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Eizaga Rebollar R, García Palacios MV, Fernández Riobó MC, Torres Morera LM. Dexmedetomidine and perioperative analgesia in children. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:487-492. [PMID: 36100555 DOI: 10.1016/j.redare.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/25/2021] [Indexed: 06/15/2023]
Abstract
Dexmedetomidine (DEX) is an anaesthetic agent that mimics natural deep sleep and produces minimal cardiorespiratory depression. As such, it is a very valuable option in the management of such a challenging population as paediatric patients. The main objective of this mini review was to evaluate the role of DEX as a perioperative analgesic in children receiving anaesthesia. We searched Google, Pubmed, Embase and the Cochrane Library for articles published between 2010 and 2021, and reviewed various of aspects of DEX, such as pharmacology, effectiveness, safety, and the most recent evidence on its clinical use as an analgesic in paediatric anaesthesia. We also include a cost estimate of perioperative analgesia with DEX.
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Affiliation(s)
- R Eizaga Rebollar
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Mar, Cádiz, Spain.
| | - M V García Palacios
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Puerta de Mar, Cádiz, Spain
| | - M C Fernández Riobó
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Mar, Cádiz, Spain
| | - L M Torres Morera
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Mar, Cádiz, Spain
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Sun Y, Wu Z, Sun S, Chen R, Dai M, Dou X, Lin Y. Evaluation of the Efficacy of Dexmedetomidine as A Local Anesthetics Adjuvant in Children: A Meta Analysis of Randomized Controlled Trials. J Clin Pharmacol 2022; 62:935-947. [PMID: 35220587 DOI: 10.1002/jcph.2039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/22/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Yan Sun
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - Zhilin Wu
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - ShuJun Sun
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - Rui Chen
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - Maosha Dai
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - Xiaoke Dou
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - Yun Lin
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
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El-Sherbiny S, Kamal R, Sadik N, Elshahat A. Effect of dexmedetomidine in sub-tenon's block on emergence agitation in pediatric strabismus surgery under sevoflurane anesthesia. Anesth Essays Res 2022; 16:160-166. [PMID: 36249154 PMCID: PMC9558671 DOI: 10.4103/aer.aer_99_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/04/2022] Open
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Effect of Epidural Dexmedetomidine as an Adjuvant to Local Anesthetics for Labor Analgesia: A Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4886970. [PMID: 34745286 PMCID: PMC8568549 DOI: 10.1155/2021/4886970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022]
Abstract
Background This study aims to determine the analgesic effect and safety of dexmedetomidine as an adjuvant to epidural local anesthetics during labor. Methods Randomized controlled trials comparing epidural blocks with or without dexmedetomidine for labor analgesia were comprehensively searched. Review manager 5.4 was used to analyze the extracted data. Results Compared with placebo and opioids, dexmedetomidine relieved labor pain of 15 min (P=0.002), 30 min (P=0.01), and 120 min (P=0.02) after block and at the moment of fetal disengagement (P=0.0002), decreased mean arterial pressure of 120 min (P=0.01), heart rate of 30 min (P=0.003), 60 min (P < 0.00001), and 120 min (P < 0.00001) after block, blood loss (P=0.02), and the incidence of nausea/vomiting (P=0.006), and increased the incidence of maternal bradycardia (P=0.04). However, sensitivity analysis only found that the incidence of nausea/vomiting was significantly different. Compared with placebo, dexmedetomidine relieved labor pain of 30 min after block (P < 0.00001) and did not increase the incidences of side effects, but only two studies were enrolled. Compared with opioids, dexmedetomidine decreased the incidence of nausea/vomiting (P=0.002), increased the incidence of maternal bradycardia (P=0.04), and had a similar effect on labor pain relief; however, sensitivity analysis found that significant difference existed only at the incidence of nausea/vomiting. Other outcomes from meta-analysis or subgroup analysis were not different. Conclusions Epidural dexmedetomidine has the potential to offer a better analgesic effect than placebo, similar labor pain control to opioids, and has no definite adverse effects on the parturient or fetus, but more high-quality studies are needed to confirm these conclusions.
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Eizaga Rebollar R, García Palacios MV, Del Carmen Fernández Riobó M, Torres Morera LM. Dexmedetomidine & perioperative analgesia in children. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00144-4. [PMID: 34049712 DOI: 10.1016/j.redar.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
Dexmedetomidine (DEX) is an anaesthetic agent that mimics natural deep sleep and produces minimal cardiorespiratory depression. As such, it is a very valuable option in the management of such a challenging population as paediatric patients. The main objective of this mini review was to evaluate the role of DEX as a perioperative analgesic in children receiving anaesthesia. We searched Google, Pubmed, Embase and the Cochrane Library for articles published between 2010 and 2021, and reviewed various of aspects of DEX, such as pharmacology, effectiveness, safety, and the most recent evidence on its clinical use as an analgesic in paediatric anaesthesia. We also include a cost estimate of perioperative analgesia with DEX.
