Feng Ji-Feng, Wang Xiao-Xia, Lu Yan-Yan, Pang Deng-Ge, Peng Wei, Mo Jian-Lan
Department of Anesthesiology, Obstetrics & Gynecology Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
J Int Med Res. 2017 Jun;45(3):912-923. doi: 10.1177/0300060517704595. Epub 2017 Apr 20.
Background Dexmedetomidine (DEX), an α-adrenergic receptor agonist, produces ideal sedation and early postoperative recovery for premedication in paediatric surgery, reducing preoperative anxiety and facilitating smooth induction of anaesthesia. We performed a meta-analysis to compare the effects of DEX and midazolam (MDZ) in paediatric anaesthesia with sevoflurane. Methods PubMed, Ovid, Web of Science, and Public Health Management Corporation were searched through December 2016 for randomized controlled trials (RCTs) that compared DEX and MDZ in children undergoing sevoflurane anaesthesia. The risk ratio (RR) with 95% incidence interval (95%CI) was used for dichotomous variables. Results Twelve RCTs involving 422 patients in the DEX group and 448 patients in the MDZ group were included. Patients in the DEX group had a significantly lower incidence of unsatisfactory sedation (RR [95%CI] = 0.71 [0.57-0.89]), unsatisfactory parental separation (RR [95%CI] = 0.56 [0.35-0.87]), and rescue analgesia (RR [95%CI] = 0.52 [0.35-0.77]) than patients in the MDZ group. However, both groups had a similar incidence of unsatisfactory mask acceptance, emergence agitation, and postoperative nausea and vomiting. Conclusion Compared with MDZ, DEX is beneficial in paediatric anaesthesia with sevoflurane because of its lower incidence of unsatisfactory sedation, parental separation, and rescue analgesia.
右美托咪定（DEX）是一种α-肾上腺素能受体激动剂，在小儿外科手术术前用药中可产生理想的镇静效果并促进术后早期恢复，减少术前焦虑并有助于麻醉诱导顺利进行。我们进行了一项荟萃分析，以比较DEX和咪达唑仑（MDZ）在小儿七氟醚麻醉中的效果。方法：检索PubMed、Ovid、Web of Science和公共卫生管理公司数据库至2016年12月，查找比较DEX和MDZ用于接受七氟醚麻醉儿童的随机对照试验（RCT）。二分类变量采用风险比（RR）及95%发生率区间（95%CI）。结果：纳入12项RCT，DEX组422例患者，MDZ组448例患者。DEX组患者镇静不满意（RR[95%CI]=0.71[0.57 - 0.89]）、家长分离不满意（RR[95%CI]=0.56[0.35 - 0.87]）及补救性镇痛（RR[95%CI]=0.52[0.35 - 0.77]）的发生率显著低于MDZ组。然而，两组面罩接受不满意、苏醒期躁动及术后恶心呕吐的发生率相似。结论：与MDZ相比，DEX用于小儿七氟醚麻醉有益，因其镇静不满意、家长分离及补救性镇痛的发生率较低。
