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Prophylactic pharmacological interventions against perioperative respiratory adverse events in children undergoing

Qi-Wen Deng1, Wen-Cheng Tan2, Ya-Qing Zhan1

  • 1Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, No.58, Zhongshan 2Nd Road, Guangzhou, 510080, China.

Journal of Anesthesia
|January 11, 2025
PubMed

Insights

This meta-analysis shows that lidocaine, dexmedetomidine, beta2-adrenoreceptor agonists, and propofol induction can help prevent perioperative respiratory adverse events (PRAE) in children. However, results should be interpreted cautiously due to varied definitions of PRAE.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Perioperative respiratory adverse events (PRAE) are common in pediatric anesthesia.
  • Effective prevention strategies are crucial for patient safety during noncardiac surgery.

Purpose of the Study:

  • To evaluate the efficacy of perioperative pharmacological interventions in preventing PRAE in pediatric patients undergoing noncardiac surgery.
  • To synthesize evidence from randomized controlled trials (RCTs) on prophylactic treatments for PRAE.

Main Methods:

  • A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and ClinicalTrials.gov for RCTs.
  • Pairwise meta-analyses were performed to compare interventions against placebo or other treatments for overall PRAE and specific subtypes.
  • Risk of bias was assessed using the Cochrane Collaboration tool.

Main Results:

  • Twenty-nine RCTs involving 4452 children were included.
  • Lidocaine, dexmedetomidine, and beta2-adrenoreceptor agonists demonstrated significant reductions in overall PRAE and specific events like laryngospasm and coughing compared to placebo.
  • Intravenous propofol induction was associated with lower odds of PRAE, laryngospasm, and airway obstruction compared to sevoflurane induction.

Conclusions:

  • Lidocaine, dexmedetomidine, beta2-adrenoreceptor agonists, and propofol induction show prophylactic potential against PRAE in pediatric surgery.
  • Caution is advised due to inconsistent definitions of PRAE and potential correlations among subtypes.
Abstract

Keywords:
Meta-analysisPediatric anesthesiaPerioperative respiratory adverse eventsPharmacological interventionsProphylaxis

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