Efficacy and Acceptability of Different Auxiliary Drugs in Pediatric Sevoflurane Anesthesia: A Network Meta-analysis of Mixed Treatment Comparisons

Wang, Wuchao; Huang, Panchuan; Gao, Weiwei; Cao, Fangli; Yi, Ming-ling; Chen, Liyong; Guo, Xiaoli

doi:10.1038/srep36553

Cited by 16 publications

(12 citation statements)

References 69 publications

(68 reference statements)

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“…A network meta‐analysis examined seven auxiliary medications that were administered along with pediatric sevoflurane anesthesia for the reduction of POV and emergence agitation. The result showed that clonidine exhibited the highest cumulative ranking probability for reducing POV when compared to other medications . However, these patients received different types of surgical operations, and some common prophylactic antiemetic drugs were not examined.…”

Section: Discussionmentioning

confidence: 99%

“…The result showed that clonidine exhibited the highest cumulative ranking probability for reducing POV when compared to other medications. 24 However, these patients received different types of surgical operations, and some common prophylactic antiemetic drugs were not examined. On the other hand, high-level evidence supporting premedication on POV prevention in pediatric ophthalmology surgery is scarce.…”

Section: Strengths and Weaknesses Concerning Other Studiesmentioning

confidence: 99%

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Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta‐analysis

Hsu

Chu

Bai

et al. 2019

Pediatric Anesthesia

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Background Postoperative vomiting and pain are common, unpleasant phenomena in pediatric patients undergoing ophthalmic surgery. Clonidine has antiemetic and analgesic properties and thus may be used as premedication to reduce postoperative vomiting and pain. Aim To assess whether clonidine premedication may safely decrease postoperative vomiting and postoperative pain in pediatric patients who received an ophthalmic surgery. Methods We systematically searched PubMed, EMBASE, Cochrane Library, and Scopus databases from their inception to September 2018. Randomized clinical trials comparing clonidine premedication with a placebo or an active comparator that investigated postoperative vomiting or postoperative pain in pediatric patients undergoing ophthalmic surgery were included. The primary outcome was postoperative vomiting. The secondary outcome was postoperative pain. We also evaluated the safety of clonidine premedication by tracking hemodynamic instability associated with its use. Results Ten studies with 979 patients were eligible for inclusion. Clonidine achieved a significantly lower incidence of postoperative vomiting within 6 hours postoperatively, 6‐24 hours postoperatively, and at the end of the study (risk difference: −0.15; 95% confidence interval: −0.32 to −0.05; risk difference: −0.15; 95% confidence interval: −0.29 to 0.01; and risk difference: −0.23; 95% confidence interval: −0.34 to −0.12, respectively) than placebo. For the subgroup of patients who received strabismus surgery, clonidine produced a lower incidence of postoperative vomiting than placebo (risk difference: −0.19; 95% confidence interval: −0.29 to −0.05). Compared to benzodiazepine, clonidine achieved a lower incidence of postoperative vomiting at the end of the study (risk difference: −0.19; 95% confidence interval: −0.31 to −0.07); the effect was only observed in patients receiving clonidine 4 μg/kg. Furthermore, children receiving clonidine had lower postoperative pain scores, lower analgesic requirements, and more of them were pain‐free compared to those who received a placebo. No patient using clonidine had any major hemodynamic instability. Conclusion Compared to placebo or benzodiazepine, clonidine premedication was effective in reducing postoperative vomiting in pediatric patients undergoing ophthalmic surgery. Clonidine premedication also provided more reduction in postoperative pain when compared to placebo. The use of clonidine premedication was not associated with adverse hemodynamic events.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Weaknesses Concerning Other Studiesmentioning

confidence: 99%

Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta‐analysis

Hsu

Chu

Bai

et al. 2019

Pediatric Anesthesia

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“…It is known that sevoflurane is the most frequent culprit agent in pediatric cases with postoperative agitation. [6][7][8] As reported by Son et al, induction of anesthesia with thiopental may decrease the frequency of postoperative agitation when compared with sevoflurane; however, a combination of propofol and ketamine may be the most effective.…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of the Factors Affecting Emergence Agitation in Pediatric Anesthesia Practise

