Amorim Marco Aurélio Soares, Govêia Catia Sousa, Magalhães Edno, Ladeira Luís Cláudio Araújo, Moreira Larissa Govêia, de Miranda Denismar Borges
Centro de Ensino e Treinamento José Quinan, Goiânia, GO, Brasil.
Universidade de Brasília (UnB), Centro de Ensino e Treinamento, Brasília, DF, Brasil; Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil; Universidade de Brasília (UnB), Faculdade de Ciências Médicas, Brasília, DF, Brasil.
Rev Bras Anestesiol. 2017 Mar-Apr;67(2):193-198. doi: 10.1016/j.bjan.2016.02.015. Epub 2016 May 4.
Sevoflurane is often used in pediatric anesthesia and is associated with high incidence of psychomotor agitation. In such cases, dexmedetomidine (DEX) has been used, but its benefit and implications remain uncertain. We assessed the effects of DEX on agitation in children undergoing general anesthesia with sevoflurane.
Meta-analysis of randomized clinical and double-blind studies, with children undergoing elective procedures under general anesthesia with sevoflurane, using DEX or placebo. We sought articles in English in PubMed database using the following terms: Dexmedetomidine, sevoflurane (Methyl Ethers/sevoflurante), and agitation (Psychomotor Agitation). Duplicate articles with children who received premedication and used active control were excluded. It was adopted random effects model with DerSimonian-Laird testing and odds ratio (OR) calculation for dichotomous variables, and standardized mean difference for continuous variables, with their respective 95% confidence interval (CI).
Of 146 studies identified, 10 were selected totaling 558 patients (282 in DEX group and 276 controls). The use of DEX was considered a protective factor for psychomotor agitation (OR=0.17; 95% CI 0.13 to 0.23; p<0.0001) and nausea and vomiting in PACU (OR=0.49; 95% CI 0.35 to 0.68; p<0.0001). Wake-up time and PACU discharge time were higher in the dexmedetomidine group. There was no difference between groups for extubation time and duration of anesthesia.
Dexmedetomidine reduces psychomotor agitation during wake-up time of children undergoing general anesthesia with sevoflurane.
七氟醚常用于小儿麻醉，且与精神运动性躁动的高发生率相关。在此类情况下，已使用右美托咪定（DEX），但其益处及影响仍不明确。我们评估了DEX对接受七氟醚全身麻醉的儿童躁动的影响。
对随机临床和双盲研究进行荟萃分析，研究对象为接受七氟醚全身麻醉下择期手术的儿童，使用DEX或安慰剂。我们在PubMed数据库中使用以下术语搜索英文文章：右美托咪定、七氟醚（甲基醚/七氟烷）和躁动（精神运动性躁动）。排除接受术前用药并使用活性对照的儿童的重复文章。采用随机效应模型，进行DerSimonian-Laird检验，对二分变量计算比值比（OR），对连续变量计算标准化均差，并给出各自的95%置信区间（CI）。
在识别出的146项研究中，选择了10项，共558例患者（DEX组282例，对照组276例）。DEX的使用被认为是精神运动性躁动的保护因素（OR = 0.17；95% CI 0.13至0.23；p < 0.0001）以及术后麻醉恢复室（PACU）恶心呕吐的保护因素（OR = 0.49；95% CI 0.35至0.68；p < 0.0001）。右美托咪定组的苏醒时间和PACU出院时间较长。两组在拔管时间和麻醉持续时间方面无差异。
右美托咪定可减少接受七氟醚全身麻醉的儿童苏醒期的精神运动性躁动
