Yang Xiaoli, Hu Zhenyu, Peng Fei, Chen Guangxiang, Zhou Yu, Yang Qiange, Yang Xiaoling, Wang Maohua
Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Front Pediatr. 2020 Nov 13;8:580226. doi: 10.3389/fped.2020.580226. eCollection 2020.
Emergence agitation (EA) is one of the most common and intractable postoperative complications among children undergoing surgery under general anesthesia. Dexmedetomidine, an α(2)-adrenoceptor agonist, offers an ideal sedation, reduces preoperative anxiety, and facilitates smooth induction of anesthesia, and it is widely used in pediatric surgery. We aimed to evaluate the efficacy of dexmedetomidine for preventing emergence agitation in children after general anesthesia. We comprehensively reviewed PubMed, Cochrane Library, EMBASE, and Web of Science databases to search all randomized controlled trials, published before April 22, 2020, investigating the efficacy of dexmedetomidine in preventing the emergence agitation in children after general anesthesia. The meta-analysis was performed using Review Manager 5.3. The primary outcome was the incidence of emergence agitation. Secondary outcomes included the number of patients requiring rescue analgesic, number of patients with postoperative nausea and vomiting, emergence time, extubation time, and time to discharge from the post-anesthesia care unit. We included a total of 33 studies, comprising 2,549 patients in this meta-analysis. Compared with saline, dexmedetomidine significantly reduced the emergence agitation incidence [risk ratio (RR) 0.29; 95% confidence interval (CI) 0.22-0.37; < 0.00001], incidence of postoperative nausea and vomiting (RR 0.46; 95% CI 0.3-0.69; = 0.0002), and the requirement of rescue analgesic (RR 0.29; 95% CI 0.18-0.44; < 0.00001). Furthermore, children in the dexmedetomidine group experienced a longer emergence time [mean difference (MD) 2.18; 95% CI 0.81-3.56; = 0.002] and extubation time (MD 0.77; 95% CI 0.22-1.31; = 0.006) compared with those in the saline group. However, no significant difference was observed in the time to discharge from the post-anesthesia care unit (MD 2.22; 95% CI -2.29-6.74; = 0.33) between the two groups. No significant differences were observed between the effects of dexmedetomidine and other drugs like midazolam, propofol, fentanyl, tramadol, and clonidine in terms of the emergence agitation incidence and other parameters, except for the requirement of rescue analgesic (RR 0.45; 95% CI 0.33-0.61; < 0.00001). Dexmedetomidine can prevent emergence agitation, relieves postoperative pain, decreases the requirement of rescue analgesic, and decreases the postoperative nausea and vomiting events.
苏醒期躁动（EA）是全身麻醉下接受手术的儿童中最常见且棘手的术后并发症之一。右美托咪定是一种α（2）-肾上腺素能受体激动剂，具有理想的镇静作用，可减轻术前焦虑，并有助于麻醉的平稳诱导，广泛应用于小儿外科手术。我们旨在评估右美托咪定预防儿童全身麻醉后苏醒期躁动的疗效。我们全面检索了PubMed、Cochrane图书馆、EMBASE和Web of Science数据库，以查找2020年4月22日前发表的所有研究右美托咪定预防儿童全身麻醉后苏醒期躁动疗效的随机对照试验。使用Review Manager 5.3进行荟萃分析。主要结局是苏醒期躁动的发生率。次要结局包括需要急救镇痛的患者数量、术后恶心呕吐的患者数量、苏醒时间、拔管时间以及离开麻醉后护理单元的时间。本荟萃分析共纳入33项研究，涵盖2549例患者。与生理盐水相比，右美托咪定显著降低了苏醒期躁动的发生率[风险比（RR）0.29；95%置信区间（CI）0.22 - 0.37；P < 0.00001]、术后恶心呕吐的发生率（RR 0.46；95% CI 0.3 - 0.69；P = 0.0002）以及急救镇痛的需求（RR 0.29；95% CI 0.18 - 0.44；P < 0.00001）。此外，与生理盐水组相比，右美托咪定组的儿童苏醒时间更长[平均差（MD）2.18；95% CI 0.81 - 3.56；P = 0.002]，拔管时间也更长（MD 0.77；95% CI 0.22 - 1.31；P = 0.006）。然而，两组在离开麻醉后护理单元的时间方面未观察到显著差异（MD 2.22；95% CI -2.29 - 6.74；P = 0.33）。在苏醒期躁动发生率和其他参数方面，除急救镇痛需求外（RR 0.45；95% CI 0.33 - 0.61；P < 0.00001），右美托咪定与咪达唑仑、丙泊酚、芬太尼、曲马多和可乐定等其他药物的效果未观察到显著差异。右美托咪定可预防苏醒期躁动，缓解术后疼痛，减少急救镇痛的需求，并减少术后恶心呕吐事件。
