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

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Hung-Chang Kuo1, Kuo-Chuan Hung2, Hung-Yu Wang3

  • 1Department of Neurology, E-Da Hospital/School of Medicine, I-Shou University, Kaohsiung, Taiwan.

Journal of Anesthesia
|July 5, 2023
PubMed

Insights

Ketamine plus propofol significantly reduced postoperative emergence delirium in children after desflurane anesthesia. This combination therapy showed the lowest incidence of emergence delirium compared to other treatments.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Pharmacology

Background:

  • Postoperative emergence delirium (pedED) in children following desflurane anesthesia occurs in 50-80% of cases.
  • Existing pharmacological strategies to prevent pedED lack conclusive evidence of superiority.
  • PROSPERO CRD42021285200.

Purpose of the Study:

  • To evaluate the prophylactic effect and safety of individual pharmacotherapies for preventing pedED after desflurane anesthesia.
  • To compare the efficacy of various drug regimens in reducing pedED incidence and severity.
  • To provide evidence-based recommendations for pedED prevention in pediatric patients.

Main Methods:

  • A frequentist model network meta-analysis (NMA) of randomized controlled trials (RCTs).
  • Included peer-reviewed RCTs with placebo-controlled or active-controlled designs.
  • Focused on pediatric patients undergoing desflurane anesthesia.

Main Results:

  • Seven studies with 573 participants were analyzed.
  • Ketamine + propofol, dexmedetomidine alone, and propofol significantly lowered pedED incidence compared to placebo.
  • Ketamine + propofol showed the lowest pedED incidence; gabapentin showed the lowest pedED severity.

Conclusions:

  • Ketamine + propofol administration demonstrated the lowest incidence of pedED among studied pharmacologic interventions.
  • Dexmedetomidine and gabapentin also showed significant benefits in reducing pedED incidence or severity.
  • Further large-scale trials are needed to compare combination regimens for optimal pedED prevention.
Abstract

Keywords:
DesfluraneEmergence agitationEmergence deliriumNetwork meta-analysisPediatric anesthesia

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