Prophylaxis for paediatric emergence delirium in desflurane-based anaesthesia: a network meta-analysis

Hung-Chang Kuo^#¹, Kuo-Chuan Hung^#², Hung-Yu Wang^#³, Bing-Syuan Zeng^#^{4

5}, Tien-Yu Chen^{6

7

8}, Dian-Jeng Li⁹, Pao-Yen Lin^{10

11}, Kuan-Pin Su^{12

13

14}, Min-Hsien Chiang¹⁵, Andre F Carvalho¹⁶, Brendon Stubbs^{17

18

19}, Yu-Kang Tu^{20

21}, Yi-Cheng Wu²², Michael Roerecke^{23

24}, Lee Smith²⁵, Shih-Pin Hsu¹, Yen-Wen Chen²⁶, Pin-Yang Yeh²⁷, Chih-Wei Hsu^#²⁸, Mein-Woei Suen^#^{29

30

31

32}, Ping-Tao Tseng^#^{33

34

35

36}

Affiliations

¹ Department of Neurology, E-Da Hospital/School of Medicine, I-Shou University, Kaohsiung, Taiwan.
² Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
³ Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
⁴ Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
⁵ Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.
⁶ Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.
⁷ Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan.
⁸ School of Medicine, National Defense Medical Center, Taipei, Taiwan.
⁹ Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
¹⁰ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
¹¹ Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
¹² Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.
¹³ College of Medicine, China Medical University, Taichung, Taiwan.
¹⁴ An-Nan Hospital, China Medical University, Tainan, Taiwan.
¹⁵ Department of Anesthesiology, Shin Huey Shin Hospital, Kaohsiung, Taiwan.
¹⁶ Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.
¹⁷ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁸ Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.
¹⁹ Positive Ageing Research Institute (PARI), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK.
²⁰ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
²¹ Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
²² Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan.
²³ Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
²⁴ Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada.
²⁵ Center for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.
²⁶ Prospect Clinic for Otorhinolaryngology and Neurology, No. 252, Nanzixin Road, Nanzi District, Kaohsiung City, 81166, Taiwan.
²⁷ Department of Psychology, College of Medical and Health Science, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City, 413, Taiwan.
²⁸ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan. harwicacademia@gmail.com.
²⁹ Department of Psychology, College of Medical and Health Science, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City, 413, Taiwan. blake@asia.edu.tw.
³⁰ Gender Equality Education and Research Center, Asia University, Taichung, Taiwan. blake@asia.edu.tw.
³¹ Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan. blake@asia.edu.tw.
³² Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan. blake@asia.edu.tw.
³³ Prospect Clinic for Otorhinolaryngology and Neurology, No. 252, Nanzixin Road, Nanzi District, Kaohsiung City, 81166, Taiwan. ducktseng@gmail.com.
³⁴ Department of Psychology, College of Medical and Health Science, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City, 413, Taiwan. ducktseng@gmail.com.
³⁵ Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan. ducktseng@gmail.com.
³⁶ Institute of Precision Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan. ducktseng@gmail.com.

^# Contributed equally.

PMID: 37405496
DOI: 10.1007/s00540-023-03219-y

Prophylaxis for paediatric emergence delirium in desflurane-based anaesthesia: a network meta-analysis

Hung-Chang Kuo et al. J Anesth. 2024 Apr.

. 2024 Apr;38(2):155-166.

doi: 10.1007/s00540-023-03219-y. Epub 2023 Jul 5.

Authors

Affiliations

¹ Department of Neurology, E-Da Hospital/School of Medicine, I-Shou University, Kaohsiung, Taiwan.
² Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
³ Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
⁴ Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
⁵ Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.
⁶ Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.
⁷ Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan.
⁸ School of Medicine, National Defense Medical Center, Taipei, Taiwan.
⁹ Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
¹⁰ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
¹¹ Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
¹² Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.
¹³ College of Medicine, China Medical University, Taichung, Taiwan.
¹⁴ An-Nan Hospital, China Medical University, Tainan, Taiwan.
¹⁵ Department of Anesthesiology, Shin Huey Shin Hospital, Kaohsiung, Taiwan.
¹⁶ Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.
¹⁷ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁸ Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.
¹⁹ Positive Ageing Research Institute (PARI), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK.
²⁰ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
²¹ Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
²² Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan.
²³ Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
²⁴ Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada.
²⁵ Center for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.
²⁶ Prospect Clinic for Otorhinolaryngology and Neurology, No. 252, Nanzixin Road, Nanzi District, Kaohsiung City, 81166, Taiwan.
²⁷ Department of Psychology, College of Medical and Health Science, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City, 413, Taiwan.
²⁸ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan. harwicacademia@gmail.com.
²⁹ Department of Psychology, College of Medical and Health Science, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City, 413, Taiwan. blake@asia.edu.tw.
³⁰ Gender Equality Education and Research Center, Asia University, Taichung, Taiwan. blake@asia.edu.tw.
³¹ Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan. blake@asia.edu.tw.
³² Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan. blake@asia.edu.tw.
³³ Prospect Clinic for Otorhinolaryngology and Neurology, No. 252, Nanzixin Road, Nanzi District, Kaohsiung City, 81166, Taiwan. ducktseng@gmail.com.
³⁴ Department of Psychology, College of Medical and Health Science, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City, 413, Taiwan. ducktseng@gmail.com.
³⁵ Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan. ducktseng@gmail.com.
³⁶ Institute of Precision Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan. ducktseng@gmail.com.

^# Contributed equally.

PMID: 37405496
DOI: 10.1007/s00540-023-03219-y

Abstract

Purpose: The prevalence of postoperative emergence delirium in paediatric patients (pedED) following desflurane anaesthesia is considerably high at 50-80%. Although several pharmacological prophylactic strategies have been introduced to reduce the risk of pedED, conclusive evidence about the superiority of these individual regimens is lacking. The aim of the current study was to assess the potential prophylactic effect and safety of individual pharmacotherapies in the prevention of pedED following desflurane anaesthesia.

Methods: This frequentist model network meta-analysis (NMA) of randomized controlled trials (RCTs) included peer-reviewed RCTs of either placebo-controlled or active-controlled design in paediatric patients under desflurane anaesthesia.

Results: Seven studies comprising 573 participants were included. Overall, the ketamine + propofol administration [odds ratio (OR) = 0.05, 95% confidence intervals (95%CIs) 0.01-0.33], dexmedetomidine alone (OR = 0.13, 95%CIs 0.05-0.31), and propofol administration (OR = 0.30, 95%CIs 0.10-0.91) were associated with a significantly lower incidence of pedED than the placebo/control groups. In addition, only gabapentin and dexmedetomidine were associated with a significantly higher improvement in the severity of emergence delirium than the placebo/control groups. Finally, the ketamine + propofol administration was associated with the lowest incidence of pedED, whereas gabapentin was associated with the lowest severity of pedED among all of the pharmacologic interventions studied.

Conclusions: The current NMA showed that ketamine + propofol administration was associated with the lowest incidence of pedED among all of the pharmacologic interventions studied. Future large-scale trials to more fully elucidate the comparative benefits of different combination regimens are warranted.

Trial registration: PROSPERO CRD42021285200.

Keywords: Desflurane; Emergence agitation; Emergence delirium; Network meta-analysis; Pediatric anesthesia.

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References

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Prophylaxis for paediatric emergence delirium in desflurane-based anaesthesia: a network meta-analysis

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Prophylaxis for paediatric emergence delirium in desflurane-based anaesthesia: a network meta-analysis

Authors

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Abstract

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