Alpha2-adrenoceptor Agonists for Prevention of Emergence Agitation in Pediatric Patients under Sevoflurane Anesthesia: A Meta Analysis of Randomized Controlled Trials_West China Medical Journal

Authors：

LI Ye ¹ , ZHANG Yanju ² , YU Hai ¹ ,  WANG Rurong ¹

1. Department of Anesthetics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China; 2. Department of anesthetics, Central Obstetrics and Gynecology Hospital, Tianjin 300052, P. R. China;

Corresponding author：

WANG Rurong, Email: fang_1959@126.com

Keywords：

可乐定; 右美托咪啶; α2受体激动剂; 七氟烷; 小儿; 术后躁动; Meta分析

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【摘要】　目的　评价α2受体激动剂是否可以降低七氟烷引起的小儿术后躁动的发生率。　方法　通过检索Medline、荷兰医学文摘、Cochrane临床试验数据库、中国生物医学文献数据库和中国期刊网全文数据库等数据库，收集可乐定或右美托咪啶对七氟烷引起的小儿术后躁动的预防作用的随机对照试验（randomized controlled trial，RCT），提取资料和评估方法学质量，采用Cochrane协作网RevMan 5.0软件进行Meta分析。　结果　最终纳入11个RCT，其中104例患儿预防性使用右美托咪啶，268例患儿使用可乐定，365例患儿使用安慰剂。Meta分析显示，可乐定组小儿术后躁动发生率的比值比（OR）为0.31，95%CI为（0.15，0.61）（P=0.000 8）；右美托咪啶组小儿术后躁动发生率的OR为0.16，95%CI为（0.08，0.31）（P lt;0.000 01）。　结论　 α2受体激动剂可以显著降低七氟烷引起的小儿术后躁动的发生率。
【Abstract】　Objective　 To determine whether alpha2-adrenoceptor agonists can decrease emergence agitation (EA) in pediatric patients after sevoflurane anesthesia.　Methods　 The Medline, Embase, Cochrane Library, CBM and CNKI were searched. All randomized controlled trials comparing clonidine or dexmedetomidine with other interventions in preventing emergence agitation after sevoflurane anesthesia were retrieved. Study selection and assessment, data collection and analyses were undertaken. Meta-analysis was done using the Cochrane Collaboration RevMan 5.0 software.　Results　 Eleven articles reached our inclusion criteria and were included in the Meta-analysis. A total of 104 children treated with dexmedetomidine, 268 children treated with clonidine, and 365 children treated with placebo were evaluated for the incidence of emergence agitation. The pooled odds ratio for the clonidine subgroup was 0.31, with a 95% confidence interval of 0.15-0.61 (P=0.000 8). The pooled odds ratio for the dexmedetomidine subgroup was 0.16, with a 95% confidence interval of 0.08-0.31 (P lt;0.000 01).　Conclusion　 Alpha2-adrenoceptor agonists can significantly decrease the incidence of emergence agitation in pediatric patients after sevoflurane anesthesia.

Citation： LI Ye,ZHANG Yanju,YU Hai,WANG Rurong. Alpha2-adrenoceptor Agonists for Prevention of Emergence Agitation in Pediatric Patients under Sevoflurane Anesthesia: A Meta Analysis of Randomized Controlled Trials. West China Medical Journal, 2011, 26(12): 1859-1863. doi: Copy

