Association of pharmacological prophylaxis with the risk of pediatric emergence delirium after sevoflurane anesthesia: An updated network meta-analysis

Wang, Hung-Yu and Chen, Tien-Yu and Li, Dian-Jeng and Lin, Pao-Yen and Su, Kuan-Pin and Chiang, Min-Hsien and Carvalho, Andre and Stubbs, Brendon and Tu, Yu-Kang and Wu, Yi-Cheng and Roerecke, Michael and Smith, Lee and Tseng, Ping-Tao and Hung, Kuo-Chaun (2021) Association of pharmacological prophylaxis with the risk of pediatric emergence delirium after sevoflurane anesthesia: An updated network meta-analysis. Journal of Clinical Anesthesia, 75. p. 110488. ISSN 0952-8180

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Official URL: https://doi.org/10.1016/j.jclinane.2021.110488

Abstract

Study objective- This 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). Design- Network meta-analysis (PROSPERO registration: CRD42020179483). Setting- Postoperative recovery area. Patients- Pediatric patients undergoing GA with sevoflurane. Interventions- Pharmacological interventions applied during GA with sevoflurane. Measurements- This 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 results- Seventy 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. Conclusions- This 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.

Item Type: Journal Article
Keywords: Combination Therapy, Delirium, Network meta-analysis, Pediatric Anesthesia, Sevoflurane
Faculty: Faculty of Science & Engineering
SWORD Depositor: Symplectic User
Depositing User: Symplectic User
Date Deposited: 20 Aug 2021 15:24
Last Modified: 24 Jan 2022 14:31
URI: https://arro.anglia.ac.uk/id/eprint/706840

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