Related Experiment Video

Updated: Sep 14, 2025

Application of Dixon's Up-and-Down Design to Estimate the Minimum Alveolar Concentration of Sevoflurane in Rats with Refined Movement Classification
03:02

Application of Dixon's Up-and-Down Design to Estimate the Minimum Alveolar Concentration of Sevoflurane in Rats with Refined Movement Classification

Published on: July 25, 2025

123

Optimizing adjuvant strategies for sevoflurane-related emergence delirium: a Bayesian network meta-analysis in

Chun-Jin Zhang1, Hong Chen2, Kang Zou3

  • 1MSN, RN, Fellow,Nursing department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Frontiers in Pharmacology
|July 21, 2025
PubMed

Insights

Dexmedetomidine combinations are effective for pediatric surgeries, with specific drug choices recommended for different procedures to reduce emergence delirium (ED) risk. Tailoring anesthetic adjuvants improves outcomes for young patients.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Emergence delirium (ED) is a common concern in pediatric anesthesia.
  • Optimizing anesthetic adjuvant strategies is crucial for improving patient safety and recovery.
  • Sevoflurane is widely used in pediatric anesthesia, but adjuvant selection impacts outcomes.

Purpose of the Study:

  • To compare the efficacy of various anesthetic adjuvants combined with sevoflurane for pediatric surgeries.
  • To identify the most effective adjuvant combinations for specific surgical sites using Bayesian network meta-analysis.

Main Methods:

  • A systematic review and PRISMA-guided meta-analysis of 100 RCTs involving 8,800 pediatric patients.
  • Evaluation of 22 drug interventions, calculating log risk ratios (logRR) and Surface Under the Cumulative Ranking (SUCRA) probabilities.

Main Results:

  • Dexmedetomidine combined with alfentanil was most effective for tonsillectomy/adenoidectomy (SUCRA: 94.63%).
  • Propofol and midazolam showed highest efficacy for ophthalmic surgery (SUCRA: 86.03%).
  • Dexmedetomidine with midazolam was optimal for hernia/hypospadias and dental repairs (SUCRA: 81.73%, 94.85%).
  • Dexmedetomidine alone was effective for cleft lip/palate repair (SUCRA: 89.15%).
  • Fentanyl was most effective for myringotomy/cochlear implantation (SUCRA: 80.02%).

Conclusions:

  • Targeted use of dexmedetomidine-based combinations is highly effective across various pediatric surgical procedures.
  • Specific adjuvant choices, including fentanyl and propofol-midazolam, offer benefits in particular surgical contexts.
  • Tailoring anesthetic adjuvants to surgical sites is essential for reducing ED risk in pediatric patients.
Abstract

Keywords:
adjuvantemergence deliriumnetwork meta-analysispediatricsevoflurane-related

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