Effect of Dexmedetomidine on emergence agitation in pediatric patients undergoing surgery with sevoflurane-based general anaesthesia: A systematic review and meta-analysis

• Author Details:   
• Meghana Prasad Hanagandi
• Vinayaka Jannu ^*

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Background: Emergence agitation (EA) is a common adverse event in pediatric patients following surgeries performed under sevoflurane-based general anesthesia. This condition is characterized by confusion, restlessness, and aggressive behavior as patients emerge from anesthesia. Dexmedetomidine (Dex) is an ?-2 adrenergic agonist that has been shown to effectively reduce the incidence of EA due to its sedative and anxiolytic properties, which are similar to natural sleep. Dexmedetomidine has minimal effects on respiration, making it a favorable option for pediatric anesthesia. Despite its potential, the extent of its effectiveness in mitigating EA in various pediatric surgical populations requires further investigation.

Aims: The objective of this systematic review and meta-analysis was to evaluate the efficacy of Dexmedetomidine in reducing the incidence of emergence agitation in pediatric patients undergoing surgeries under sevoflurane anesthesia. We aimed to assess the impact of Dexmedetomidine across a range of pediatric surgeries, including those for conditions such as cleft palate, adenotonsillectomy, and cataract surgery, among others

Materials and Methods: A comprehensive search of PubMed and Google Scholar was conducted for randomized controlled trials (RCTs) from 2002 to 2024 that investigated the use of Dexmedetomidine in paediatric patients. The analysis was performed using RevMan 5.4. The effectiveness of Dexmedetomidine in preventing emergence agitation was examined across various surgical procedures, including cleft palate surgery, elective cardiac surgery, palatoplasty, adenotonsillectomy, elective strabismus surgery, cataract surgery, ambulatory surgery, paediatric liver surgery, laryngeal mask insertion, vitreoretinal surgery, outpatient surgery, spinal dysraphism surgery, and inguinal hernia repair. The risk of bias (ROB) was assessed using the Cochrane ROB-1 tool.

Results: A total of 370 research articles were identified from English-language databases. Following the application of inclusion and exclusion criteria, 15 studies were included in the review. Ten of these were selected for meta-analysis, involving 1,091 children aged between 8 months and 12 years. The results revealed that the 1 mcg/kg Dexmedetomidine group experienced a statistically significant reduction in the incidence of postoperative emergence agitation compared to the control group (OR = 0.30, 95% CI: 0.24, 0.39, P < 0 xss=removed xss=removed>

Conclusions: Dexmedetomidine is highly effective in significantly reducing the incidence of emergence agitation in children undergoing a variety of surgeries, particularly those under sevoflurane-based anesthesia.

Keywords: Dexmedetomidine, Sevoflurane, Emergency agitation.