Department of Anesthesiology, Robert Debre University Hospital, Paris, France.
Acta Anaesthesiol Scand. 2010 Apr;54(4):397-402. doi: 10.1111/j.1399-6576.2009.02207.x. Epub 2010 Jan 18.
Premedication is considered important in pediatric anesthesia. Benzodiazepines are the most commonly used premedication agents. Clonidine, an alpha2 adrenoceptor agonist, is gaining popularity among anesthesiologists. The goal of the present study was to perform a meta-analysis of studies comparing premedication with clonidine to Benzodiazepines.
A comprehensive literature search was conducted to identify clinical trials focusing on the comparison of clonidine and Benzodiazepines for premedication in children. Six reviewers independently assessed each study to meet the inclusion criteria and extracted data. Original data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), 95% confidence intervals [95% CI] and statistical heterogeneity were accessed.
Ten publications fulfilling the inclusion criteria were found. Premedication with clonidine, in comparison with midazolam, exhibited a superior effect on sedation at induction (OR=0.49 [0.27, 0.89]), decreased the incidence of emergence agitation (OR=0.25 [0.11, 0.58]) and produced a more effective early post-operative analgesia (OR=0.33 [0.21, 0.58]). Compared with diazepam, clonidine was superior in preventing post-operative nausea and vomiting (PONV).
Premedication with clonidine is superior to midazolam in producing sedation, decreasing post-operative pain and emergence agitation. However, the superiority of clonidine for PONV prevention remains unclear while other factors such as nausea prevention might interfere with this result.
在小儿麻醉中，术前用药被认为很重要。苯二氮䓬类药物是最常用的术前用药。可乐定，一种α2 肾上腺素受体激动剂，在麻醉师中越来越受欢迎。本研究的目的是对比较可乐定与苯二氮䓬类药物作为小儿术前用药的研究进行荟萃分析。
进行了全面的文献检索，以确定专注于比较可乐定和苯二氮䓬类药物用于儿童术前用药的临床试验。六位审查员独立评估了每一项研究，以符合纳入标准并提取数据。从每个试验中提取原始数据以计算合并的比值比（OR）或平均差异（MD）、95%置信区间[95%CI]和评估统计异质性。
发现了 10 项符合纳入标准的出版物。与咪达唑仑相比，可乐定作为术前用药，在诱导时镇静方面具有更好的效果（OR=0.49 [0.27, 0.89]），降低了苏醒期躁动的发生率（OR=0.25 [0.11, 0.58]），并产生了更有效的术后早期镇痛效果（OR=0.33 [0.21, 0.58]）。与地西泮相比，可乐定在预防术后恶心和呕吐（PONV）方面更有效。
可乐定作为术前用药，在产生镇静、减轻术后疼痛和苏醒期躁动方面优于咪达唑仑。然而，可乐定在预防 PONV 方面的优势尚不清楚，而其他因素，如预防恶心，可能会影响这一结果。
