Jen Chun-Kai, Lu Kuo-Ching, Chen Kuan-Wen, Lu Yun-Ru, Huang I-Tao, Huang Yu-Chen, Huang Chun-Jen
Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei 116, Taiwan.
Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
J Clin Med. 2024 Feb 19;13(4):1174. doi: 10.3390/jcm13041174.
: Oral midazolam is the most commonly used sedative premedication agent in pediatric patients. While effective, oral midazolam cannot reduce the incidence of emergence agitation. Oral dexmedetomidine may be effective in providing satisfactory sedation and reduce the incidence of emergence agitation, although the results of different randomized controlled trials are conflicting. : This study enrolled randomized controlled trials (RCTs) examining premedication with oral dexmedetomidine versus oral midazolam in pediatric patients undergoing general anesthesia. PubMed, the Cochrane Library, Embase, and the Web of Science database were searched from their inception until June 2023. The outcomes were the incidence of satisfactory preoperative sedation, satisfactory sedation during separation from parents, satisfactory sedation during anesthesia induction using an anesthesia mask, and the incidence of emergence agitation. : A total of 9 RCTs comprising 885 patients were analyzed. Our data revealed comparable effects of dexmedetomidine and midazolam with respect to satisfactory preoperative sedation and a satisfactory incidence of sedation during parental separation and mask acceptance before anesthesia induction. Notably, our data revealed that the rate of emergence agitation was significantly lower in pediatric patients receiving dexmedetomidine ( = 162) than in those receiving midazolam ( = 159) (odds ratio = 0.16; 95% confidence interval: 0.06 to 0.44; < 0.001; = 35%). : Data from this meta-analysis revealed comparable effects for premedication with oral dexmedetomidine or oral midazolam with respect to satisfactory sedation; furthermore, premedication with oral dexmedetomidine more effectively mitigated emergence agitation in pediatric patients receiving general anesthesia compared with oral midazolam.
口服咪达唑仑是儿科患者中最常用的镇静术前用药。虽然有效，但口服咪达唑仑不能降低苏醒期躁动的发生率。口服右美托咪定可能有效提供满意的镇静效果并降低苏醒期躁动的发生率，尽管不同随机对照试验的结果存在冲突。：本研究纳入了比较口服右美托咪定与口服咪达唑仑在接受全身麻醉的儿科患者中作为术前用药的随机对照试验（RCT）。检索了PubMed、Cochrane图书馆、Embase和Web of Science数据库，检索时间从建库至2023年6月。观察指标为术前满意镇静的发生率、与父母分离期间的满意镇静率、使用麻醉面罩进行麻醉诱导期间的满意镇静率以及苏醒期躁动的发生率。：共分析了9项RCT，包括885例患者。我们的数据显示，在术前满意镇静以及与父母分离和麻醉诱导前接受面罩时的满意镇静发生率方面，右美托咪定和咪达唑仑的效果相当。值得注意的是，我们的数据显示，接受右美托咪定的儿科患者（n = 162）的苏醒期躁动发生率显著低于接受咪达唑仑的患者（n = 159）（比值比 = 0.16；95%置信区间：0.06至0.44；P < 0.001；I² = 35%）。：这项荟萃分析的数据显示，口服右美托咪定或口服咪达唑仑作为术前用药在满意镇静方面效果相当；此外，与口服咪达唑仑相比，口服右美托咪定在接受全身麻醉的儿科患者中更有效地减轻了苏醒期躁动。
