Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis.
<h4>Background</h4>Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-ana...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0240553 |
| _version_ | 1828955027189792768 |
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| author | Fu-Wei Chiang Jin-Lin Chang Shih-Chang Hsu Kuo-Yuan Hsu Karen Chia-Wen Chu Chun-Jen Huang Chyi-Huey Bai Chiehfeng Chen Chin-Wang Hsu Yuan-Pin Hsu |
| author_facet | Fu-Wei Chiang Jin-Lin Chang Shih-Chang Hsu Kuo-Yuan Hsu Karen Chia-Wen Chu Chun-Jen Huang Chyi-Huey Bai Chiehfeng Chen Chin-Wang Hsu Yuan-Pin Hsu |
| author_sort | Fu-Wei Chiang |
| collection | DOAJ |
| description | <h4>Background</h4>Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery.<h4>Method</h4>Five databases were searched for randomized controlled trials published from database inception to April 2020 that compared dexmedetomidine use with placebo or active comparator use and evaluated EA, PONV, or postoperative pain incidence (main outcomes) in patients who had undergone pediatric strabismus surgery. Oculocardiac reflex (OCR) incidence and postanesthesia care unit (PACU) stay duration were considered as safety outcomes. All meta-analyses were performed using a random-effects model.<h4>Results</h4>In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced EA incidence [risk ratio (RR): 0.39; 95% confidence interval (CI): 0.25-0.62, I2 = 66%], severe EA incidence (RR: 0.27, 95% CI: 0.17-0.43, I2 = 0%), PONV incidence (RR: 0.33, 95% CI: 0.21-0.54, I2 = 0%), analgesia requirement (RR: 0.38, 95% CI: 0.25-0.57, I2 = 0%), and pain scores (standardized mean difference: -1.02, 95% CI: -1.44 to -0.61, I2 = 75%). Dexmedetomidine also led to lower EA incidence in the sevoflurane group than in the desflurane group (RR: 0.26 for sevoflurane vs. 0.45 for desflurane). Continuous dexmedetomidine infusion (RR: 0.19) led to better EA incidence reduction than did bolus dexmedetomidine infusion at the end of surgery (RR: 0.26) or during the peri-induction period (RR: 0.36). Compared with placebo use, dexmedetomidine use reduced OCR incidence (RR: 0.63; I2 = 40%). No significant between-group differences were noted for PACU stay duration.<h4>Conclusion</h4>In patients who have undergone pediatric strabismus surgery, dexmedetomidine use may alleviate EA, PONV, and postoperative pain and reduce OCR incidence. Moreover, dexmedetomidine use does not affect the PACU stay duration. |
| first_indexed | 2024-12-14T07:41:37Z |
| format | Article |
| id | doaj.art-7cf7ea448934454ba70acc7a950529b8 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-14T07:41:37Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj.art-7cf7ea448934454ba70acc7a950529b82022-12-21T23:11:01ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-011510e024055310.1371/journal.pone.0240553Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis.Fu-Wei ChiangJin-Lin ChangShih-Chang HsuKuo-Yuan HsuKaren Chia-Wen ChuChun-Jen HuangChyi-Huey BaiChiehfeng ChenChin-Wang HsuYuan-Pin Hsu<h4>Background</h4>Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery.<h4>Method</h4>Five databases were searched for randomized controlled trials published from database inception to April 2020 that compared dexmedetomidine use with placebo or active comparator use and evaluated EA, PONV, or postoperative pain incidence (main outcomes) in patients who had undergone pediatric strabismus surgery. Oculocardiac reflex (OCR) incidence and postanesthesia care unit (PACU) stay duration were considered as safety outcomes. All meta-analyses were performed using a random-effects model.<h4>Results</h4>In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced EA incidence [risk ratio (RR): 0.39; 95% confidence interval (CI): 0.25-0.62, I2 = 66%], severe EA incidence (RR: 0.27, 95% CI: 0.17-0.43, I2 = 0%), PONV incidence (RR: 0.33, 95% CI: 0.21-0.54, I2 = 0%), analgesia requirement (RR: 0.38, 95% CI: 0.25-0.57, I2 = 0%), and pain scores (standardized mean difference: -1.02, 95% CI: -1.44 to -0.61, I2 = 75%). Dexmedetomidine also led to lower EA incidence in the sevoflurane group than in the desflurane group (RR: 0.26 for sevoflurane vs. 0.45 for desflurane). Continuous dexmedetomidine infusion (RR: 0.19) led to better EA incidence reduction than did bolus dexmedetomidine infusion at the end of surgery (RR: 0.26) or during the peri-induction period (RR: 0.36). Compared with placebo use, dexmedetomidine use reduced OCR incidence (RR: 0.63; I2 = 40%). No significant between-group differences were noted for PACU stay duration.<h4>Conclusion</h4>In patients who have undergone pediatric strabismus surgery, dexmedetomidine use may alleviate EA, PONV, and postoperative pain and reduce OCR incidence. Moreover, dexmedetomidine use does not affect the PACU stay duration.https://doi.org/10.1371/journal.pone.0240553 |
| spellingShingle | Fu-Wei Chiang Jin-Lin Chang Shih-Chang Hsu Kuo-Yuan Hsu Karen Chia-Wen Chu Chun-Jen Huang Chyi-Huey Bai Chiehfeng Chen Chin-Wang Hsu Yuan-Pin Hsu Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis. PLoS ONE |
| title | Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis. |
| title_full | Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis. |
| title_fullStr | Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis. |
| title_full_unstemmed | Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis. |
| title_short | Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis. |
| title_sort | dexmedetomidine use in pediatric strabismus surgery a systematic review and meta analysis |
| url | https://doi.org/10.1371/journal.pone.0240553 |
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