 years. LMA removal time for groups D 1.5 and D 2.0 was 9.6 AE 2.2 and 9.7 AE 2.5 min, respectively, for children less than 3 years, and 9.4 AE 2.0 and 9.9 AE 2.7 min in children at least 3 years, respectively. Length of stay in the postanaesthesia care unit for Groups D 1.5 and D 2.0 was 34.3 AE 9.6 and 37.1 AE 11.2 min, respectively, in children less than 3 years, and 34.7 AE 10.2 and 37.3 AE 8.3 min in children at least 3 years, respectively. These times were longer in the D 1.5 and D 2.0 subgroups than in the control subgroup in the two age groups of less than 3 years and at least 3 years, respectively: 7.2 AE 1.9 min in children less than 3 years and 7.3 AE 2.5 min in children at least 3 years for LMA removal time, 22.2 AE 7.9 min in children less than 3 years and 22.0 AE 7.7 min in children at least 3 years for PACU stay time in control subgroup, respectively (P < 0.05).CONCLUSION Intranasal dexmedetomidine prevented emergence agitation after paediatric surgery in a dose-dependent manner. The optimal dose of intranasal dexmedetomidine for preventing emergence agitation was higher in younger children.

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Effect of different administration and dosage of dexmedetomidine in the reduction of emergence agitation in children: a meta-analysis of randomized controlled trials with sequential trial analysis

Cited by 11 publications

References 93 publications

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Improved postoperative recovery profile in pediatric oral rehabilitation with low-dose dexmedetomidine as an opioid substitute for general anesthesia: a randomized double-blind clinical trial

Efficacy of different doses of intranasal dexmedetomidine in preventing emergence agitation in children with inhalational anaesthesia

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