Effects of intravenous dexmedetomidine on emergence agitation in children under sevoflurane anesthesia: a meta-analysis of randomized controlled trials

Chengliang Zhang, Jiajia Hu, Xinyao Liu, Jianqin Yan, Chengliang Zhang, Jiajia Hu, Xinyao Liu, Jianqin Yan

Abstract

Objective: Emergence agitation (EA) is a common complication in children under sevoflurane anesthesia. The aim of this meta-analysis was to evaluate the effects of intravenous dexmedetomidine on EA in children under sevoflurane anesthesia.

Methods: A comprehensive literature search was conducted to identify clinical trials that evaluated the effects of intravenous dexmedetomidine and placebo on EA in children under sevoflurane anesthesia. The search collected trials from MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science. Analysis was conducted using STATA version 12.0. Data from each trial were pooled using relative ratio (RR) for dichotomous data or weighted mean difference (WMD) for continuous data and corresponding 95% confidence interval (95% CI). Heterogeneity assessment, sensitivity analysis, and publication bias were performed.

Results: Twelve trials, in which 459 patients received dexmedetomidine and 353 patients received placebo, were included in this analysis. We found that intravenous dexmedetomidine decreased the incidences of EA (RR = 0.346, 95% CI 0.263 to 0.453, P<0.001), and postoperative pain (RR = 0.405, 95% CI 0.253 to 0.649, P<0.001). Intravenous dexmedetomidine also prolonged extubation time (WMD = 0.617, 95% CI 0.276 to 958, P<0.001), and emergence time (WMD = 0.997, 95% CI 0.392 to 1.561, P = 0.001). Further evidences are required to evaluate the incidence of postoperative nausea and vomiting (PONV). Sensitivity analysis strengthened evidences for lower incidences of EA, pain, and prolonged extubation time, and emergence time. Funnel plots did not detect any significant publication bias.

Conclusion: Meta-analysis demonstrated that dexmedetomidine decreased the incidence of EA in children under sevoflurane anesthesia.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart of meta-analysis.
Figure 1. Flow chart of meta-analysis.
Figure 2. Forest plot of EA incidence.
Figure 2. Forest plot of EA incidence.
Figure 3. Sensitivity analysis result of EA…
Figure 3. Sensitivity analysis result of EA incidence.
Figure 4. Funnel plot of EA incidence.
Figure 4. Funnel plot of EA incidence.
Figure 5. Forest plot of PONV incidence.
Figure 5. Forest plot of PONV incidence.
Figure 6. Forest plot of pain incidence.
Figure 6. Forest plot of pain incidence.
Figure 7. Forest plot of extubation time.
Figure 7. Forest plot of extubation time.
Figure 8. Forest plot of PACU length…
Figure 8. Forest plot of PACU length of stay.
Figure 9. Forest plot of emergence time.
Figure 9. Forest plot of emergence time.

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