Efficacy and Safety of Different Preoperative Sedative Regimens in Alleviating Pediatric Preoperative Anxiety: A Systematic Review and Network Meta-Analysis

IF 3.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine Pub Date : 2025-09-24 DOI:10.1111/jebm.70068

Hu Zhenyu, Haizhou Xiang, Zeng Ziran, Wu Jiali, Liu Li, Tang Jianwen, Long Menghong, Wang Maohua

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引用次数: 0

Abstract

Background

Pediatric preoperative anxiety (PPA) is a prevalent condition that exhibits significant effects on the psychological and physiological status of children both preoperatively and postoperatively.

Methods

We conducted systematic review and network meta-analysis. PubMed, Embase, Web of Science Core Collection, and The Cochrane Library were searched up to December 1, 2024. RCTs of pediatric patients (0–14 years) receiving preoperative sedatives were included. Primary outcome was Parental Separation Anxiety Scale (PSAS); secondary outcomes were Mask Acceptance Scale (MAS), postoperative nausea/vomiting (PONV), and delirium/agitation (PODA).

Results

Seventy studies (16,626 participants) were included. Five sedatives including midazolam, dexmedetomidine, ketamine (oral, intranasal, nebulized), clonidine (oral, intranasal), and melatonin (oral) were compared with placebo. Data from 20 interventions (5581 patients) assessed PPA. Intranasal dexmedetomidine (ID) showed highest single-drug efficacy (SUCRA: PSAS 68.1%, MAS 48.8%, PONV 65.7%, PODA 67.8%). Oral ketamine (OK) and midazolam (OM/IM) were effective alternatives. Combined regimens were promising but inconclusive.

Conclusions

ID significantly alleviated PPA with minimal adverse effects in single-drug regimens (optimal dose: 1–2 µg/kg). OK, OM or IM served as potential alternative options for clinical application. While combination regimens (notably OM+OK) demonstrated superior efficacy across outcomes, small sample sizes necessitate cautious interpretation, underscoring the need for future comparative studies.

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不同术前镇静方案缓解儿科术前焦虑的有效性和安全性：系统评价和网络荟萃分析。

背景：儿童术前焦虑（PPA）是一种普遍存在的疾病，对儿童术前和术后的心理和生理状况都有显著影响。方法：进行系统评价和网络meta分析。PubMed, Embase， Web of Science Core Collection和Cochrane Library的检索截止日期为2024年12月1日。纳入术前使用镇静剂的儿科患者（0-14岁）的随机对照试验。主要结局为父母分离焦虑量表（PSAS）；次要结局是口罩接受度量表（MAS）、术后恶心/呕吐（PONV）和谵妄/躁动（PODA）。结果：纳入70项研究（16,626名受试者）。将咪达唑仑、右美托咪定、氯胺酮（口服、鼻内、雾化）、可乐定（口服、鼻内）、褪黑素（口服）等5种镇静剂与安慰剂进行比较。来自20项干预措施（5581例患者）的数据评估了PPA。右美托咪定鼻内单药疗效最高（supra: PSAS 68.1%, MAS 48.8%, PONV 65.7%, PODA 67.8%）。口服氯胺酮（OK）和咪达唑仑（OM/IM）是有效的替代药物。联合治疗方案很有希望，但不确定。结论：单药方案（最佳剂量：1-2µg/kg）中，ID可显著缓解PPA，且不良反应最小。好的，OM或IM是临床应用的潜在选择。虽然联合治疗方案（特别是OM+OK）在所有结果中都显示出优越的疗效，但样本量小，需要谨慎解释，强调了未来比较研究的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.