Key result
Dexmedetomidine significantly decreased the incidence of emergence agitation compared to placebo (RR 0.37) in children after sevoflurane anesthesia.
Why the study?
Does dexmedetomidine reduce emergence agitation and improve recovery profiles in children after sevoflurane anesthesia?
Meta-Analysis (n=1,364)
Does dexmedetomidine reduce emergence agitation and improve recovery profiles in children after sevoflurane anesthesia?
Relative Risk: 0.37 (95% CI 0.3–0.46)
p-value: p=<0.00001
Dexmedetomidine effectively reduces emergence agitation and postoperative nausea and vomiting in children after sevoflurane anesthesia compared to placebo, though it prolongs recovery times.
Supports dexmedetomidine to reduce emergence agitation after pediatric sevoflurane; confirms efficacy across pooled RCTs.
The objective of this article is to evaluate the effect of dexmedetomidine on emergence agitation (EA) and recovery profiles in children after sevoflurane anesthesia and its pharmacological mechanisms. Standard bibliographic databases, including MEDLINE, EMBASE, PsycINFP, Springer and ISI Web of Knowledge, were artificially searched to identify all randomized controlled trials (RCTs) comparing the impact of dexmedetomidine with placebo, fentanyl and midazolam on EA and recovery profiles after sevoflurane anesthesia in post-anesthesia care unit (PACU). Two authors assessed the quality of each study independently in accordance with strict inclusion criteria and extracted data. RevMan 5.0 software was applied for performing statistic analysis. The outcomes analyzed included: 1) incidence of EA, 2) emergence time, 3) time to extubation, 4) incidence of post-operation nausea and vomiting, 5) number of patients requiring an analgesic, and 6) time to discharge from PACU. A total of 1364 patients (696 in the dexmedetomidine group and 668 in the placebo, fentanyl and midazolam group) from 20 prospective RCTs were included in the meta-analysis. Compared with placebo, dexmedetomidine decreased the incidence of EA (risk ratio [RR] 0.37; 95% CI 0.30 to 0.46), incidence of nausea and vomiting (RR 0.57; 95% CI 0.38 to 0.85) and number of patients requiring an analgesic (RR 0.43; 95% CI 0.31 to 0.59). However, dexmedetomidine had a significantly delayed effect on the emergence time (weighted mean differences [WMD] 1.16; 95% CI 0.72 to 1.60), time to extubation (WMD 0.61; 95% CI 0.27 to 0.95), and time to discharge from recovery room (WMD 2.67; 95% CI 0.95 to 4.39). Compared with fentanyl (RR 1.39; 95% CI 0.78 to 2.48) and midazolam (RR 1.12; 95% CI 0.54 to 2.35), dexmedetomidine has no significantly difference on the incidence of EA. However, the analgesia effect of dexmedetomidine on postoperation pain has no significantly statistical differences compared with fentanyl (RR 1.12; 95% CI 0.66 to 1.91), which implied that its analgesia effect might play an important role in decreasing the incident of EA. No evidence of publication bias was observed.
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Zhu et al. (2015) conducted a meta-analysis in Emergence agitation after sevoflurane anesthesia (n=1,364). Dexmedetomidine vs. Placebo, fentanyl, or midazolam was evaluated on Incidence of emergence agitation (EA) compared to placebo (RR 0.37, 95% CI 0.30 to 0.46, p=<0.00001). Dexmedetomidine significantly decreased the incidence of emergence agitation compared to placebo (RR 0.37) in children after sevoflurane anesthesia.
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