Premedication with dexmedetomidine in pediatric patients: a systematic review and meta-analysis
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 midazola...
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Published in | Clinics (São Paulo, Brazil) Vol. 69; no. 11; pp. 777 - 786 |
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Main Authors | , , , |
Format | Journal Article |
Language | English Portuguese |
Published |
Brazil
Elsevier España, S.L.U
01.11.2014
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Faculdade de Medicina / USP Elsevier España |
Subjects | |
Online Access | Get full text |
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Summary: | 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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Bibliography: | SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Review-1 ObjectType-Article-3 ObjectType-Undefined-4 Peng K and Wu SR independently searched the following databases up to April 2014: MEDLINE, EMBASE and CENTRAL. Any controversy concerning study selection or data extraction was resolved by consensus with Ji FH. Peng K, Wu SR and Ji FH read the full texts of all papers and determined which papers should be included or excluded. Peng K and Wu SR extracted and tabulated all relevant data from the included studies. Validity was assessed and scored by Wu SR and Li J, and checked by Ji FH. |
ISSN: | 1807-5932 1980-5322 1980-5322 |
DOI: | 10.6061/clinics/2014(11)12 |