Premedication with dexmedetomidine to reduce emergence agitation: a randomized controlled trial

Kim, Jong Chan; Kim, Jihee; Kwak, Hayeon; Ahn, So Woon

doi:10.21203/rs.2.9493/v1

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…This may be due to the higher dose (0.5-4 μg/kg) and the more uniform route (transnasal or oral) of DEX administration in the premedication subgroup, leading to a more consistent DEX effect in reducing the incidence of EA. Preoperative administration of DEX has been shown to have several significant benefits, including a lower incidence of EA, reduced agitation severity, and a shorter duration of agitation (94). Therefore, high-quality evidence supports preoperative DEX administration to prevent EA in children.…”

Section: Discussionmentioning

confidence: 99%

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

Xu¹,

Bai²,

Shi³

et al. 2021

Transl Pediatr

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Background: Beneficial effects of dexmedetomidine (DEX) against emergence agitation (EA) in children remain controversial. We performed a more comprehensive meta-analysis to evaluate the protective effect of different administration routes, timing, patterns, and doses of DEX on EA in children. Methods:The randomized controlled trials about DEX preventing EA in children were searched in PubMed, Cochrane Library, Embase, and Web of Sciences up to October 7, 2020. The traditional meta-analysis and subgroup analysis were performed to study the influence of DEX on EA in children. The sequential trial analysis (TSA) further analyzed the pooled results to evaluate meta-analyses' robustness. Grading of recommendation, assessment, development, and evaluation (GRADE) was used to assess evidence quality.Results: Sixty-seven studies with 5,688 pediatric patients were included. DEX significantly decreased EA in children compared to placebo [RR 0.29, 95% confidence intervals (CI): 0.25-0.34] and midazolam (RR 0.34, 95% CI: 0.25-0.45), with firm evidence from TSA. Notably, using DEX significantly reduced severe EA incidence (RR 0.23, 95% CI: 0.16-0.32), with firm evidence by TSA and high quality of GRADE. Pre-specified subgroup analyses revealed firm and high-quality evidence for a reduction of EA, only if the perineural route administers DEX (RR 0.24, 95% CI: 0.14-0.41), as premedication (RR 0.27, 95% CI: 0.20-0.36), as continuous dosage (RR 0.25, 95% CI: 0.18-0.33), at high dose (RR 0.24, 95% CI: 0.18-0.31). The pooled results also showed that DEX reduced the incidence of PONV compared to placebo (RR 0.43, 95% CI: 0.33-0.55). Evidence for DEX's influence on other secondary outcomes (emergence time, time in PACU, rescue analgesia, hypotension, and bradycardia) is insufficient to draw any conclusion.Conclusions: Our findings confirm the beneficial effects of DEX on EA, severe EA, and PONV in children. There was firm and high-quality evidence for the efficacy of DEX in preventing EA in children when perineural routes administered DEX, as premedication, as continuous dosage, and at a high dose. The best dose, route, patterns, and timing of DEX and influence on other outcomes call for further studies.

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Section: Discussionmentioning

confidence: 99%

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

Xu¹,

Bai²,

Shi³

et al. 2021

Transl Pediatr

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“…A recent systematic review and network meta-analysis investigated which medications' relative e cacies on decreasing emergence cough after general anesthesia, the result found dexmedetomidine ranked more effective than lidocaine, remifentanil and fentanyl in reducing moderate to severe cough reponse [17]. Kim et al found a calm state at emergence in the group receiving dexmedetomidine compared with that receiving placebo for nasal bone fracture surgery [18]. A meta-analysis including 19 randomized controlled trials concluded that dexmedetomine signi cantly reduced the incidence of agitation and severe pain during recovery period [19].…”

Section: Discussionmentioning

confidence: 99%

Dexdemetomidine for Prevention of Cough Response and Agitation in Patients with Intubation after Flap Reconstructive Surgery for Oral Cancer

