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05-07-2023 | Gabapentin | Original Article

Prophylaxis for paediatric emergence delirium in desflurane-based anaesthesia: a network meta-analysis

Authors: 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, Ping-Tao Tseng

Published in: Journal of Anesthesia | Issue 2/2024

Abstract

Purpose

The 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.

Methods

This 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.

Results

Seven 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.

Conclusions

The 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 registration

PROSPERO CRD42021285200.

Available only for authorised users

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Title: Prophylaxis for paediatric emergence delirium in desflurane-based anaesthesia: a network meta-analysis
Authors: 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
Ping-Tao Tseng
Publication date: 05-07-2023
Publisher: Springer Nature Singapore
Keywords: Gabapentin
Agitation
Desflurane
Propofol
Ketamine
Midazolam
Published in: Journal of Anesthesia / Issue 2/2024
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-023-03219-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prophylaxis for paediatric emergence delirium in desflurane-based anaesthesia: a network meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Trial registration

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