Uğur¹

2018

South Clin Ist Euras

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Objective:The agitation that is sometimes seen in children during the recovery period after the administration of anesthesia can be a difficult problem to solve, and can turn a successful procedure into a distressing situation. This prospective, observational study was intended to determine factors that may lead to postoperative agitation in children in order to contribute to future pediatric anesthesia studies. Methods:A total of 206 patients between 3 and 10 years of age who underwent operations performed by the departments of orthopedics and traumatology; urology; eye diseases; ear, nose, and throat diseases; pediatric surgery; and plastic and reconstructive surgery and whose physical status was classified as American Society of Anaesthesiologists I or II were included in the study. The patients' age, gender, details of preoperative fasting, previous surgeries (if any), premedication used (if any) and the method of application, the induction technique and drug used for anesthesia, airway management method, drugs used to maintain anesthesia and duration, postoperative analgesic management, and the duration of stay in the recovery room were recorded. In addition, the Face, Legs, Activity, Cry, Consolability score; the Pediatric Anesthesia Emergence Delirium score; and the modified Aldrete score recorded at the postoperative 10 th minute were analyzed.Results: Statistical evaluation revealed that age, operation type, anesthesia technique and drug selected, airway management method, drug used for induction and maintenance of anesthesia, and the duration of anesthesia significantly affected postoperative agitation (p<0.05). Regression analysis determined that patient age and the drug selected for the induction and the maintenance of anesthesia were independent risk factors for agitation developing during the recovery period. Conclusion:The age of the child, the duration of anesthesia, and the preferred anesthesia induction technique were the primary factors affecting agitation seen in children during recovery from anesthesia. Since the age of the patient and the duration of the surgery and anesthesia are factors that it is difficult or impossible to change, the anesthesia induction technique to be used is an important tool for the anesthesiologist to control the development of agitation during the recovery period.

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“…Clonidine acts as an alpha2‐adrenoceptor agonist and is approved for the treatment of hypertension, as an adjunct for epidural pain management, and for the management of pediatric attention deficit hyperactivity disorder. Clonidine is used off‐label in pediatric anesthesia for several indications, for example, treatment of acute pain, sedation in intensive care, treatment and prevention of postoperative agitation and to counter withdrawal symptoms in children after long‐term sedation 1‐5 . Pharmacokinetic knowledge is helpful for optimal clinical use, and clonidine pharmacokinetics in children has been investigated for oral, 6 intranasal, 7 rectal, 8 epidural, 9,10 and intravenous administration 11‐13 .…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics of an intravenous bolus dose of clonidine in children undergoing surgery

Nielsen

Anderson

Falcon

et al. 2020

Pediatric Anesthesia

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Background Clonidine is used off‐label in children but only limited pediatric pharmacokinetic data are available for intravenously administered clonidine. Objectives To determine pharmacokinetic parameter estimates of clonidine in healthy children undergoing surgery and to investigate age‐related differences. Furthermore, to investigate possible pharmacokinetic differences of clonidine between this group of children and a cohort with cardiac diseases. Methods In a randomized placebo‐controlled trial (The PREVENT AGITATION trial), blood samples for clonidine pharmacokinetic analysis were collected in a proportion of the enrolled patients. Healthy children with ASA score 1‐2 in the age‐groups 1 to <2 years and 2‐5 years were randomized for blood sampling. Clonidine was administered as a single intravenous bolus of 3 µg/kg intraoperatively. Blood samples were drawn at baseline, 5, 10, 15, 30, 60 minutes after dosing and additionally every hour until discharge from the PACU. Clonidine analysis was performed on liquid chromatography‐mass spectrometry. Results Data form eighteen children were available for pharmacokinetic analysis (ASA I; male/female: 17/1; age: 1‐5 years; weight 8.7‐24 kg). Population parameter estimates for the 2‐compartment model were similar to previous published data for children who underwent cardiac surgery. A pooled analysis including data from 59 children indicated clearance of 14.4 L h−1 70 kg−1 and volume of distribution of 192.6 L 70 kg−1. No age‐related pharmacokinetic differences and no difference in time from administration of study medication to awakening were found. Children 1 to <2 years had a shorter PACU stay than children 2‐5 years (mean difference 17% 95% CI:3%‐34%, P = .02). Conclusion Pharmacokinetic parameter estimates were similar for children undergoing general surgery and cardiac surgery given a single dose of intravenous clonidine. These results indicated that no dose reduction is needed in children aged 1 to <2 years compared with those 2‐5 years, which was supported by pharmacodynamic observations.

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Efficacy and Acceptability of Different Auxiliary Drugs in Pediatric Sevoflurane Anesthesia: A Network Meta-analysis of Mixed Treatment Comparisons

Cited by 16 publications

References 69 publications

Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta‐analysis

Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta‐analysis

The Evaluation of the Factors Affecting Emergence Agitation in Pediatric Anesthesia Practise

Pharmacokinetics of an intravenous bolus dose of clonidine in children undergoing surgery

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