预防性使用右美托咪定可降低儿童出现谵妄的几率：系统回顾与元分析。

IF 3.7 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine Pub Date : 2024-09-16 DOI:10.1016/j.accpm.2024.101426

Sai-hao Fu , Meng-rong Miao , Lu-yao Zhang , Jing Bian , Yun-xiang Fu , Jia-qiang Zhang , Ming-yang Sun

{"title":"预防性使用右美托咪定可降低儿童出现谵妄的几率：系统回顾与元分析。","authors":"Sai-hao Fu , Meng-rong Miao , Lu-yao Zhang , Jing Bian , Yun-xiang Fu , Jia-qiang Zhang , Ming-yang Sun","doi":"10.1016/j.accpm.2024.101426","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>The primary purpose</h3><div>was to verify whether dexmedetomidine can reduce the occurrence of ED in children.</div></div><div><h3>Research type</h3><div>Systematic review and meta-analysis of RCTs.</div></div><div><h3>Data acquisition</h3><div>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.</div></div><div><h3>Eligibility criteria</h3><div>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.</div></div><div><h3>Results</h3><div>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], <em>P</em> < 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], <em>P</em> = 0.0001) and PACU stay time after extubation (mean difference (MD) = −1.57, 95%CI [−3.07 to −0.07], <em>P</em> = 0.04). However, sensitivity analysis of RCTs showed that our effect estimates were not stable (MD = −1.78, 95%CI [−4.18−0.62], <em>P</em> = 0.15).</div></div><div><h3>Conclusion</h3><div>The prophylactic use of dexmedetomidine was associated with a reduction of ED. However, our findings only apply to eye and neck surgery.</div></div><div><h3>Trial registration</h3><div>PROSPERO: CRD42022371840.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101426"},"PeriodicalIF":3.7000,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prophylactic application of dexmedetomidine reduces the incidence of emergence delirium in children: A systematic review and meta-analysis\",\"authors\":\"Sai-hao Fu , Meng-rong Miao , Lu-yao Zhang , Jing Bian , Yun-xiang Fu , Jia-qiang Zhang , Ming-yang Sun\",\"doi\":\"10.1016/j.accpm.2024.101426\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>The primary purpose</h3><div>was to verify whether dexmedetomidine can reduce the occurrence of ED in children.</div></div><div><h3>Research type</h3><div>Systematic review and meta-analysis of RCTs.</div></div><div><h3>Data acquisition</h3><div>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.</div></div><div><h3>Eligibility criteria</h3><div>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.</div></div><div><h3>Results</h3><div>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], <em>P</em> < 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], <em>P</em> = 0.0001) and PACU stay time after extubation (mean difference (MD) = −1.57, 95%CI [−3.07 to −0.07], <em>P</em> = 0.04). However, sensitivity analysis of RCTs showed that our effect estimates were not stable (MD = −1.78, 95%CI [−4.18−0.62], <em>P</em> = 0.15).</div></div><div><h3>Conclusion</h3><div>The prophylactic use of dexmedetomidine was associated with a reduction of ED. However, our findings only apply to eye and neck surgery.</div></div><div><h3>Trial registration</h3><div>PROSPERO: CRD42022371840.</div></div>\",\"PeriodicalId\":48762,\"journal\":{\"name\":\"Anaesthesia Critical Care & Pain Medicine\",\"volume\":\"43 6\",\"pages\":\"Article 101426\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-09-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Anaesthesia Critical Care & Pain Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2352556824000845\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anaesthesia Critical Care & Pain Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352556824000845","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景谵妄（ED）是儿童术后常见的认知功能障碍。ED 可能会在麻醉后早期对患者及其家属造成困扰，并对儿童产生长期不良影响。研究类型系统综述和荟萃分析 RCTs.DATA ACQUISITION在 Web of Science、WHO Trials、Cochrane Library、Clinical Trials.gov 和 PubMed 上搜索了从开始到 2022 年 10 月 23 日发表的所有研究。.筛选标准符合以下标准的随机临床试验：患者年龄在 1-18 岁之间，研究地点在 PACU（麻醉后护理病房），ED 发生率为主要结果，预防性使用右美托咪定的定义是在进入 PACU 之前注射。结果共纳入了 7 项随机试验（6 项在眼部和颈部手术中进行，1 项在疝气手术中进行），涉及 512 名患者（257 人（50.1%）使用右美托咪定，250 人（49.9%）使用对照组。在使用右美托咪定的患者中，17.51%的患者出现了ED，而在使用对照组的患者中，43.14%的患者出现了ED（风险比（RR）= 0.40，95%置信区间[CI] [0.30 - 0.55]，P < 0.00001）。此外，预防性应用右美托咪定还减少了术后恶心和呕吐的发生率（RR = 0.24，95% 置信区间 [0.12 - 0.49]，P = 0.0001）和拔管后在 PACU 的停留时间（平均差 (MD) =-1.57，95% 置信区间 [-3.07 to -0.07]，P = 0.04）。结论预防性使用右美托咪定可减少 ED。然而，我们的研究结果仅适用于眼部和颈部手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

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.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Anaesthesia Critical Care & Pain Medicine ANESTHESIOLOGY-

CiteScore

6.70

自引率

5.50%

发文量

150

审稿时长

18 days

期刊介绍： Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.