• Hung-Chang Kuo, Kuo-Chuan Hung, Hung-Yu Wang, Bing-Syuan Zeng, Tien-Yu Chen, Dian-Jeng Li, Pao-Yen Lin, Kuan-Pin Su, Min-Hsien Chiang, Andre F Carvalho, Brendon Stubbs, Yu-Kang Tu, Yi-Cheng Wu, Michael Roerecke, Lee Smith, Shih-Pin Hsu, Yen-Wen Chen, Pin-Yang Yeh, Chih-Wei Hsu, Mein-Woei Suen, and Ping-Tao Tseng.
• Department of Neurology, E-Da Hospital/School of Medicine, I-Shou University, Kaohsiung, Taiwan.
• J Anesth. 2024 Apr 1; 38 (2): 155166155-166.

PurposeThe prevalence of postoperative emergence delirium in paediatric patients (pedED) following desflurane anaesthesia is considerably high at 50-80%. Although several pharmacological prophylactic strategies have been introduced to reduce the risk of pedED, conclusive evidence about the superiority of these individual regimens is lacking. The aim of the current study was to assess the potential prophylactic effect and safety of individual pharmacotherapies in the prevention of pedED following desflurane anaesthesia.MethodsThis frequentist model network meta-analysis (NMA) of randomized controlled trials (RCTs) included peer-reviewed RCTs of either placebo-controlled or active-controlled design in paediatric patients under desflurane anaesthesia.ResultsSeven studies comprising 573 participants were included. Overall, the ketamine + propofol administration [odds ratio (OR) = 0.05, 95% confidence intervals (95%CIs) 0.01-0.33], dexmedetomidine alone (OR = 0.13, 95%CIs 0.05-0.31), and propofol administration (OR = 0.30, 95%CIs 0.10-0.91) were associated with a significantly lower incidence of pedED than the placebo/control groups. In addition, only gabapentin and dexmedetomidine were associated with a significantly higher improvement in the severity of emergence delirium than the placebo/control groups. Finally, the ketamine + propofol administration was associated with the lowest incidence of pedED, whereas gabapentin was associated with the lowest severity of pedED among all of the pharmacologic interventions studied.ConclusionsThe current NMA showed that ketamine + propofol administration was associated with the lowest incidence of pedED among all of the pharmacologic interventions studied. Future large-scale trials to more fully elucidate the comparative benefits of different combination regimens are warranted.Trial RegistrationPROSPERO CRD42021285200.© 2023. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.

22 keywords...

hide…