Melatonin for pre-medication in children: a systematic review

Area of Science:

• Pediatric Anesthesiology
• Pharmacology
• Evidence-Based Medicine

Background:

• Melatonin's anxiolytic effects are established in adults, but its efficacy in children remains uncertain.
• Previous studies on pre-operative melatonin in pediatric surgical patients have yielded conflicting results.

Purpose of the Study:

• To systematically review the existing literature on the use of melatonin as a pre-operative anxiolytic in pediatric populations.
• To evaluate the efficacy and safety of melatonin compared to placebo or standard pre-medications in children undergoing surgery.

Main Methods:

• A systematic review was conducted using multiple databases (MEDLINE, Embase, Cochrane, Web of Science) and clinical trial registries.
• Eleven studies were included, with no restrictions on comparators or outcomes, assessing anxiety, anesthetic success, sedation, recovery, and safety.
• Significant heterogeneity was noted in melatonin dosing, timing, and outcome assessment measures across studies.

Main Results:

• Conflicting evidence exists regarding melatonin's anxiolytic properties in pediatric pre-operative settings.
• Melatonin demonstrated potential benefits, including reduced sedation, less post-operative excitement, and improved emergence behavior.
• No significant adverse safety events were associated with melatonin, supporting its favorable safety profile. One study noted improved sleep disturbance at two weeks post-surgery.

Conclusions:

• Despite potential advantages, current evidence is insufficient to confirm melatonin's non-inferiority to standard pre-operative medications in pediatric surgery.
• Further rigorous research is required to establish the role of melatonin as an anxiolytic pre-medication in pediatric surgical care.