Dexmedetomidine in Pediatric Patients during the Recovery Period after Sevoflurane-Based General Anesthesia: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Fengshou ,  MA Hong

Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China;

Corresponding author：

MA Hong, Email: mahong5466@yahoo.com

Keywords：

Dexmedetomidine; Pediatric; Sevoflurane; General anesthesia; Recovery; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130102

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Objective 　To assess the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia.
Methods 　Such databases as PubMed (1966 to March 2012), The Cochrane Library (Issue 1, 2012), EBSCO (ASP) (1984 to March 2012), Journals@Ovid Full Text (1993 to March 2012), CBM (1978 to March 2012), CNKI (1979 to March 2012), VIP (1989 to March 2012), and WanFang Data (1998 to March 2012) were searched to collect randomized controlled trials (RCTs) about the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia, and the references of the included studies were also retrieved. Two researchers extracted the data and evaluated the methodological quality of the included studies independently. Then the RevMan 5.2 software was used for meta-analysis.
Results 　A total of 16 RCTs involving 1 217 patients were included. The results of meta-analysis showed that, compared with the placebo, dexmedetomidine could reduce the occurrence of emergence agitation (OR=0.18, 95%CI 0.13 to 0.25, P lt;0.000 01) and increase the occurrence of postoperative lethargy (OR=0.14, 95%CI 0.03 to 0.68, P=0.01), but there were no differences in the occurrence of side effects including bronchospasm, bucking, breathholding, and oxygen desaturation. Dexmedetomidine could also reduce mean arterial blood pressure (MAP) and heart rate (HR) of pediatric patients during the recovery period after sevoflurane anesthesia, but it increased emergence time (MD=2.14, 95%CI 0.95 to 3.33, P=0.000 4), extubation time (MD=1.26, 95%CI 0.51 to 2.00, P=0.000 9) and the time of staying in PACU (MD=4.72, 95%CI 2.07 to 7.38, P=0.000 5).
Conclusions 　For pediatric patients recovering from sevoflurane-based general anesthesia, dexmedetomidine can reduce the occurrence of emergence agitation, and is helpful to maintain the hemodynamic balance. But it prolongs emergence time, extubation time (or the time of using the laryngeal mask) and the time of staying in PACU, and increases the occurrence of postoperative lethargy.

Citation： CHEN Fengshou,MA Hong. Dexmedetomidine in Pediatric Patients during the Recovery Period after Sevoflurane-Based General Anesthesia: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(5): 580-587. doi: 10.7507/1672-2531.20130102 Copy

1.	Tobias JD, Berkenbosch JW. Initial experience with dexmedetomidine in paediatric-aged patients. Paediatr Anaesth, 2002, 12(2): 171-175.
2.	Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth, 2005, 15(9): 762-766.
3.	Ibacache ME, Muñoz HR, Brandes V, et al. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anesth Analg, 2004, 98(1): 60-63.
4.	Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth, 2005, 15(12): 1098-1104.
5.	Isik B, Arslan M, Tunga AD, et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth, 2006, 16(7): 748-753.
6.	Erdil F, Demirbilek S, Begec Z, et al. The effects of dexmedetomidine and fentanyl on emergence characteristics after adenoidectomy in children. Anaesth Intensive Care, 2009, 37(4): 571-576.
7.	Sato M, Shirakami G, Tazuke-Nishimura M, et al. Effect of single-dose dexmedetomidine on emergence agitation and recovery profiles after sevoflurane anesthesia in pediatric ambulatory surgery. J Anesth, 2010, 24(5): 675-682.
8.	Al-Zaben KR, Qudaisat IY, Al-Ghanem SM, et al. Intraoperative administration of dexmedetomidine reduces the analgesic requirements for children undergoing hypospadius surgery. Eur J Anaesthesiol, 2010, 27(3): 247-252.
9.	张加强, 孟凡民, 侯艳华, 等. 右旋美托咪啶对小儿七氟醚麻醉苏醒期躁动及血流动力学的影响. 临床麻醉学杂志, 2010, 26(7): 627-628.
10.	房洁渝, 肖亮灿, 郭隽英, 等. 右美托咪啶预防儿童全身麻醉后躁动的临床研究. 中国医药指南, 2010, 37(7): 121-122.
11.	Özcengiz D, Gunes Y, Ozmete O. Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children. J Anesth, 2011, 25(2): 184-188.
12.	甘秀峰, 陈彦青, 邹聪华. 右美托咪啶对七氟醚麻醉患儿麻醉恢复期躁动的影响. 中华麻醉学杂志, 2011, 31(2): 166-167.
13.	金约西, 李军. 右美托咪啶用于小儿全麻苏醒期躁动的临床观察. 中国医院药学杂志, 2011, 31(13): 1117-1120.
14.	薛涛, 孙红梅, 孙剑. 右美托咪啶减轻小儿全身麻醉术后躁动的临床观察. 山西医药杂志, 2011, 40(8): 783-784.
15.	黄毓婵, 房洁瑜, 朱琼芳. 右美托咪啶预防儿童术后躁动的观察及护理.临床护理杂志, 2011, 10(5): 51-53.
16.	朱琼芳, 房洁渝, 陈旭素. 全麻诱导前应用右美托咪啶对腺样体切除术儿童苏醒期应激反应的影响. 中山大学学报(医学科学版), 2011, 32(6): 803-806.
17.	Lili X, Jianjun S, Haiyan Z. The application of dexmedetomidine in children undergoing vitreoretinal surgery. J Anesth, 2012, 26(4): 556-561.
18.	刘建平. 系统评价. 见: 梁万年, 主编. 医学科研方法学. 第1版. 北京: 人民卫生出版社, 2002: 451-486.
19.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
20.	Szumita PM, Baroletti SA, Anger KE, et al. Sedation and analgesia in the intensive care unit evaluating the role of dexmedetomidine. Am J Health Syst Pharm, 2007, 64(1): 37-44.
21.	Tobias JD. Dexmedetomidine applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med, 2007, 8(2): 115-131.
22.	赵博, 马虹. 右旋美托咪啶用于椎管内麻醉随机对照试验的Meta分析. 中国循证医学杂志, 2011, 11(12): 1419-1426.
23.	Keaney A, Diviney D, Harte S, et al. Postoperative behavioral changes following anesthesia with sevoflurane. Paediatr Anaesth, 2004, 14(10): 866-870.
24.	Cohen IT, Finkel JC, Hannallah RS, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13(1): 63-67.
25.	Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: acomparison with halothane. Paediatr Anaesth, 2000, 10(4): 419-424.
26.	Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg, 2007, 104(1): 84-91.
27.	Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg, 2003, 96(6): 1625-1630.

