Prophylaxis for paediatric emergence delirium in desflurane-based anaesthesia: a network meta-analysis.
Desflurane
Emergence agitation
Emergence delirium
Network meta-analysis
Pediatric anesthesia
Journal
Journal of anesthesia
ISSN: 1438-8359
Titre abrégé: J Anesth
Pays: Japan
ID NLM: 8905667
Informations de publication
Date de publication:
Apr 2024
Apr 2024
Historique:
received:
17
03
2023
accepted:
08
06
2023
pubmed:
5
7
2023
medline:
5
7
2023
entrez:
5
7
2023
Statut:
ppublish
Résumé
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. 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. 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. 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. PROSPERO CRD42021285200.
Identifiants
pubmed: 37405496
doi: 10.1007/s00540-023-03219-y
pii: 10.1007/s00540-023-03219-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
155-166Informations de copyright
© 2023. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.
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