The Safety and Efficacy Evaluation of Dexmedetomidine for Procedural Sedation and Postoperative Behaviors in Pediatric Populations: A Systematic Review and Meta-analysis
Restricted accessResearch articleFirst published online January, 2022
The Safety and Efficacy Evaluation of Dexmedetomidine for Procedural Sedation and Postoperative Behaviors in Pediatric Populations: A Systematic Review and Meta-analysis
This study systematically evaluated the safety and efficacy of dexmedetomidine for procedural sedation and postoperative behaviors in a pediatric population as well as whether the results met the information required to draw conclusions.
Objective:
To evaluate the safety and efficacy evaluation of dexmedetomidine for procedural sedation and postoperative behaviors in a pediatric population.
Methods:
PubMed, Cochrane library, Web of Science and Ovid MEDLINE were searched to obtain randomized controlled trials (RCTs) comparing dexmedetomidine with control medicine and comparing different doses of dexmedetomidine.
Results:
There were a total of 16 RCTs for a total of 3240 patients. Dexmedetomidine slowed down the heart rate (HR; mean difference: −13.27; 95% CI: −16.41 to 10.14; P < 0.001) and reduced postoperative delirium (risk ratio [RR]: 0.31; 95% CI: 0.20-0.50; P < 0.001), the number of pain patients (RR: 0.48; 95% CI: 0.30-0.75; P = 0.002), and desaturation (RR: 0.34; 95% CI: 0.13-0.89; P = 0.03) compared with the control group. The limitation was that it was difficult to determine the range of low- and high-dose dexmedetomidine.
Conclusion and Relevance:
Dexmedetomidine slowed down intraoperative HR within the normal range, which might reduce myocardial oxygen consumption. It reduced postoperative pain and postoperative complications: delirium and desaturation. Dexmedetomidine showed no dose-dependent increase in the procedural sedation time of pediatric patients. Clinically, dexmedetomidine can improve pediatric procedural sedation and postoperative behavior, and it can be considered as a related medicine for safety in pediatric surgery.
FooTYMohd NoorNYazidMBFauziMHWahabSFAAhmadMZ.Ketamine-propofol (Ketofol) for procedural sedation and analgesia in children: a systematic review and meta-analysis. BMC Emerg Med. 2020;20:81. doi:10.1186/s12873-020-00373-4
2.
KrieserDKocharA.Paediatric procedural sedation within the emergency department. J Paediatr Child Health. 2016;52:197-203. doi:10.1111/jpc.13081
3.
LeiHChaoLMiaoT, et al. Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation. Acta Anaesthesiol Scand. 2020;64:464-471. doi:10.1111/aas.13509
4.
BaddigamKRussoPRussoJTobiasJD.Dexmedetomidine in the treatment of withdrawal syndromes in cardiothoracic surgery patients. J Intensive Care Med. 2005;20:118-123. doi:10.1177/0885066604273481
5.
TrevisanMRomanoSBarbiEBrunoIMurruFMCozziG.Intranasal dexmedetomidine and intravenous ketamine for procedural sedation in a child with alpha-mannosidosis: a magic bullet?Ital J Pediatr. 2019;45:119. doi:10.1186/s13052-019-0711-1
6.
El AmrousyDMElshmaaNSEl-KashlanM, et al. Efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia after pediatric cardiac surgery. J Am Heart Assoc. 2017;6:e004780. doi:10.1161/jaha.116.004780
7.
MillerJWDivanovicAAHossainMMMahmoudMALoepkeAW.Dosing and efficacy of intranasal dexmedetomidine sedation for pediatric transthoracic echocardiography: a retrospective study. Can J Anaesth. 2016;63:834-841. doi:10.1007/s12630-016-0617-y
8.
SunMLiuHYuQ, et al. A comparison of intranasal dexmedetomidine and dexmedetomidine-ketamine combination sedation for transthoracic echocardiography in pediatric patients with congenital heart disease: a randomized controlled trial. J Cardiothorac Vasc Anesth. 2020;34:1550-1555. doi:10.1053/j.jvca.2019.12.045
9.
IbacacheMEMuñozHRBrandesV, et al. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anesth Analg. 2004;98:60-63. doi:10.1213/01.ane.0000094947.20838.8e
10.
DevroeSDevrieseLDebuckF, et al. Effect of xenon and dexmedetomidine as adjuncts for general anesthesia on postoperative emergence delirium after elective cardiac catheterization in children: study protocol for a randomized, controlled, pilot trial. Trials. 2020;21:310. doi:10.1186/s13063-020-4231-5
11.
ShiMMiaoSGuTWangDZhangHLiuJ.Dexmedetomidine for the prevention of emergence delirium and postoperative behavioral changes in pediatric patients with sevoflurane anesthesia: a double-blind, randomized trial. Drug Des Devel Ther. 2019;13:897-905. doi:10.2147/dddt.S196075
12.
LiSLiuTXiaJ, et al. Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: a randomized controlled study. BMC Ophthalmol. 2020;20:86. doi:10.1186/s12886-020-01359-3
13.
KimHKwonHJeonSJiaJLiW.The effect of dexmedetomidine and remifentanil on the postoperative sore throat after thyroidectomy. Medicine (Baltimore). 2020;99:e21060. doi:10.1097/md.0000000000021060
14.