Huang

Qin

Wang

2021

Preprint

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Background: To investigate whether intraoperative infusion of dexmedetomidine could safely prevent the incidence of cough response and agitation in patients with intubation after flap reconstructive surgery for oral cancer.Methods: Sixty-four patients undergoing flap reconstructive surgeries were randomly divided into dexmedetomidine (D) group and control (C) group. Within 15 min before anesthesia induction, dexmedetomidine was infused with a 0.5μg/kg loading dose followed by a maintenance dose of o.4μg/kg/h in group D, while the same volume saline was administered in group C. All patients kept the tracheal tube and maintained spontaneous respiratory in intensive care unit (ICU). Postoperative cough response, the Richmond Agitation-Sedation Scale (RASS) score, the behavioral pain scale (BPS) score, blood oxygen saturation (SpO2 ), respiratory rate (RR) and end-tidal carbon dioxide (EtCO2) were recorded at 10min (T1), 20 min(T2), 30 min (T3), 1h(T4), 6h(T5), 12h(T6) and 24h (T7) after surgery. Meanwhile, the length of ICU stay and adverse effects were also calculated.Results: The data of 32 patients in each group were included in this study. The incidence of cough response were significantly lower in group D than that in group C at T1-6 (P<0.05); The RASS scores in group D were significantly lower than that in group C at T1-5 (P<0.05); The BPS score in group C was much higher than that in group D at all time-points (P<0.05). And there was no significant difference in the SpO2, RR, EtCO2, the length of ICU stay and other complications. Conclusion: Dexmedetomidine as an anesthetic adjuvant could safely prevent the incidence of cough response and agitation in patients with intubation after flap reconstructive surgery for oral cancer. Trial registration: Chinese Clinical Trial Registry, ChiCTR-1800018367.

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“…In the past few years, anesthesiologists have been striving to reduce the incidence of EA and improve the quality of patient's postoperative condition with the help of various drugs and techniques. Several drugs such as remifentanil (9), magnesium sulphate (5) and dexmedetomidine (1,10,11) have been suggested as potential prophylactic interventions of EA in adult patients. However, little progress has been made in therapeutics.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Effects of Dexmedetomidine versus Propofol on the Treatment of Emergence Agitation in Adults after General Anesthesia: study protocol for a randomized controlled trial (DP-TEA Trial)

Shi

Xue

Zhu

et al. 2021

Preprint

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BackgroundEmergence agitation (EA) from general anesthesia is a common complication in the post anesthesia care unit (PACU). Once EA happens, there is still no guidelines established to recommend the medication administration in adults. Propofol is widely used in managing agitated patient in the PACU, but it is lack of analgesia and can suppress breathing transiently. Intraoperative infusion of dexmedetomidine is proved to have preventive effect on EA, but the treatment effect of dexmedetomidine on EA occurring in the PACU remains unknown. This study aims to compare the effects between dexmedetomidine and propofol on relieving emergence agitation in the PACU in adult patients after general anesthesia. MethodsIn this randomized, controlled, single-blinded clinical study, a total of 120 adult patients aged 18-65 years of both genders, with American Society of Anesthesiologists (ASA) classification I or II who develop emergence agitation in the PACU after general anesthesia will be included. Patients will be randomized at 1:1 ratio to two groups, receiving either a single dose of dexmedetomidine (0.7ug/kg) or propofol (0.5mg/kg). The primary outcome is the recurrence rate of EA assessed by the Riker Sedation-Agitation Scale (RSAS). The secondary outcomes are RSAS scores and vital signs before and after intervention, the consumption of sufentanil in the PACU, nausea and vomiting scores evaluated by a four-point postoperative nausea and vomiting (PONV) scale when leaving the PACU, duration in the PACU, adverse events (desaturation, severe bradycardia, shivering, dizziness, laryngospasm, severe coughing, reintubation) and recovering quality evaluated by the 40-item quality of recovery scale (Qo-R 40).DiscussionPrevious studies are almost about the efficacy of premedication on preventing EA, while medicine administration on treating EA is reported rarely. This study is designed to investigate whether a single dose of dexmedetomidine can relieve EA more efficiently and improve recovery quality of adult patients form general anesthesia more significantly comparing to propofol.Trial registrationClinicalTrials.gov ID: NCT04142840.Registered on October 26, 2019. https://clinicaltrials.gov/ct2/show/NCT04142840.

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Premedication with dexmedetomidine to reduce emergence agitation: a randomized controlled trial

Abstract: Background

Cited by 3 publications

References 9 publications

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

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

Dexdemetomidine for Prevention of Cough Response and Agitation in Patients with Intubation after Flap Reconstructive Surgery for Oral Cancer

Comparing the Effects of Dexmedetomidine versus Propofol on the Treatment of Emergence Agitation in Adults after General Anesthesia: study protocol for a randomized controlled trial (DP-TEA Trial)

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