Prophylactic application of dexmedetomidine reduces the incidence of emergence delirium in children: A systematic review and meta-analysis

Background

Emergence delirium (ED) is a common postoperative cognitive dysfunction in children. ED may cause distress to patients and their families in the early post-anesthesia period and have long-term adverse effects on children.

The primary purpose

was to verify whether dexmedetomidine can reduce the occurrence of ED in children.

Research type

Systematic review and meta-analysis of RCTs.

Data acquisition

A search was conducted on Web of Science, WHO Trials, Cochrane Library, Clinical Trials.gov, and PubMed for all published studies from inception to 23 Oct. 2022.

Eligibility criteria

Randomized clinical trials that met the following criteria: patients aged 1–18 years, study site in the PACU (Post-anesthesia care unit), incidence of ED as the primary outcome, and prophylactic use of dexmedetomidine defined as injected before admission to the PACU.

Results

A total of 7 randomized trials were included (6 studies during eye and neck surgery, 1 during hernia surgery), involving 512 patients (257 (50.1%) with dexmedetomidine, and 250 (49.9%) with control. ED was observed in 17.51% of the patients treated with dexmedetomidine and in 43.14% of those receiving control (risk ratio (RR) = 0.40, 95 % confidence interval [CI] [0.30−0.55], P < 0.00001). Additionally, the prophylactic application of dexmedetomidine also reduced the occurrence of Post-Operating Nausea and Vomiting (RR = 0.24, 95%CI [0.12−0.49], P = 0.0001) and PACU stay time after extubation (mean difference (MD) = −1.57, 95%CI [−3.07 to −0.07], P = 0.04). However, sensitivity analysis of RCTs showed that our effect estimates were not stable (MD = −1.78, 95%CI [−4.18−0.62], P = 0.15).

Conclusion

The prophylactic use of dexmedetomidine was associated with a reduction of ED. However, our findings only apply to eye and neck surgery.

Trial registration

PROSPERO: CRD42022371840.