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. 2022 Jul;11(7):1156-1170.
doi: 10.21037/tp-22-172.

A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children

Yuanxia Tang  1 , Yun Song  1 , Wei Tian  2 , Gongxue Chen  3 , Yan Gu  1
Affiliations

A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children

Yuanxia Tang et al. Transl Pediatr. 2022 Jul.

Abstract

Background: The incidence of restlessness in the wake-up period of sevoflurane inhalation anesthesia is high. Although many studies have explored the relationship between dexmedetomidine and restlessness in the wake-up period of sevoflurane anesthesia in children, they can't keep consistent conclusions and lack evidence-based medical evidence. Meta-analysis was conducted to explore the efficacy and safety of dexmedetomidine in the treatment of restlessness during the recovery period of sevoflurane anesthesia in children, and to provide reference for clinic.

Methods: Relevant articles were retrieved from PubMed, Embase, MEDLINE, Science Direct, The Cochrane Library, the Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, the Chinese Science and Technology Periodical Database, and the Chinese BioMedical Literature Database (CBM). The Chinese and English search keywords included "dexmedetomidine", "children", "sevoflurane", and "emergence agitation". The articles included were independently evaluated and cross-checked by 2 professionals in strict accordance with the 5 evaluation criteria for randomized controlled trials (RCTs) in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.0.1).

Results: A total of 16 articles were included in this meta-analysis. Of the 16 RCTs, 14 described the generation of random sequences in detail, 8 described allocation concealment in detail, no patient blinding was described due to different surgical methods, 8 articles used operator blinding, and all 16 articles had complete outcome measures. The incidence of emergence agitation in the 0.5 µg/kg dexmedetomidine group was significantly lower than that in the control group, and the difference was statistically significant [odds ratio (OR) =0.22, 95% CI: 0.13, 0.40, P<0.00001]. The incidence of analgesic rescue in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (OR =0.29, 95% CI: 0.13, 0.63, Z =3.13, P=0.002). The incidence of postoperative nausea and vomiting in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (OR =0.33, 95% CI: 0.20, 0.55, Z =4.29, P<0.0001).

Discussion: The results of this meta-analysis confirmed that dexmedetomidine could reduce the incidence of emergence agitation, postoperative analgesic rescue, and nausea and vomiting in children after sevoflurane anesthesia.

Keywords: Dexmedetomidine; anesthetics; children; emergence agitation; sevoflurane.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-22-172/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of article retrieval.
Figure 2
Figure 2
The risk-of-bias evaluation of the included articles.
Figure 3
Figure 3
Summary chart of the risk-of-bias evaluation of the included articles. Note: “+” signifies low risk, “−” signifies high risk, and “?” signifies unclear risk.
Figure 4
Figure 4
Forest plot of 0.25 µg/kg dexmedetomidine using a FEM. FEM, fixed-effects model; Chi2, chi-square; CI, confidence interval; df, degree of freedom.
Figure 5
Figure 5
Forest plot of 0.5 µg/kg dexmedetomidine using a FEM. FEM, fixed-effects model; Chi2, chi-square; CI, confidence interval; df, degree of freedom.
Figure 6
Figure 6
Forest plot of 1 µg/kg dexmedetomidine using a FEM. FEM, fixed-effects model; Chi2, chi-square; CI, confidence interval; df, degree of freedom.
Figure 7
Figure 7
Forest plot of 2 µg/kg dexmedetomidine using a REM. REM, random-effects model; Chi2, chi-square; CI, confidence interval; df, degree of freedom.
Figure 8
Figure 8
Funnel plot of 1 µg/kg dexmedetomidine. SE, standard error; OR, odds ratio.
Figure 9
Figure 9
Forest plot of time of awakening using a REM. REM, random-effects model; Chi2, chi-square; SD, standard deviation; CI, confidence interval; df, degree of freedom.
Figure 10
Figure 10
Funnel plot of time of awakening. SE, standard error; MD, mean difference.
Figure 11
Figure 11
Forest plot of duration of PACU stay with dosage of 1 µg/kg dexmedetomidine using a FEM. PACU, postanesthesia care unit; FEM, fixed-effects model; Chi2, chi-square; SD, standard deviation; CI, confidence interval; df, degree of freedom.
Figure 12
Figure 12
Forest plot of duration of PACU stay with dosage of 2 µg/kg dexmedetomidine using a FEM. PACU, postanesthesia care unit; FEM; fixed-effects model; Chi2, chi-square; SD, standard deviation; CI, confidence interval; df, degree of freedom.
Figure 13
Figure 13
Funnel plot of duration of PACU stay with dosage of 1 µg/kg dexmedetomidine. PACU, postanesthesia care unit; SE, standard error; MD, mean difference.
Figure 14
Figure 14
Forest plot of incidence of analgesic rescue using a FEM. FEM, fixed-effects model; Chi2, chi-square; CI, confidence interval; df, degree of freedom.
Figure 15
Figure 15
Funnel plot of incidence of analgesic rescue. SE, standard error; OR, odds ratio.
Figure 16
Figure 16
Forest plot of incidence of postoperative nausea and vomiting using a FEM. FEM, fixed-effects model; Chi2, chi-square; CI, confidence interval; df, degree of freedom.
Figure 17
Figure 17
Funnel plot of incidence of postoperative nausea and vomiting. SE, standard error; OR, odds ratio.
Figure 18
Figure 18
Forest plot of emergence agitation with dosage of 1 µg/kg dexmedetomidine using a REM. REM, random-effects model; Chi2, chi-square; CI, confidence interval; df, degree of freedom.
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