Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
PLoS One. 2023 Feb 14;18(2):e0281751. doi: 10.1371/journal.pone.0281751. eCollection 2023.
Midazolam and α2-adrenoceptor agonists have been widely used off-label as intranasal sedatives for children. The present meta-analysis aimed to evaluate the effects of two interventions in pediatric sedation.
PubMed, Embase, and Cochrane Library were searched from inception to April 2022. All randomized controlled trials used intranasal α2-adrenoceptor agonists and midazolam as sedatives in children were enrolled. Parental separation, anesthesia induction or facemask acceptance, sedation level, different hemodynamic parameters and adverse events were considered as outcomes.
Totally 21 studies with 1,495 patients were included. Only one study reported comparison between midazolam and clonidine met the inclusion criteria, and patients in clonidine group had significantly better mask acceptance compared to midazolam group. Compared with midazolam, using of dexmedetomidine was associated with higher rate of satisfactory parental separation (52.88% vs 75.18%, RR = 0.70, with 95%CI [0.55, 0.90]), anesthesia induction or facemask acceptance (60.92% vs 81.47%, RR = 0.76, 95% CI [0.68, 0.84]) and less incidence of postoperative pain and nasal irritation.
Compared with midazolam, dexmedetomidine should be considered as the preferred intranasal sedative option for pediatric patients, since it provides more satisfactory sedative level with less incidence of several side effects. But insufficient evidences about effects of intranasal clonidine and overall low and moderate quality evidences evaluated by GRADE system indicate that superiority of intranasal α2-adrenoceptor agonists in pediatric sedation needs to be validated by more studies with high quality and large sample size in future.
咪达唑仑和 α2-肾上腺素受体激动剂已被广泛用于非适应证的儿童鼻腔镇静。本荟萃分析旨在评估两种干预措施在儿科镇静中的效果。
从建库到 2022 年 4 月，检索了 PubMed、Embase 和 Cochrane Library。所有使用鼻腔 α2-肾上腺素受体激动剂和咪达唑仑作为镇静剂的儿童随机对照试验均被纳入。父母分离、麻醉诱导或面罩接受情况、镇静水平、不同的血液动力学参数和不良事件被视为结局。
共纳入 21 项研究，共计 1495 例患者。只有一项研究报告了咪达唑仑与可乐定的比较符合纳入标准，可乐定组的面罩接受情况明显优于咪达唑仑组。与咪达唑仑相比，使用右美托咪定与更高的父母分离满意度（52.88%比 75.18%，RR=0.70，95%CI[0.55, 0.90]）、麻醉诱导或面罩接受率（60.92%比 81.47%，RR=0.76，95%CI[0.68, 0.84]）和术后疼痛及鼻腔刺激发生率较低相关。
与咪达唑仑相比，右美托咪定应作为儿科患者首选的鼻腔镇静药物，因为它提供了更满意的镇静效果，且不良反应发生率较低。但鼻腔可乐定的作用证据不足，以及 GRADE 系统评估的整体低质量和中质量证据表明，鼻腔 α2-肾上腺素受体激动剂在儿科镇静中的优势需要更多高质量、大样本量的研究来验证。
