Effect of Dexmedetomidine on Preventing Postoperative Agitation in Children: A Meta-Analysis

<div><p>Background</p><p>Emergence agitation (EA) is one of the most common postoperative complications in children. The purpose of this meta-analysis is to assess the effect of dexmedetomidine for preventing postoperative agitation in children.</p><p>Methods</p><p>We searched the Cochrane Central Register of Controlled Trails, MEDLINE, and EMBASE. Randomized controlled trials were included. The following outcome measures were evaluated: incidence of EA, number of patients requiring rescue, time to eye-open, time to extubation, time to discharge from the postanesthesia care unit (PACU).</p><p>Results</p><p>We analyzed 19 trials (1608 patients) that met the inclusion criteria. Compared with placebo, intravenous dexmedetomidine significantly reduced the incidence of EA [risk ratio (RR) 0.34, 95% confidence interval (CI) 0.25–0.44, <i>P</i><0.00001). Dexmedetomidine also decreased the incidence of severe pain (RR 0.41, 95% CI 0.27–0.62, <i>P</i><0.0001) and requirement of a rescue drug (RR 0.31, 95% CI 0.18–0.53, <i>P</i><0.0001). However, compared with placebo, dexmedetomidine increased the time to eye-open by 0.98 min (<i>P</i> = 0.01) and the time to PACU discharge by 4.63 min (<i>P</i> = 0.02). Dexmedetomidine was also compared with midazolam, propofol, ketamine, and fentanyl, among others. No significant difference was found in the incidence of EA for most of these comparisons, with the exception of fentanyl and propofol, where dexmedetomidine was more beneficial.</p><p>Conclusions</p><p>Dexmedetomidine was proved effective for preventing EA and for reducing severe pain and the requirement of rescue drugs. It slightly increased the time to eye-open and the time to PACU discharge. Dexmedetomidine was also more beneficial than propofol or fentanyl in preventing EA.</p></div

Incidence of EA: dexmedetomidine vs. fentanyl.

<p>Forest plot shows that the overall effect of pooled trials without the Pestieau 2011 was in favor of dexmedetomidine. The Pestieau 2011 study was excluded because of clinical and statistical heterogeneity. D, dexmedetomidine; F, fentanyl</p

Flow diagram of included/excluded studies.

<p>Flow diagram of included/excluded studies.</p

Incidence of emergence agitation (EA): dexmedetomidine vs. placebo.

<p>Forest plot shows that the overall effect of pooled trials was in favor of dexmedetomidine. D, dexmedetomidine; P, placebo.</p

Time to eye-open: dexmedetomidine vs. placebo.

<p>Forest plot shows that the overall effect of pooled trials was in favor of placebo. Patients given dexmedetomidine took more time to recover. Heterogeneity was observed when these studies were pooled and the random effects model was chosen for analysis. D, dexmedetomidine; P, placebo</p

Incidence of severe postoperative pain: dexmedetomidine vs. placebo.

<p>Forest plot shows that the overall effect of pooled trials was in favor of dexmedetomidine. D, dexmedetomidine; P, placebo</p