Lin Yiquan, Zhang Rui, Shen Weihua, Chen Qianru, Zhu Yanling, Li Jinfei, Chi Wei, Gan Xiaoliang
Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, China.
Department of Anesthesiology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, China.
J Clin Anesth. 2020 Jun;62:109736. doi: 10.1016/j.jclinane.2020.109736. Epub 2020 Feb 1.
Procedural sedation for non-painful pediatric examinations outside the operating room remains a challenge, this study was designed to compare the safety and effectiveness of sedation provided by dexmedetomidine versus other sedatives including chloral hydrate, midazolam, and pentobarbital for pediatric patients to complete diagnostic examinations.
Systematic review and meta-analysis of RCTs.
Pediatric procedural sedation.
Comparison of sedation by dexmedetomidine and chloral hydrate, or pentobarbital, or midazolam for pediatric non-painful sedation.
The PubMed, Embase, and Cochrane Library databases and the Cochrane Controlled Trials Register for randomized clinical trials were searched and limited the studies to those published in English through July 30, 2018.
Prospective randomized clinical trials (RCTs) comparing dexmedetomidine to chloral hydrate, pentobarbital, and midazolam for pediatric procedural examinations outside the operating room were included in the meta-analysis. Search terms included dexmedetomidine, precede, adrenergic alpha-2 receptor agonists, adrenergic alpha 2 agonists, adrenergic alpha-agonists, adrenergic alpha 2 receptor agonists, chloral hydrate, pentobarbital, midazolam, AND sedation.
A total of 1486 studies were screened and nine RCTs were identified; 1076 patients were analyzed. Sedation with dexmedetomidine provided statistically higher incidences in completing examinations with fewer episodes of desaturation than the other sedatives did (OR 2.90, 95% CI: 1.39-6.07, P = 0.005, I = 77%; OR 0.29, 95% CI: 0.15-0.57, P = 0.0004, I = 0%, respectively).
The meta-analysis shows that sedation by dexmedetomidine has lower incidence of respiratory depression and provides higher success rates in completing examinations than other traditional sedatives without compromising safety, indicating a prospective clinical use for procedural sedation.
在手术室以外对小儿进行非疼痛性检查时实施程序性镇静仍然是一项挑战，本研究旨在比较右美托咪定与其他镇静剂（包括水合氯醛、咪达唑仑和戊巴比妥）对小儿患者完成诊断性检查时镇静的安全性和有效性。
对随机对照试验进行系统评价和荟萃分析。
小儿程序性镇静。
比较右美托咪定与水合氯醛、或戊巴比妥、或咪达唑仑用于小儿非疼痛性镇静的效果。
检索了PubMed、Embase和Cochrane图书馆数据库以及Cochrane随机临床试验对照试验注册库，并将研究限制为截至2018年7月30日以英文发表的研究。
将右美托咪定与水合氯醛、戊巴比妥和咪达唑仑用于手术室以外小儿程序性检查的前瞻性随机临床试验纳入荟萃分析。检索词包括右美托咪定、前驱、肾上腺素能α-2受体激动剂、肾上腺素能α2激动剂、肾上腺素能α激动剂、肾上腺素能α2受体激动剂、水合氯醛、戊巴比妥、咪达唑仑和镇静。
共筛选了1486项研究，确定了9项随机对照试验；对1076例患者进行了分析。与其他镇静剂相比，右美托咪定镇静在完成检查时的发生率在统计学上更高，且低氧血症发作次数更少（分别为OR 2.90，95%CI：1.39 - 6.07，P = 0.005，I = 77%；OR 0.29，95%CI：0.15 - 0.57，P = 0.0004，I = 0%）。
荟萃分析表明，右美托咪定镇静的呼吸抑制发生率较低，在完成检查方面比其他传统镇静剂成功率更高，且不影响安全性，表明其在程序性镇静方面有临床应用前景。
