Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Oct 12;15(10):e0240553.
doi: 10.1371/journal.pone.0240553. eCollection 2020.

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

Fu-Wei Chiang  1   2 , Jin-Lin Chang  1   2 , Shih-Chang Hsu  1   2 , Kuo-Yuan Hsu  1   2 , Karen Chia-Wen Chu  1   2 , Chun-Jen Huang  3 , Chyi-Huey Bai  4 , Chiehfeng Chen  5   6   7 , Chin-Wang Hsu  1   2 , Yuan-Pin Hsu  1   2
Affiliations
Meta-Analysis

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

Fu-Wei Chiang et al. PLoS One. .

Abstract

Background: Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery.

Method: Five databases were searched for randomized controlled trials published from database inception to April 2020 that compared dexmedetomidine use with placebo or active comparator use and evaluated EA, PONV, or postoperative pain incidence (main outcomes) in patients who had undergone pediatric strabismus surgery. Oculocardiac reflex (OCR) incidence and postanesthesia care unit (PACU) stay duration were considered as safety outcomes. All meta-analyses were performed using a random-effects model.

Results: In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced EA incidence [risk ratio (RR): 0.39; 95% confidence interval (CI): 0.25-0.62, I2 = 66%], severe EA incidence (RR: 0.27, 95% CI: 0.17-0.43, I2 = 0%), PONV incidence (RR: 0.33, 95% CI: 0.21-0.54, I2 = 0%), analgesia requirement (RR: 0.38, 95% CI: 0.25-0.57, I2 = 0%), and pain scores (standardized mean difference: -1.02, 95% CI: -1.44 to -0.61, I2 = 75%). Dexmedetomidine also led to lower EA incidence in the sevoflurane group than in the desflurane group (RR: 0.26 for sevoflurane vs. 0.45 for desflurane). Continuous dexmedetomidine infusion (RR: 0.19) led to better EA incidence reduction than did bolus dexmedetomidine infusion at the end of surgery (RR: 0.26) or during the peri-induction period (RR: 0.36). Compared with placebo use, dexmedetomidine use reduced OCR incidence (RR: 0.63; I2 = 40%). No significant between-group differences were noted for PACU stay duration.

Conclusion: In patients who have undergone pediatric strabismus surgery, dexmedetomidine use may alleviate EA, PONV, and postoperative pain and reduce OCR incidence. Moreover, dexmedetomidine use does not affect the PACU stay duration.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interests.

Figures

Fig 1
Fig 1. Study screening and selection strategy.
Fig 2
Fig 2. Summary of risk of bias assessment.
Fig 3
Fig 3
Forest plot for (A) EA and (B) severe EA incidence. Dex, dexmedetomidine.
Fig 4
Fig 4. Forest plot for PONV incidence.
Dex, dexmedetomidine.
Fig 5
Fig 5
Forest plot for postoperative pain: (A) patient requiring rescue analgesia and (B) pain scores. Dex, dexmedetomidine.
Fig 6
Fig 6. Forest plot for OCR incidence.
Dex, dexmedetomidine.
Fig 7
Fig 7. Forest plot for PACU stay duration.
Dex, dexmedetomidine.
See this image and copyright information in PMC

References

    1. Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg. 2003;96(6):1625–30, table of contents. Epub 2003/05/23. 10.1213/01.ane.0000062522.21048.61 . - DOI - PubMed
    1. Joo J, Park S, Park HJ, Shin SY. Ramosetron versus ondansetron for postoperative nausea and vomiting in strabismus surgery patients. BMC Anesthesiol. 2016;16(1):41 Epub 2016/07/28. 10.1186/s12871-016-0210-5 - DOI - PMC - PubMed
    1. Finley GA, McGrath PJ, Forward SP, McNeill G, Fitzgerald P. Parents' management of children's pain following 'minor' surgery. Pain. 1996;64(1):83–7. Epub 1996/01/01. 10.1016/0304-3959(95)00091-7 . - DOI - PubMed
    1. Gayer S, Tutiven J. Anesthesia for pediatric ocular surgery. Ophthalmol Clin North Am. 2006;19(2):269–78. Epub 2006/05/17. 10.1016/j.ohc.2006.02.012 . - DOI - PubMed
    1. Chhabra A, Pandey R, Khandelwal M, Subramaniam R, Gupta S. Anesthetic techniques and postoperative emesis in pediatric strabismus surgery. Reg Anesth Pain Med. 2005;30(1):43–7. Epub 2005/02/04. 10.1016/j.rapm.2004.08.023 . - DOI - PubMed

Publication types