背景:出现谵妄(ED)是儿科麻醉后事件中常见的一种情况,导致负面结果。右美托咪定(DEX),作为麻醉佐剂,在预防成人手术中的ED方面表现出了希望,它已越来越多地用于儿科手术。然而,它在其他麻醉后事件中的有效性,如MRI检查和门诊手术中心,尚不清楚。这项荟萃分析旨在评估DEX在手术以外的各种儿科麻醉后事件中预防ED的安全性和有效性。
方法:在Pubmed,WebofScience,和EBSCO,直到2023年10月13日。在不同的麻醉后事件(包括手术操作,核磁共振检查,日间手术,和侵入性动作)。根据药物递送方法进行亚组分析,用药时机,DEX剂量,使用镇痛药,事件类型,和恢复时间。
结果:共纳入33项试验,涉及3395例患者。DEX显着降低ED的发生率(比值比[OR]=0.23,95%置信区间[CI]:0.19-0.27,I2=37%,P<.00001)。DEX鼻内给药最有效(OR0.18,95%CI:0.10-0.32,P<.00001,I2=0%)。DEX在日间手术和面罩插入事件中也显示出益处(OR0.30,95%CI:0.14-0.26,P=.001,I2=0%)。
结论:与其他镇静剂和镇痛药相比,DEX在预防小儿麻醉后事件中的ED方面具有更好的疗效。由于其在管理ED中的安全性和有效性,建议在各种环境中使用。
BACKGROUND: Emergence delirium (ED) is a common occurrence in pediatric postanesthesia events, leading to negative outcomes. Dexmedetomidine (DEX), as an anesthesia adjuvant, has shown promise in preventing ED in adult surgeries, and it has been increasingly used in pediatric surgical settings. However, its effectiveness in other postanesthesia events, such as MRI examinations and ambulatory surgery centers, remains unclear. This meta-analysis aims to assess the safety and efficacy of DEX in preventing ED in various pediatric postanesthesia events beyond surgery.
METHODS: Prospective randomized controlled trials were searched in Pubmed, Web of Science, and EBSCO until October 13, 2023. Comparisons were made between DEX and other sedatives or analgesics in different postanesthesia events (including surgery operations, the examination of MRI, day surgery, and invasive action). Subgroup analyses were conducted based on drug delivery methods, medication timing, DEX dosages, use of analgesics, event types, and recovery time.
RESULTS: A total of 33 trials involving 3395 patients were included. DEX significantly reduced the incidence of ED (odds ratios [OR] = 0.23, 95% confidence interval [CI]: 0.19-0.27, I2 = 37%, P < .00001). Intranasal delivery of DEX was the most effective (OR 0.18, 95% CI: 0.10-0.32, P < .00001, I2 = 0%). DEX also showed benefits in day surgery and mask insertion events (OR 0.30, 95% CI: 0.14-0.26, P = .001, I2 = 0%).
CONCLUSIONS: DEX demonstrates superior efficacy in preventing ED in pediatric postanesthesia events compared to other sedatives and analgesics. Its use is recommended in various settings for its safety and effectiveness in managing ED.