• Hung-Yu Wang, Tien-Yu Chen, Dian-Jeng Li, Pao-Yen Lin, Kuan-Pin Su, Min-Hsien Chiang, Andre F Carvalho, Brendon Stubbs, Yu-Kang Tu, Yi-Cheng Wu, Michael Roerecke, Lee Smith, Ping-Tao Tseng, and Kuo-Chuan Hung.
• Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
• J Clin Anesth. 2021 Dec 1; 75: 110488.

Study ObjectiveThis updated network meta-analysis aims at exploring whether the concurrent use of midazolam or antiemetics may enhance the efficacy of other pharmacological regimens for delirium prophylaxis in pediatric population after general anesthesia (GA).DesignNetwork meta-analysis (PROSPERO registration: CRD42020179483).SettingPostoperative recovery area.PatientsPediatric patients undergoing GA with sevoflurane.InterventionsPharmacological interventions applied during GA with sevoflurane.MeasurementsThis network meta-analysis of randomized controlled trials (RCTs) was conducted with a frequentist model. PubMed, Embase, ProQuest, ScienceDirect, Cochrane CENTRAL, ClinicalKey, Web of Science, and ClinicalTrials.gov were searched from their inception dates to April 12, 2020, for RCTs of either placebo-controlled or active-controlled design containing information on the incidence of emergence delirium in pediatric patients undergoing sevoflurane anesthesia.Main ResultsSeventy studies comprising 6904 participants were included for the analysis of 30 pharmacological interventions. Based on surface under the cumulative ranking curve (SUCRA) analysis, midazolam was ranked the lowest in therapeutic effect (SUCRA: 20%), while antiemetics as a monotherapy had no effect on delirium prophylaxis. However, there was a trend that most combination therapies with midazolam or antiemetics were superior to monotherapies for delirium prophylaxis. Subgroup analyses based on age (i.e., ≤7 years) and a validated scoring system (i.e., the Pediatric Anesthesia Emergence Delirium scale) for delirium also suggested a better efficacy of combination therapies than monotherapies. Overall, combination therapies with midazolam or antiemetics did not have a negative impact on the incidence of postoperative nausea and vomiting, length of stay in the postanesthesia care unit, or time to extubation. The dexmedetomidine-midazolam-antiemetic combination was the most effective strategy for the prevention of emergence delirium.ConclusionsThis network meta-analysis suggested that the incorporation of midazolam or antiemetics as adjuncts for combination therapies may have synergistic effects against pediatric postoperative emergence delirium. Future large-scale placebo-controlled RCTs are warranted to validate our findings.Copyright © 2021 Elsevier Inc. All rights reserved.

17 keywords...

hide…