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Meta-Analysis
. 2014 Nov;69(11):777-86.
doi: 10.6061/clinics/2014(11)12.

Premedication with dexmedetomidine in pediatric patients: a systematic review and meta-analysis

Ke Peng  1 , Shao-ru Wu  1 , Fu-hai Ji  1 , Jian Li  1
Affiliations
Meta-Analysis

Premedication with dexmedetomidine in pediatric patients: a systematic review and meta-analysis

Ke Peng et al. Clinics (Sao Paulo). 2014 Nov.

Abstract

Premedication is important in pediatric anesthesia. This meta-analysis aimed to investigate the role of dexmedetomidine as a premedicant for pediatric patients. A systematic literature search was conducted to identify randomized controlled trials comparing dexmedetomidine premedication with midazolam or ketamine premedication or placebo in children. Two reviewers independently performed the study selection, quality assessment and data extraction. The original data were pooled for the meta-analysis with Review Manager 5. The main parameters investigated included satisfactory separation from parents, satisfactory mask induction, postoperative rescue analgesia, emergence agitation and postoperative nausea and vomiting. Thirteen randomized controlled trials involving 1190 patients were included. When compared with midazolam, premedication with dexmedetomidine resulted in an increase in satisfactory separation from parents (RD = 0.18, 95% CI: 0.06 to 0.30, p = 0.003) and a decrease in the use of postoperative rescue analgesia (RD = -0.19, 95% CI: -0.29 to -0.09, p = 0.0003). Children treated with dexmedetomidine had a lower heart rate before induction. The incidence of satisfactory mask induction, emergence agitation and PONV did not differ between the groups. Dexmedetomidine was superior in providing satisfactory intravenous cannulation compared to placebo. This meta-analysis suggests that dexmedetomidine is superior to midazolam premedication because it resulted in enhanced preoperative sedation and decreased postoperative pain. Additional studies are needed to evaluate the dosing schemes and long-term outcomes of dexmedetomidine premedication in pediatric anesthesia.

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Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Flow chart of retrieved, excluded and included trials.
Figure 2
Figure 2
Meta-analysis of satisfactory separation from parents in children treated with dexmedetomidine vs. midazolam.
Figure 3
Figure 3
Meta-analysis of satisfactory mask induction in children treated with dexmedetomidine vs. midazolam.
Figure 4
Figure 4
Meta-analysis of postoperative rescue analgesia in children treated with dexmedetomidine vs. midazolam.
Figure 5
Figure 5
Meta-analysis of EA in children treated with dexmedetomidine vs. midazolam. EA: emergence agitation.
Figure 6
Figure 6
Meta-analysis of PONV in children treated with dexmedetomidine vs. midazolam. PONV: postoperative nausea and vomiting.
See this image and copyright information in PMC

References

    1. Kain ZN, Mayes LC, O′Connor TZ, Cicchetti DV. Preoperative anxiety in children. Predictors and outcomes. Arch Pediatr Adolesc Med. 1996;150(12):1238–45. - PubMed
    1. Yuki K, Daaboul DG. Postoperative maladaptive behavioral changes in children. Middle East J Anesthesiol. 2011;21(2):183–9. - PubMed
    1. Aydin T, Sahin L, Algin C, Kabay S, Yucel M, Hacioglu A, et al. Do not mask the mask: use it as a premedicant. Paediatric Anaesth. 2008;18(2):107–12. - PubMed
    1. Karling M, Stenlund H, Hagglof B. Child behaviour after anaesthesia: associated risk factors. Acta Paediatr. 2007;96(5):740–7. - PubMed
    1. Kain ZN, Caldwell-Andrews AA, Maranets I, McClain B, Gaal D, Mayes LC, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg. 2004;99(6):1648–54. - PubMed