Prophylactic application of dexmedetomidine reduces the incidence of Emergence delirium in children A systematic review and meta-analysis
Authors: Fu Sai-hao , Miao Meng-rong , Zhang Lu-yao , Bian Jing , Fu Yun-xiang , Zhang Jia-qiang , Sun Ming-yang 
Published: April 2023

Background Emergence delirium (ED) is a postoperative cognitive dysfunction that not only causes distress to patients and their families in the early post-anesthesia period, but also has long-term adverse effects in children. There are assumptions that non-delirium sedatives reduce adverse outcomes in children admitted to PACU( Post anesthesia care unit )1.
Main purpose to verify whether dexmedetomidine can reduce the occurrence of PACU ED in children. To compare the effects of different administration methods of dexmedetomidine on reducing ED. And exploring whether giving dexmedetomidine at different times during the perioperative period affects the incidence of ED.
Research type A systematic review and meta-analysis of randomized controlled trials.
Data acquisition We searched WOS, WHO Trials, Cochrane Library, Clinical Trials.gov and PubMed for all published studies from the establishment of the library up to 23 Oct.2022.
Eligibility criteria If the subjects were actively given dexmedetomidine before entering the PACU, and the occurrence of ED was used as the outcome measure, and the sample mean / median age was no more than 18 years old, they were included in the study. Studies examining the use of dexmedetomidine after surgery were excluded.
Results A data analysis from seven studies involving 512 patients showed that prophylactic use of dexmedetomidine reduced the incidence of ED in children(risk ratio[RR] 0.40 ; 95% confidence interval [CI] 0.30–0.55 ; P < 0.00001).Compared with intravenous infusion of dexmedetomidine(n = 350, [RR] 0.48, 95%[CI] 0.31–0.76, P = 0.002.), intranasal injection of dexmedetomidine (n = 162, [RR] 0.29, 95%[CI] 0.16–0.52, P < 0.0001.) has a lower risk ratio and may better reduce the incidence of ED, although no difference in incidence was observed in subgroup analysis. Compared with dexmedetomidine given at the end of surgery (n = 213, [RR] 0.41, 95%[CI] 0.17–0.98, P = 0.05.), dexmedetomidine given before and during surgery (n = 162, [RR] 0.29, 95%[CI] 0.16–0.52, P < 0.0001./n = 137, [RR] 0.56, 95%[CI] 0.35–0.90, P = 0.02) has a better effect on reducing the incidence of ED. In addition, prophylactic application of dexmedetomidine can reduce the occurrence of PONV (postoperative nausea and vomiting): 7 studies: n = 512 patients; [RR] 0.24; 95%[CI] 0.12–0.49; P = 0.0001. The occurrence of bradycardia was not statistically significant (2 studies: n = 157; [RR] 3.24; 95%[CI] 0.52–20.40; P = 0.21). Otherwise, because there was only one case of hypotension, we did not perform a meta-analysis. Prophylactic application of dexmedetomidine reduced PACU stay time after extubation (n = 446; mean difference [MD] -1.57; 95%[CI] -3.07 to -0.07, P = 0.04). However, sensitivity analysis of PACU stay time after extubation was not statistically significant and stable (n = 296; [MD] -0.55; 95%[CI] -1.30-0.19, P = 0.15)
Conclusion Prophylactic use of dexmedetomidine can reduce the occurrence of ED in children and the adverse events no significant increase. In pediatric surgery, the anesthesiologist should consider the use of dexmedetomidine. In the future, we hope to confirm our findings through multi-center trials and clarify and explain the mechanism behind the reduction of ED with dexmedetomidine.
TRIAL REGISTRATION
PROSPERO: CRD42022371840.