Zhang Chun-Jin, Chen Hong, Zou Kang, Qu Xi
MSN, RN, Fellow,Nursing department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
MSN, RN, Chief Head Nurse, Nursing department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Front Pharmacol. 2025 Jul 4;16:1573640. doi: 10.3389/fphar.2025.1573640. eCollection 2025.
To compare the efficacy of different anesthetic adjuvants combined with sevoflurane across specific surgical sites using a Bayesian network meta-analysis.
A systematic review was conducted, following PRISMA guidelines, including 100 randomized controlled trials (RCTs) involving 8,800 pediatric patients undergoing various surgeries. The network meta-analysis evaluated 22 drug interventions, with log risk ratios (logRR) and Surface Under the Cumulative Ranking (SUCRA) probabilities calculated for each drug or combination.
Among all interventions, dexmedetomidine combined with alfentanil was the most effective in reducing ED risk for tonsillectomy/adenoidectomy, achieving a SUCRA ranking of 94.63% (logRR = -2.82). For ophthalmic surgery, propofol and midazolam showed the highest efficacy (logRR = -1.83, SUCRA: 86.03%). Dexmedetomidine combined with midazolam was the optimal combination for inguinal hernia/hypospadias (logRR = -2.16, SUCRA: 81.73%) and dental/oral repairs (logRR = -1.83, SUCRA: 94.85%). For cleft lip/palate repair, dexmedetomidine alone showed significant efficacy (logRR = -1.65, SUCRA: 89.15%). In myringotomy/cochlear implantation, fentanyl was the most effective adjuvant (logRR = -1.17, SUCRA: 80.02%).
Targeted use of dexmedetomidine-based combinations was found to be particularly effective across various surgeries, while fentanyl and propofol-midazolam combinations excelled in specific contexts. This study underscores the importance of tailoring anesthetic adjuvant strategies to specific surgical sites to reduce the risk of ED in pediatric patients, and provides a valuable reference for optimizing anesthetic care in this vulnerable population.
采用贝叶斯网络meta分析比较不同麻醉辅助药物与七氟醚联合用于特定手术部位的疗效。
按照PRISMA指南进行系统评价，纳入100项随机对照试验（RCT），涉及8800例接受各种手术的儿科患者。网络meta分析评估了22种药物干预措施，计算每种药物或联合用药的对数风险比（logRR）和累积排序曲线下面积（SUCRA）概率。
在所有干预措施中，右美托咪定联合阿芬太尼在降低扁桃体切除术/腺样体切除术的急诊风险方面最有效，SUCRA排名为94.63%（logRR = -2.82）。对于眼科手术，丙泊酚和咪达唑仑显示出最高疗效（logRR = -1.83，SUCRA：86.03%）。右美托咪定联合咪达唑仑是腹股沟疝/尿道下裂（logRR = -2.16，SUCRA：81.73%）和牙科/口腔修复（logRR = -1.83，SUCRA：94.85%）的最佳联合用药。对于唇腭裂修复，单独使用右美托咪定显示出显著疗效（logRR = -1.65，SUCRA：89.15%）。在鼓膜切开术/人工耳蜗植入术中，芬太尼是最有效的辅助药物（logRR = -1.17，SUCRA：80.02%）。
研究发现，针对性地使用以右美托咪定为基础的联合用药在各种手术中特别有效，而芬太尼以及丙泊酚-咪达唑仑联合用药在特定情况下表现出色。本研究强调了根据特定手术部位调整麻醉辅助策略以降低儿科患者急诊风险的重要性，并为优化这一脆弱人群的麻醉护理提供了有价值的参考。
