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Comparative efficacy of ancillary drugs in sevoflurane‐related emergence agitation after paediatric adenotonsillectomy: A Bayesian network meta‐analysis
Author(s) -
Jiao Hongmei,
Wang Hongwei,
Jiang Ziru,
Hu Jingli
Publication year - 2020
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.13133
Subject(s) - medicine , dexmedetomidine , sevoflurane , fentanyl , anesthesia , midazolam , remifentanil , sufentanil , propofol , cochrane library , ketamine , randomized controlled trial , clonidine , placebo , meta analysis , sedation , surgery , alternative medicine , pathology
What is known and objective The comparative efficacy of ancillary drugs on sevoflurane‐related emergence agitation (EA) in paediatric anaesthesia for adenotonsillectomy remains unclear. The purpose of this Bayesian network meta‐analysis was to investigate the efficacy of ancillary drugs on sevoflurane‐related EA in paediatric anaesthesia for adenotonsillectomy. Methods MEDLINE, Embase, the Cochrane Library and Web of Science databases were electronically searched to identify randomized controlled trials (RCTs) of different ancillary drugs used in adenotonsillectomy from inception to April 2019. Two reviewers independently screened the literature, extracted data and assessed the risk of bias in included studies. Subsequently, a network meta‐analysis was performed using the R software and RevMan 5.3 software. Results and discussion We included 25 RCTs, involving 2151 participants. The proportion of patients with sevoflurane‐related EA was significantly lower in the dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil and clonidine groups than in the placebo group ( P < .05). Fentanyl was superior to sufentanil ( P < .05), whereas dexmedetomidine was superior to fentanyl ( P < .05). Among ancillary drugs, dexmedetomidine (90.04%) showed the highest possibility of reducing the risk of EA, followed by fentanyl (87.45%), remifentanil (63.85%), ketamine (52.07%), midazolam (51.27%), clonidine (49.94%), propofol (29.89%), sufentanil (21.38%) and placebo (4.09%). What is new and conclusion Evidence suggests that the effects of dexmedetomidine in reducing the risk of sevoflurane‐related EA in paediatric anaesthesia for adenotonsillectomy were better than the effects of other drugs. However, large, high‐quality RCTs are required to further confirm this.