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Affiliation(s)
- R Eizaga Rebollar
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Mar, Cádiz, España.
| | - M V García Palacios
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Puerta de Mar, Cádiz, España
| | | | - L M Torres Morera
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Mar, Cádiz, España
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Shah UJ, Nguyen D, Karuppiaah N, Martin J, Sehmbi H. Efficacy and safety of caudal dexmedetomidine in pediatric infra-umbilical surgery: a meta-analysis and trial-sequential analysis of randomized controlled trials. Reg Anesth Pain Med 2021; 46:422-432. [PMID: 33452203 DOI: 10.1136/rapm-2020-102024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dexmedetomidine is used as a local-anesthetics adjuvant in caudal block to prolong analgesia in pediatric infra-umbilical surgery. OBJECTIVE We evaluated the analgesic efficacy and safety of the addition of caudal dexmedetomidine to local anesthetics (vs local anesthetics alone) in pediatric infra-umbilical surgery. EVIDENCE REVIEW We searched 10 databases for randomized controlled trials (RCTs) of pediatric patients undergoing infra-umbilical surgery, comparing caudal block with and without dexmedetomidine as local anesthetic adjuvant. We performed a frequentist random-effects meta-analysis (R statistical package). We analyzed continuous outcomes as a ratio of means (ROM) and dichotomous data as relative risk (RR), along with 95% CI. We included 19 RCTs (n=1190 pediatric patients) in the meta-analysis. The primary outcome was duration of analgesia (defined as 'the time from caudal injection to the time at which the study-specific pain score was greater than a cut-off threshold'). FINDINGS Data from 19 included RCTs (n=1190) suggested that compared with control (mean duration 346 min), the addition of caudal dexmedetomidine significantly prolonged the duration of analgesia (ratio of means 2.14, 95% CI 1.83 to 2.49, p<0.001; 'moderate' evidence). Trial-sequential analysis showed adequate 'information size' for the primary outcome. Caudal dexmedetomidine also reduced the number of analgesic administrations ('low' evidence), total acetaminophen dose ('moderate' evidence) and the risk of emergence delirium ('moderate' evidence). There were no significant differences in adverse effects such as hypotension, bradycardia, post-operative nausea and vomiting, urinary retention and respiratory depression. CONCLUSIONS Our results suggest that the addition of dexmedetomidine to local anesthetic in caudal block significantly improves the duration of analgesia and reduces the analgesic requirements, while maintaining a similar risk-profile compared with local anesthetic alone. Further data on neurological safety are needed.
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Affiliation(s)
- Ushma Jitendra Shah
- Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada.,Anesthesia & Perioperative Medicine, London Health Sciences Centre Children's Hospital, London, Ontario, Canada
| | - Derek Nguyen
- Bachelor of Medical Sciences, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Niveditha Karuppiaah
- Anesthesia & Perioperative Medicine, London Health Sciences Centre Children's Hospital, London, Ontario, Canada.,Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Janet Martin
- Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada.,Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Herman Sehmbi
- Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
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Dexmedetomidine: What's New for Pediatrics? A Narrative Review. J Clin Med 2020; 9:jcm9092724. [PMID: 32846947 PMCID: PMC7565844 DOI: 10.3390/jcm9092724] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Over the past few years, despite the lack of approved pediatric labelling, dexmedetomidine’s (DEX) use has become more prevalent in pediatric clinical practice as well as in research trials. Its respiratory-sparing effects and bioavailability by various routes are only some of the valued features of DEX. In recent years the potential organ-protective effects of DEX, with the possibility for preserving neurocognitive function, has put it in the forefront of clinical and bench research. This comprehensive review focused on the pediatric literature but presents relevant, supporting adult and animal studies in order to detail the recent growing body of literature around the pharmacology, end-organ effects, organ-protective effects, alternative routes of administration, synergetic effects, and clinical applications, with considerations for the future.
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Shen QH, Li HF, Zhou XY, Yuan XZ, Lu YP. Dexmedetomidine as an adjuvant for single spinal anesthesia in patients undergoing cesarean section: a system review and meta-analysis. J Int Med Res 2020; 48:300060520913423. [PMID: 32466699 PMCID: PMC7263150 DOI: 10.1177/0300060520913423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Previous studies reported the effect of dexmedetomidine on intrathecal anesthesia. In this review, we explored the impact of dexmedetomidine as an adjunct for lumbar anesthesia in patients undergoing cesarean section. METHODS Two authors searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Chinese BioMedical database, Chinese Scientific Journal Database, and the Wanfang database. RESULTS Ten trials comprising 970 patients were included in this review. Intrathecal dexmedetomidine significantly reduced the onset time of sensory block (standardized mean difference (SMD), -1.50, 95% confidence interval (CI) -2.15, -0.85, I2 = 92%) and motor block (SMD -0.77, 95% CI -1.50, -0.49, I2 = 60%) and prolonged the block duration time (sensory block: SMD 2.02, 95% CI 1.29, 2.74, I2 = 93%; motor block: SMD 1.90, 95% CI 1.07, 2.74, I2 = 94%). Patients who received dexmedetomidine showed a lower incidence of shivering. No significant difference was reported for the neonatal Apgar score and other complications. CONCLUSION The use of intrathecal dexmedetomidine during cesarean section can shorten the onset time of spinal anesthesia and enhance the effect of local anesthetic. It has no significant impact on neonates and there were no other adverse events.
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Affiliation(s)
- Qi-Hong Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Hui-Fang Li
- Department of Gynecology, Tongxiang Maternal and Child Health Care Hospital, Tongxiang, Zhejiang, China
| | - Xu-Yan Zhou
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Xiao-Zong Yuan
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Ya-Ping Lu
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
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