1. Tobias JD, Berkenbosch JW. Initial experience with dexmedetomidine in paediatric-aged patients. Paediatr Anaesth, 2002, 12(2): 171-175.
2. Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth, 2005, 15(9): 762-766.
3. Ibacache ME, Muñoz HR, Brandes V, et al. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anesth Analg, 2004, 98(1): 60-63.
4. Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth, 2005, 15(12): 1098-1104.
5. Isik B, Arslan M, Tunga AD, et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth, 2006, 16(7): 748-753.
6. Erdil F, Demirbilek S, Begec Z, et al. The effects of dexmedetomidine and fentanyl on emergence characteristics after adenoidectomy in children. Anaesth Intensive Care, 2009, 37(4): 571-576.
7. Sato M, Shirakami G, Tazuke-Nishimura M, et al. Effect of single-dose dexmedetomidine on emergence agitation and recovery profiles after sevoflurane anesthesia in pediatric ambulatory surgery. J Anesth, 2010, 24(5): 675-682.
8. Al-Zaben KR, Qudaisat IY, Al-Ghanem SM, et al. Intraoperative administration of dexmedetomidine reduces the analgesic requirements for children undergoing hypospadius surgery. Eur J Anaesthesiol, 2010, 27(3): 247-252.
9. 张加强, 孟凡民, 侯艳华, 等. 右旋美托咪啶对小儿七氟醚麻醉苏醒期躁动及血流动力学的影响. 临床麻醉学杂志, 2010, 26(7): 627-628.
10. 房洁渝, 肖亮灿, 郭隽英, 等. 右美托咪啶预防儿童全身麻醉后躁动的临床研究. 中国医药指南, 2010, 37(7): 121-122.
11. Özcengiz D, Gunes Y, Ozmete O. Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children. J Anesth, 2011, 25(2): 184-188.
12. 甘秀峰, 陈彦青, 邹聪华. 右美托咪啶对七氟醚麻醉患儿麻醉恢复期躁动的影响. 中华麻醉学杂志, 2011, 31(2): 166-167.
13. 金约西, 李军. 右美托咪啶用于小儿全麻苏醒期躁动的临床观察. 中国医院药学杂志, 2011, 31(13): 1117-1120.
14. 薛涛, 孙红梅, 孙剑. 右美托咪啶减轻小儿全身麻醉术后躁动的临床观察. 山西医药杂志, 2011, 40(8): 783-784.
15. 黄毓婵, 房洁瑜, 朱琼芳. 右美托咪啶预防儿童术后躁动的观察及护理.临床护理杂志, 2011, 10(5): 51-53.
16. 朱琼芳, 房洁渝, 陈旭素. 全麻诱导前应用右美托咪啶对腺样体切除术儿童苏醒期应激反应的影响. 中山大学学报(医学科学版), 2011, 32(6): 803-806.
17. Lili X, Jianjun S, Haiyan Z. The application of dexmedetomidine in children undergoing vitreoretinal surgery. J Anesth, 2012, 26(4): 556-561.
18. 刘建平. 系统评价. 见: 梁万年, 主编. 医学科研方法学. 第1版. 北京: 人民卫生出版社, 2002: 451-486.
19. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
20. Szumita PM, Baroletti SA, Anger KE, et al. Sedation and analgesia in the intensive care unit evaluating the role of dexmedetomidine. Am J Health Syst Pharm, 2007, 64(1): 37-44.
21. Tobias JD. Dexmedetomidine applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med, 2007, 8(2): 115-131.
22. 赵博, 马虹. 右旋美托咪啶用于椎管内麻醉随机对照试验的Meta分析. 中国循证医学杂志, 2011, 11(12): 1419-1426.
23. Keaney A, Diviney D, Harte S, et al. Postoperative behavioral changes following anesthesia with sevoflurane. Paediatr Anaesth, 2004, 14(10): 866-870.
24. Cohen IT, Finkel JC, Hannallah RS, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13(1): 63-67.
25. Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: acomparison with halothane. Paediatr Anaesth, 2000, 10(4): 419-424.
26. Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg, 2007, 104(1): 84-91.
27. Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg, 2003, 96(6): 1625-1630.

Chinese Journal of Evidence-Based Medicine

Dexmedetomidine in Pediatric Patients during the Recovery Period after Sevoflurane-Based General Anesthesia: A Meta-Analysis

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