Key result
Compared to placebo, dexmedetomidine significantly reduced the incidence of emergence agitation in children after general anesthesia (RR 0.29; 95% CI 0.22-0.37; P<0.00001).
Why the study?
Emergence agitation is a common and intractable postoperative complication among children undergoing surgery with general anesthesia, motivating an evaluation of dexmedetomidine for its prevention.
Does dexmedetomidine reduce the incidence of emergence agitation in children undergoing surgery with general anesthesia?
Meta-Analysis (n=2,549)
Does dexmedetomidine reduce the incidence of emergence agitation in children undergoing surgery with general anesthesia?
Relative Risk: 0.29 (95% CI 0.22–0.37)
p-value: p=<0.00001
Dexmedetomidine significantly reduces the incidence of emergence agitation, postoperative nausea and vomiting, and the need for rescue analgesics in children after general anesthesia, though it may prolong emergence and extubation times.
Supports dexmedetomidine prophylaxis to reduce emergence agitation in children; confirms efficacy via Level 1 meta-analysis of RCTs.
Background: Emergence agitation is one of the most common and intractable postoperative complications among children undergoing surgery with general anesthesia. Our aim was to evaluate the efficacy of dexmedetomidine for preventing emergence agitation in children after general anesthesia. Methods: PubMed, Cochrane Library, EMBASE and Web of Science databases were comprehensively searched for all randomized controlled trials published before April 22th, 2020 that investigated the efficacy of dexmedetomidine for prevention of emergence agitation in children after general anesthesia. Meta-analysis was performed with Review Manager 5.3. Our primary outcome was the incidence of emergence agitation. Second outcomes included: number of patients need rescue analgesic, number of patients having postoperative nausea and vomiting, emergence time, extubation time, time to discharge from post-anesthesia care unit. Results: Thirty-three studies involving 2549 patients were included in our meta-analysis. Compared to placebo, dexmedetomidine significantly reduced the incidence of emergence agitation [risk ratio (RR) 0.29, 95% confidence interval (CI) 0.22-0.37, P<0.00001]. Dexmedetomidine also reduced the incidence of postoperative nausea and vomiting [risk ratio (RR) 0.46, 95% confidence interval (CI) 0.3-0.69, P=0.0002] and the requirement of rescue analgesic [risk ratio (RR) 0.29, 95% confidence interval (CI) 0.18-0.44, P<0.00001]. While, patients in the dexmedetomidine group experienced a longer emergence time [risk ratio (RR) 2.18, 95% confidence interval (CI) 0.81-3.56, P=0.002]and a longer extubation time [risk ratio (RR) 0.77, 95% confidence interval (CI) 0.22-1.31, P=0.006]. There was no significant difference in terms of time to discharge from post-anesthesia care unit [risk ratio (RR) 2.22, 95% confidence interval (CI) -2.29-6.74, P=0.33]. When compared to midazolam, propofol, fentanyl, tramadol, clonidine and other drugs, no significant difference was found for the incidence of emergence agitation and other comparisons except for the requirement of rescue analgesic [risk ratio (RR) 0.45, 95% confidence interval (CI) 0.33-0.61, P<0.00001]. Conclusions: Dexmedetomidine has a positive effect on prevention of emergence agitation, relieving postoperative pain, reducing the consumption of rescue analgesic and the incidence of postoperative nausea and vomiting.
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Yang et al. (2020) conducted a meta-analysis in Emergence agitation in children after general anesthesia (n=2,549). Dexmedetomidine vs. Placebo was evaluated on Incidence of emergence agitation (RR 0.29, 95% CI 0.22-0.37, p=<0.00001). Compared to placebo, dexmedetomidine significantly reduced the incidence of emergence agitation in children after general anesthesia (RR 0.29; 95% CI 0.22-0.37; P<0.00001).
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