Department of Pediatrics, Gachon University Gil Medical Center, Incheon.
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Laryngoscope. 2018 May;128(5):E184-E193. doi: 10.1002/lary.26888. Epub 2017 Sep 12.
This study aimed to assess the effects of perioperative dexmedetomidine as an adjuvant to tonsillectomy compared with opioid or sham in children.
Five databases (PubMed, SCOPUS, Embase, Web of Science, and Cochrane Central Register of Controlled Trials) were searched from inception of article collections to April 2017.
Prospective, randomized controlled studies that compared outcomes between children who underwent tonsillectomy plus dexmedetomidine administration (intervention) and children who underwent tonsillectomy with placebo or opioid (control) were systemically and independently reviewed by two researchers. The outcomes of interest were emergence agitation, postoperative pain intensity, rescue analgesic consumption, and other morbidities (nausea and vomiting and agitation).
Fifteen studies with n = 1,552 met the inclusion criteria. Postoperative pain scores and the need for analgesics in the postanesthesia care unit (PACU) were significantly decreased in the dexmedetomidine group versus the control group. The incidence and degree of agitation and desaturation incidence in the PACU also were significantly lower in the dexmedetomidine group than in the control group. Additionally, there was no significant difference in the duration of staying PACU between both groups. In subgroup analyses by administration method (bolus injection or continuous injection), dexmedetomidine was shown to be effective at reducing postoperative morbidities regardless of administration method.
Perioperative administration of dexmedetomidine can provide pain and agitation relief without side effects in children undergoing adenotonsillectomy. Considering the high heterogeneity of results within some parameters; however, further clinical trials with robust research methodology should be conducted to confirm the results of this study. Laryngoscope, 128:E184-E193, 2018.
本研究旨在评估围手术期右美托咪定作为扁桃体切除术辅助药物与阿片类药物或假对照相比在儿童中的作用。
从文献收集开始到 2017 年 4 月，我们在五个数据库（PubMed、SCOPUS、Embase、Web of Science 和 Cochrane 对照试验中心注册库）中进行了搜索。
我们系统地、独立地对比较行扁桃体切除术加右美托咪定给药（干预）的儿童与行扁桃体切除术加安慰剂或阿片类药物（对照）的儿童之间结局的前瞻性、随机对照研究进行了综述。感兴趣的结局包括苏醒期躁动、术后疼痛强度、补救性镇痛药物消耗以及其他并发症（恶心、呕吐和躁动）。
15 项研究（n = 1552）符合纳入标准。与对照组相比，右美托咪定组术后疼痛评分和术后麻醉恢复室（PACU）内镇痛药物需求显著降低。右美托咪定组在 PACU 中的激越和脱氧发生率以及程度也显著低于对照组。此外，两组在 PACU 停留时间方面无显著差异。根据给药方法（推注或持续输注）进行的亚组分析显示，无论给药方法如何，右美托咪定均能有效降低术后并发症。
在接受腺样体扁桃体切除术的儿童中，围手术期给予右美托咪定可缓解疼痛和躁动，且无副作用。然而，鉴于一些参数内结果的高度异质性，应进行具有稳健研究方法的进一步临床试验，以确认本研究的结果。《喉镜》，128：E184-E193，2018。
