Open AccessDexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis
Author(s) -
Fu Wei Chiang,
Jin Chang,
Shih Chang Hsu,
Kuo Yuan Hsu,
Karen Chia Wen Chu,
Chun Jen Huang,
Chyi Huey Bai,
Chiehfeng Chen,
Yuan Pin Hsu
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0240553
Subject(s) - dexmedetomidine , medicine , anesthesia , strabismus surgery , postoperative nausea and vomiting , pacu , placebo , relative risk , strabismus , incidence (geometry) , analgesic , confidence interval , surgery , nausea , sedation , physics , alternative medicine , pathology , optics
Background Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery. Method Five databases were searched for randomized controlled trials published from database inception to April 2020 that compared dexmedetomidine use with placebo or active comparator use and evaluated EA, PONV, or postoperative pain incidence (main outcomes) in patients who had undergone pediatric strabismus surgery. Oculocardiac reflex (OCR) incidence and postanesthesia care unit (PACU) stay duration were considered as safety outcomes. All meta-analyses were performed using a random-effects model. Results In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced EA incidence [risk ratio (RR): 0.39; 95% confidence interval (CI): 0.25–0.62, I 2 = 66%], severe EA incidence (RR: 0.27, 95% CI: 0.17–0.43, I 2 = 0%), PONV incidence (RR: 0.33, 95% CI: 0.21–0.54, I 2 = 0%), analgesia requirement (RR: 0.38, 95% CI: 0.25–0.57, I 2 = 0%), and pain scores (standardized mean difference: −1.02, 95% CI: −1.44 to −0.61, I 2 = 75%). Dexmedetomidine also led to lower EA incidence in the sevoflurane group than in the desflurane group (RR: 0.26 for sevoflurane vs. 0.45 for desflurane). Continuous dexmedetomidine infusion (RR: 0.19) led to better EA incidence reduction than did bolus dexmedetomidine infusion at the end of surgery (RR: 0.26) or during the peri-induction period (RR: 0.36). Compared with placebo use, dexmedetomidine use reduced OCR incidence (RR: 0.63; I 2 = 40%). No significant between-group differences were noted for PACU stay duration. Conclusion In patients who have undergone pediatric strabismus surgery, dexmedetomidine use may alleviate EA, PONV, and postoperative pain and reduce OCR incidence. Moreover, dexmedetomidine use does not affect the PACU stay duration.