• Am J Ther · Jul 2016

    Meta Analysis

    Network Meta-Analysis on the Efficacy of Dexmedetomidine, Midazolam, Ketamine, Propofol, and Fentanyl for the Prevention of Sevoflurane-Related Emergence Agitation in Children.

    • Xiang-Zhi Fang, Ju Gao, Ya-Li Ge, Luo-Jing Zhou, and Yang Zhang.
    • Departments of 1Anesthesiology and 2Scientific Research, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu Province, China.
    • Am J Ther. 2016 Jul 1; 23 (4): e1032-42.

    AbstractSevoflurane is associated with a relatively high incidence of emergence agitation (EA) in children. Prophylactic treatment, including midazolam, dexmedetomidine, ketamine, fentanyl and propofol, has been used to prevent EA. However, the question of which prophylactic treatment should be preferred to decrease the incidence of EA is still unclear. We conducted a network meta-analysis of randomized controlled trials to investigate the comparative efficacy of midazolam, dexmedetomidine, ketamine, fentanyl, and propofol for the prevention of sevoflurane-related EA in children. First, we used the odds ratios and 95% confidence interval as effect size. The results revealed that dexmedetomidine 0.19 (0.14-0.27), midazolam 0.22 (0.07-0.60), ketamine 0.28 (0.16-0.51), propofol 0.23 (0.10-0.53), and fentanyl 0.25 (0.17-0.36) led to a significant reduction of the incidence of EA when compared with placebo. With placebo as the standard of comparison, the degree of incoherence (a measure of how closely the entire network fits together) was small (ω = 8.66728e-08). The logor were dexmedetomidine -1.75 (-2.11 to -1.39), midazolam -1.07 (-1.54 to -0.60), ketamine -1.292 (-1.92 to -0.66), and fentanyl -1.13 (-1.56 to -0.70). When compared with dexmedetomidine, the logor were placebo 1.75 (1.39-2.11), midazolam 0.67 (0.09-1.25), ketamine 0.45 (-0.25-1.15), propofol 0.75 (0.19-1.31), and fentanyl 0.617 (0.13-1.11). When compared with ketamine, the logor were placebo 1.29 (0.66-1.92), midazolam 0.22 (-0.56 to 1.00), dexmedetomidine -0.45 (-1.15-0.25); propofol 0.29 (-0.45-1.03); and fentanyl 0.16 (-0.59-0.92). The study that showed dexmedetomidine, midazolam, ketamine, propofol, and fentanyl could significantly decrease the incidence of EA when compared with placebo. One interesting finding of this network meta-analysis is that dexmedetomidine might be the best choice to prevent EA. However, there is weak evidence that dexmedetomidine is better than ketamine for the prevention of sevoflurane-related EA in children. As a result, more studies are needed to compare dexmedetomidine with ketamine.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…