JoosteEHHammerGBReyesCRKatkadeVSzmukP.Phase IV, open-label, safety study evaluating the use of dexmedetomidine in pediatric patients undergoing procedure-type sedation. Front Pharmacol. 2017;8:529. doi:10.3389/fphar.2017.00529
15.
AzematiSPouraliAAghazadehS.Effects of adding dexmedetomidine to local infiltration of bupivacaine on postoperative pain in pediatric herniorrhaphy: a randomized clinical trial. Korean J Anesthesiol. 2020;73:212-218. doi:10.4097/kja.19111
16.
YoungET.Dexmedetomidine sedation in a pediatric cardiac patient scheduled for MRI. Can J Anaesth. 2005;52:730-732. doi:10.1007/bf03016562
17.
MasonKPLubischNRobinsonFRoskosREpsteinMA.Intramuscular dexmedetomidine: an effective route of sedation preserves background activity for pediatric electroencephalograms. J Pediatr. 2012;161:927-932. doi:10.1016/j.jpeds.2012.05.011
18.
GanXLinHChenJLinZLinYChenW.Rescue sedation with intranasal dexmedetomidine for pediatric ophthalmic examination after chloral hydrate failure: a randomized, controlled trial. Clin Ther. 2016;38:1522-1529. doi:10.1016/j.clinthera.2016.04.036
19.
GhoshADasAKMukherjeeMBagumSAChatterjeeS.Comparative evaluation of intranasal dexmedetomidine & intranasal midazolam for pre-operative sedation in children. J Evol Med Dent Sci. 2020;9:731-735. doi:10.14260/jemds/2020/159
20.
JooEYKimYJParkYS, et al. Intramuscular dexmedetomidine and oral chloral hydrate for pediatric sedation for electroencephalography: a propensity score-matched analysis. Pediatr Anesth. 2020;30:584-591. doi:10.1111/pan.13844
21.
FilhoEMRobinsonFde CarvalhoWBGilioAEMasonKP.Intranasal dexmedetomidine for sedation for pediatric computed tomography imaging. J Pediatr. 2015;166:1313-1315.e1. doi:10.1016/j.jpeds.2015.01.036
22.
UusaloPGuillaumeSSirenS, et al. Pharmacokinetics and sedative effects of intranasal dexmedetomidine in ambulatory pediatric patients. Anesth Analg. 2020;130:949-957. doi:10.1213/ane.0000000000004264
23.
LangBZhangLZhangWLinYFuYChenS.A comparative evaluation of dexmedetomidine and midazolam in pediatric sedation: a meta-analysis of randomized controlled trials with trial sequential analysis. CNS Neurosci Ther. 2020;26:862-875. doi:10.1111/cns.13377
24.
PereiraJVSanjanwalaRMMohammedMKLeMLAroraRC.Dexmedetomidine versus propofol sedation in reducing delirium among older adults in the ICU: a systematic review and meta-analysis. Eur J Anaesthesiol. 2020;37:121-131. doi:10.1097/eja.0000000000001131
25.
WangLShenJGeL, et al. Dexmedetomidine for craniotomy under general anesthesia: a systematic review and meta-analysis of randomized clinical trials. J Clin Anesth. 2019;54:114-125. doi:10.1016/j.jclinane.2018.11.001
26.
MasonKPPrescillaRFontainePJZurakowskiD.Pediatric CT sedation: comparison of dexmedetomidine and pentobarbital. AJR Am J Roentgenol. 2011;196:W194-W198. doi:10.2214/ajr.10.5045
27.
JonesJSCotugnoRESinghalNR, et al. Evaluation of dexmedetomidine and postoperative pain management in patients with adolescent idiopathic scoliosis: conclusions based on a retrospective study at a tertiary pediatric hospital. Pediatr Crit Care Med. 2014;15:e247-e252. doi:10.1097/pcc.0000000000000119
28.
LinYChenYHuangJ, et al. Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane. J Clin Anesth. 2016;33:289-295. doi:10.1016/j.jclinane.2016.04.027
29.
EricksonSJMillarJAndersonBJ, et al. Dexmedetomidine sedation in mechanically ventilated critically ill children: a pilot randomized controlled trial. Pediatr Crit Care Med. 2020;21:e731-e739. doi:10.1097/pcc.0000000000002483
30.
KimEHLeeJHKimHS, et al. Effects of intraoperative dexmedetomidine on the incidence of acute kidney injury in pediatric cardiac surgery patients: a randomized controlled trial. Paediatr Anaesth. 2020;30:1132-1138. doi:10.1111/pan.13995
31.
Lee-ArcherPFvon Ungern-SternbergBSReadeM, et al. The effect of dexmedetomidine on postoperative behaviour change in children: a randomised controlled trial. Anaesthesia. 2020;75:1461-1468. doi:10.1111/anae.15117
32.
SuvvariPMishraSBhatnagarS, et al. Comparison of intranasal dexmedetomidine versus intranasal ketamine as premedication for level of sedation in children undergoing radiation therapy: a prospective, randomised, double-blind study. Turk J Anaesthesiol Reanim. 2020;48:215-222. doi:10.5152/tjar.2019.45087
33.
MoherDLiberatiATetzlaffJAltmanDG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. doi:10.1136/bmj.b2535
34.
KarrenEAKingABHughesCG.Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery. J Thorac Dis. 2016;8:E1759-E1762. doi:10.21037/jtd.2016.12.56
35.
WangYHanRZuoZ.Dexmedetomidine-induced neuroprotection: is it translational?Transl Perioper Pain Med. 2016;1:15-19.