1.	Aono J, Ueda W, Mamiya K, et al. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys[J]. Anesthesiology, 1997, 87(6): 1298-1300.
2.	Kuratani N, Yumiko Oi. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane[J]. Anesthesiology, 2008, 109(2): 225-232.
3.	Kulka PJ, Bressem M, Tryba M. Clonidine prevents sevoflurane-induced agitation in children[J]. Anesth Analg, 2001, 93(2): 335-338.
4.	Bock M, Kunz P, Schreckenberger R, et al. Comparison of caudal and intravenous clonidine in the prevention of agitation after sevoflurane in children[J]. Br J Anaesth, 2002, 88(6): 790-796.
5.	Sipiläinen U, Avela R, Tarkkila P, et al. Prophylaxis of emergence agitation after sevoflurane anaesthesia in children undergoing outpatient adenoidectomy[J]. Finnanest, 2003, 36(5): 491.
6.	Tesoro S, Mezzetti D, Marchesini L, et al. Clonidine treatment for agitation in children after sevoflurane anesthesia[J]. Anesth Analg, 2005, 101(16): 1619-1622.
7.	Malviya S, Terri Voepel-Lewis, Ramamurthi RJ, et al. Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile[J]. Pediatr Anesth, 2006, 16(5): 554-559.
8.	Lankinen U, Avela R, Tarkkila P, et al. The prevention of emergence agitation with tropisetron or clonidine after sevoflurane anesthesia in small children undergoing adenoidectomy[J]. Anesth Analg, 2006, 102(5): 1383-1386.
9.	Tazeroualti N, De Groote F, De Hert S, et al. Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective, randomized, controlled trial[J]. Br J Anaesth, 2007, 98(5): 667-671.
10.	Ibacache ME, Muoz HR, Brandes V, et al. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in childred[J]. Anesth Analg, 2004, 98(1): 60-63.
11.	Guler G, Akīn A, Tosun Z, et al. Single dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy[J]. Pediatr Anesth, 2005, 15(9): 762-766.
12.	Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia?[J]. Pediatr Anesth, 2005, 15(12): 1098-1104.
13.	Isik B, Arslan M, Dogan, A et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery[J]. Pediatr Anesth, 2006, 16(7): 748-753.
14.	Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit[J]. Anesth Analg, 2003, 96(6): 1625-1630.
15.	Goa KL, Noble S, Spencer CM. Sevoflurane in paediatric anaesthesia: a review[J]. Paediatr Drugs, 1999, 1(2): 127-153.
16.	Maze M, Tranquilli W. Alpha2-adrenergic agonists: defining the role in clinical anesthesia[J]. Anesthesiology, 1991, 74(3): 581-605.

1. 　Aono J, Ueda W, Mamiya K, et al. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys[J]. Anesthesiology, 1997, 87(6): 1298-1300.
2. 　Kuratani N, Yumiko Oi. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane[J]. Anesthesiology, 2008, 109(2): 225-232.
3. 　Kulka PJ, Bressem M, Tryba M. Clonidine prevents sevoflurane-induced agitation in children[J]. Anesth Analg, 2001, 93(2): 335-338.
4. 　Bock M, Kunz P, Schreckenberger R, et al. Comparison of caudal and intravenous clonidine in the prevention of agitation after sevoflurane in children[J]. Br J Anaesth, 2002, 88(6): 790-796.
5. 　Sipiläinen U, Avela R, Tarkkila P, et al. Prophylaxis of emergence agitation after sevoflurane anaesthesia in children undergoing outpatient adenoidectomy[J]. Finnanest, 2003, 36(5): 491.
6. 　Tesoro S, Mezzetti D, Marchesini L, et al. Clonidine treatment for agitation in children after sevoflurane anesthesia[J]. Anesth Analg, 2005, 101(16): 1619-1622.
7. 　Malviya S, Terri Voepel-Lewis, Ramamurthi RJ, et al. Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile[J]. Pediatr Anesth, 2006, 16(5): 554-559.
8. 　Lankinen U, Avela R, Tarkkila P, et al. The prevention of emergence agitation with tropisetron or clonidine after sevoflurane anesthesia in small children undergoing adenoidectomy[J]. Anesth Analg, 2006, 102(5): 1383-1386.
9. 　Tazeroualti N, De Groote F, De Hert S, et al. Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective, randomized, controlled trial[J]. Br J Anaesth, 2007, 98(5): 667-671.
10. 　Ibacache ME, Muoz HR, Brandes V, et al. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in childred[J]. Anesth Analg, 2004, 98(1): 60-63.
11. 　Guler G, Akīn A, Tosun Z, et al. Single dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy[J]. Pediatr Anesth, 2005, 15(9): 762-766.
12. 　Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia?[J]. Pediatr Anesth, 2005, 15(12): 1098-1104.
13. 　Isik B, Arslan M, Dogan, A et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery[J]. Pediatr Anesth, 2006, 16(7): 748-753.
14. 　Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit[J]. Anesth Analg, 2003, 96(6): 1625-1630.
15. 　Goa KL, Noble S, Spencer CM. Sevoflurane in paediatric anaesthesia: a review[J]. Paediatr Drugs, 1999, 1(2): 127-153.
16. 　Maze M, Tranquilli W. Alpha2-adrenergic agonists: defining the role in clinical anesthesia[J]. Anesthesiology, 1991, 74(3): 581-605.

West China Medical Journal

Alpha2-adrenoceptor Agonists for Prevention of Emergence Agitation in Pediatric Patients under Sevoflurane Anesthesia: A Meta Analysis of Randomized Controlled Trials

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