The sedative effects of the intranasal administration of dexmedetomidine in children undergoing surgeries compared to other sedation methods: A systematic review and meta-analysis

Kim, Hyun Jung; Shin, WooJong; Park, Suin; Ahn, Hyeong Sik; Oh, Jin-Seok

doi:10.1016/j.jclinane.2017.01.014

Cited by 37 publications

(33 citation statements)

References 25 publications

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“… 27 – 66 The median (interquartile range) of the sample size for included studies was 60 (40–70) and the Jadad score was 4 (2–5). Articles that did not meet the inclusion criteria upon further evaluation of full text were omitted 67 – 113 and they included incomplete data on analgesic outcomes, 114 – 117 age limit exceeded, 118 – 181 trials involving dental procedures, 182 – 186 and non-translated articles. 187 – 189 The characteristics of the included trials are presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

Kendall

Alves

Suh

et al. 2018

LRA

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Regional anesthesia is becoming increasingly popular among anesthesiologists in the management of postoperative analgesia following pediatric surgery. The main objective of this review was to systematically evaluate the last 5 years of randomized controlled trials on the role of regional anesthesia techniques in alleviating postoperative pain associated with various pediatric surgical procedures. Forty studies on 2,408 pediatric patients were evaluated. The majority of the articles published from 2013 to 2017 reported that the use of regional anesthesia minimized postoperative pain and reduced opioid consumption. Only a few surgical procedures (cholecystectomy, inguinal hernia repair, and non-laparoscopic major abdominal surgery) reported no significant difference in the postoperative pain relief compared with the standard anesthetic management. The growing number of randomized controlled trials in the pediatric literature is very promising; however, additional confirmation is needed to reinforce the use of specific regional anesthesia techniques to provide optimal postoperative pain relief for a few surgical procedures (reconstructive ear surgery, chest wall deformity, hypospadias, umbilical hernia, cleft palate repair) in pediatric patients. More randomized controlled trials are needed to establish regional anesthesia as an essential component of postoperative analgesia management in children.

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Section: Resultsmentioning

confidence: 99%

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

Kendall

Alves

Suh

et al. 2018

LRA

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“…[40][41][42] Previously published meta-analyses on the use of intranasal dexmedetomidine as a premedication before surgery also revealed similar results on the superiority of intranasal dexmedetomidine premedication in comparison with benzodiazepines. 16,20,21 Sedating children outside the operating room during therapeutic and diagnostic interventions is continuously increasing. Traditional sedative drugs are often insufficient to provide sedation and anxiolysis in paediatric procedures when used as a sole sedative agent.…”

Section: Relationship To Other Reviewsmentioning

confidence: 99%

“…Although rapid intravenous administration of dexmedetomidine may initially cause elevated blood pressure, cardiovascular responses are mainly bradycardic and, to some extent, hypotensive 18,19 . Previous meta‐analyses have revealed that intranasal dexmedetomidine was a more effective preoperative sedative drug than other traditional sedatives 16,20,21 . Intranasal dexmedetomidine is expected to be a feasible and effective alternative to chloral hydrate and midazolam and have a better safety profile, especially due to its potential neuroprotective properties 22 …”

Section: Introductionmentioning

confidence: 99%

“…Greater doses of sedative drugs produce a deeper level of sedation, which may lead to improved procedural success, but with an increased likelihood of adverse events. Although the onset time or duration of sedation could not be compared between patients receiving dexmedetomidine and those receiving midazolam, one study reported a slower onset of sedation using intranasal dexmedetomidine than using oral benzodiazepines 21.…”

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confidence: 99%

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Systematic review and meta‐analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation

et al. 2020

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Aim This systematic review and meta‐analysis evaluated the effectiveness of intranasal dexmedetomidine as a sole sedative during paediatric procedural sedation outside the operating room. Methods Relevant literature identified by PubMed, Scopus, ClinicalTrials.gov, ScienceDirect and Cochrane Library up to 31 December 2019 was systematically reviewed. Randomised controlled trials that compared intranasal dexmedetomidine with another sedative or placebo during paediatric procedural sedation were included. Trials that studied intranasal dexmedetomidine as a premedication before anaesthesia were excluded. The primary outcome was the success of the planned procedure. Results We analysed seven randomised controlled trials of 730 patients: four trials with 570 patients compared dexmedetomidine with chloral hydrate and three trials with 160 patients compared dexmedetomidine with midazolam. The incidence of successfully completing the procedure did not differ between dexmedetomidine and chloral hydrate, but dexmedetomidine had a higher success rate than midazolam. The incidence of hypotension, bradycardia or respiratory complications did not differ between the sedatives used. Nausea and vomiting were more common in children treated with chloral hydrate than in those treated with other sedatives. Conclusion Intranasal dexmedetomidine was a safe and effective sedative for minor paediatric procedures.

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“…sedation) in pediatric patients undergoing surgical procedures. 2,3 The current emphasis on the need to improve safety in non-operating room procedures makes the topic very relevant in perioperative medicine. 4,5 Although the Oh et al study was done well, there are questions that need to be clarified in order to support the authors' conclusions.…”

mentioning

confidence: 99%

Sedation target and propofol dosage in pediatric patients

Kendall

2019

Pediatrics International

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The sedative effects of the intranasal administration of dexmedetomidine in children undergoing surgeries compared to other sedation methods: A systematic review and meta-analysis

Cited by 37 publications

References 25 publications

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

Systematic review and meta‐analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation

Sedation target and propofol dosage in pediatric patients

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