Efficacy of low-dose caudal clonidine in reduction of sevoflurane-induced agitation in children undergoing urogenital and lower limb surgery: a prospective randomised double-blind study

Ghosh, Samhati Mondal; Agarwala, Radhika B; Pandey, Maitree; Vajifdar, Homay

doi:10.1097/eja.0b013e3283416754

Cited by 20 publications

(12 citation statements)

References 21 publications

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“…As a result of this, 45 articles published from 1999 to 2015 were complied with the selection criteria (Fig. 1)5678910111213141516171819202122232425262728293031323334353637383940414243444546474849. A total of 4,032 cases were included and the detailed baseline characteristics of the included studies were displayed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

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

Wang

Huang

Gao

et al. 2016

Sci Rep

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Emergence agitation preventive medicine should be combined with pediatric anesthesia because of the high frequency of emergence agitation. However, it is challenging to determine the most appropriate medication that can be introduced into pediatric anesthesia for the sake of emergence agitation prevention. We reviewed and retrieved the data from PubMed and Embase. Various medications were assessed based on several endpoints including Emergence agitation outcomes (EA), postoperative nausea and vomiting (PONV), the number of patients who required analgesic (RA), pediatric anesthesia emergence delirium (PAED), the extubation time, the emergency time and the duration of post-anesthesia care unit (PACU) stay. Both traditional and network meta-analysis were carried in this study. A total of 45 articles were complied with the selection criteria and the corresponding articles were reviewed. Fentanyl demonstrated the highest cumulative ranking probability which was followed by those of ketamine and dexmedetomidine with respect to EA and PAED. When PONV and RA were concerned together, clonidine exhibited the highest cumulative ranking probability compared to other medications. Our study suggested that dexmedetomidine perhaps is the most appropriate prophylactic treatment which can be introduced into anesthesia for preventing emergence agitation.

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Section: Resultsmentioning

confidence: 99%

“…It is suspected that these properties may enhance the hemodynamic stability, hence contributing to risk reduction of EA5152. It is acknowledged that pain relief medicine is able to reduce anesthesia-related EA effectively232953. However, some researchers argued that the use of general analgesic is not effective in reducing the risk of EA54.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Huang

Gao

et al. 2016

Sci Rep

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“…It is widely believed that relieving pain decreases the incidence of EA associated with anesthetic agents such as sevoflurane. Several studies demonstrated that regional block, opioids and NSAIDs decrease the incidence of EA. However, EA often occurs even after adequate pain treatment or after procedures that are not associated with pain …”

Section: Discussionmentioning

confidence: 99%

“…The high incidence of EA has led many investigators to provide prophylactic treatment, such as propofol, opioid, midazolam, nonsteroidal anti‐inflammatory drugs (NSAIDs), nitrous oxide (N 2 O), ketamine, 5‐hydroxytryptamin 3 inhibitors, magnesium and regional block . Another choice is to use dexmedetomidine, an α 2 ‐adrenoceptor (α 2 ‐AR) agonist with sedative, analgesic and anxiolytic actions, which has been widely used in pediatric and adult populations .…”

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confidence: 99%

Dexmedetomidine for preventing sevoflurane‐related emergence agitation in children: a meta‐analysis of randomized controlled trials

Guo

2014

Acta Anaesthesiol Scand

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Emergence agitation (EA) is a common problem after sevoflurane anesthesia in children. Prophylactic dexmedetomidine has been directed at this issue; however, the efficacy remains controversial. We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effectiveness of dexmedetomidine on the incidence of sevoflurane-related EA. A comprehensive literature search was performed to identify RCTs that compared dexmedetomidine with placebo about the reduction in the incidence of sevoflurane-related EA for children. Heterogeneity between studies was anticipated; therefore, random effects models were chosen to calculate the pooled risk ratio (RR) and 95% confidence interval (CI), and I(2) statistics were used to assess statistical heterogeneity. The funnel plot and Egger test were used to assess potential publication bias. Subgroup analysis was run to explore the possible effects of age, surgical procedure, regional block/local anesthetics, supplemental analgesic, propofol, N2O, pre-medication and methodological quality on the incidence of EA using dexemedetomidine. Totally, 15 RCTs were included (518 patients received dexmedetomidine and 413 had placebo). Dexmedetomidine reduced the incidence of sevofurane-related EA (pooled RR = 0.351; 95% CI: 0.275-0.449; P = 0.965; heterogeneity test, I(2) = 0.0%), and it also resulted in a lower incidence of severe EA (pooled RR = 0.119; 95% CI: 0.033-0.422; P = 0.962; heterogeneity test, I(2) = 0.0%). All subgroup analyses for potential sources of heterogeneity showed a lower incidence of sevoflurane-related EA after dexmedetomidine administration. This meta-analysis demonstrated that dexemedetomidine was effective in reducing the incidence of sevoflurane-induced EA in children as compared with placebo.

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“…Drugs such as analgesics, opioids, benzodiazepines, clonidine, remifentanil and dexmedetomidine have been used either prophylactically or as treatment of emergence agitation with variable success. [17,18,[20][21][22][23][24] The presence of pain, a predisposing factor for postoperative agitation, explains the effectiveness of analgesic drugs such as fentanyl and ketorolac given either as prophylaxis or for treatment of agitation. [18] Although pain may be one of the causes of agitation following general anesthesia; it is not the only cause.…”

Section: Discussionmentioning

confidence: 99%

Gabapentin premedication for postoperative analgesia and emergence agitation after sevoflurane anesthesiain peadiatric patients.

Salman¹,

Camkiran²,

Oğuz³

et al. 2013

Agri

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Efficacy of low-dose caudal clonidine in reduction of sevoflurane-induced agitation in children undergoing urogenital and lower limb surgery: a prospective randomised double-blind study

Abstract: Caudal clonidine at a lower dose (1 μg kg⁻¹) could be effective in reducing the incidence of sevoflurane-induced emergence agitation in children undergoing urogenital and lower limb surgery without any significant adverse effects.

Cited by 20 publications

References 21 publications

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

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

Dexmedetomidine for preventing sevoflurane‐related emergence agitation in children: a meta‐analysis of randomized controlled trials

Gabapentin premedication for postoperative analgesia and emergence agitation after sevoflurane anesthesiain peadiatric patients.

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