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Xiaochun Zheng - One of the best experts on this subject based on the ideXlab platform.
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intranasal dexmedetomidine versus oral midazolam premedication to prevent Emergence Delirium in children undergoing strabismus surgery a randomised controlled trial
European Journal of Anaesthesiology, 2020Co-Authors: Yusheng Yao, Yang Sun, Jiancheng Lin, Wenjun Chen, Ying Lin, Xiaochun ZhengAbstract:BACKGROUND Dexmedetomidine is being used increasingly as a premedicant in the paediatric population. However, the effectiveness of pre-operative intranasal dexmedetomidine premedication, compared with oral midazolam, for Emergence Delirium is not well characterised. OBJECTIVE To identify the effectiveness of pre-operative intranasal dexmedetomidine for Emergence Delirium in the paediatric patient population following general anaesthesia. DESIGN A prospective, randomised, double-blind, parallel-group, placebo-controlled trial. SETTING Single university teaching hospital, from September 2013 to August 2014. PATIENTS One hundred and fifty-six patients undergoing anaesthesia for strabismus surgery were included in the study. INTERVENTION Patients were randomised in a 1 : 1 : 1 ratio to receive premedication with intranasal dexmedetomidine 2 μg kg (the dexmedetomidine group), oral midazolam 0.5 mg kg (the midazolam group), or 0.9% saline (the placebo group). MAIN OUTCOME MEASURES The primary outcome was the incidence of Emergence Delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included the quality of the inhalational induction, Emergence time, postoperative pain intensity, length of stay in the postanaesthesia care unit, the incidence of postoperative nausea or vomiting (PONV) and parents' satisfaction. RESULTS The incidence of Emergence Delirium was lower in patients given dexmedetomidine compared with that in patients given midazolam (11.5 versus 44%, relative risk = 0.262, 95% confidence interval 0.116 to 0.592) or 0.9% saline (11.5 versus 49%, relative risk = 0.235, 95% confidence interval 0.105 to 0.525). Likewise, the incidence of PONV was lower in the dexmedetomidine group (3.8%) than that in the midazolam (22%; P = 0.006) or placebo (29.4%; P < 0.001) groups. However, there was no difference among the groups concerning postoperative pain scores and length of postanaesthesia care unit stay. CONCLUSION In paediatric patients undergoing strabismus surgery intranasal dexmedetomidine 2 μg kg premedication decreases the incidence of Emergence Delirium and PONV, and improves parents' satisfaction compared with oral midazolam. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT01895023).
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Intranasal dexmedetomidine versus oral midazolam premedication to prevent Emergence Delirium in children undergoing strabismus surgery: A randomised controlled trial.
European journal of anaesthesiology, 2020Co-Authors: Yusheng Yao, Yang Sun, Jiancheng Lin, Wenjun Chen, Ying Lin, Xiaochun ZhengAbstract:BACKGROUND Dexmedetomidine is being used increasingly as a premedicant in the paediatric population. However, the effectiveness of pre-operative intranasal dexmedetomidine premedication, compared with oral midazolam, for Emergence Delirium is not well characterised. OBJECTIVE To identify the effectiveness of pre-operative intranasal dexmedetomidine for Emergence Delirium in the paediatric patient population following general anaesthesia. DESIGN A prospective, randomised, double-blind, parallel-group, placebo-controlled trial. SETTING Single university teaching hospital, from September 2013 to August 2014. PATIENTS One hundred and fifty-six patients undergoing anaesthesia for strabismus surgery were included in the study. INTERVENTION Patients were randomised in a 1 : 1 : 1 ratio to receive premedication with intranasal dexmedetomidine 2 μg kg (the dexmedetomidine group), oral midazolam 0.5 mg kg (the midazolam group), or 0.9% saline (the placebo group). MAIN OUTCOME MEASURES The primary outcome was the incidence of Emergence Delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included the quality of the inhalational induction, Emergence time, postoperative pain intensity, length of stay in the postanaesthesia care unit, the incidence of postoperative nausea or vomiting (PONV) and parents' satisfaction. RESULTS The incidence of Emergence Delirium was lower in patients given dexmedetomidine compared with that in patients given midazolam (11.5 versus 44%, relative risk = 0.262, 95% confidence interval 0.116 to 0.592) or 0.9% saline (11.5 versus 49%, relative risk = 0.235, 95% confidence interval 0.105 to 0.525). Likewise, the incidence of PONV was lower in the dexmedetomidine group (3.8%) than that in the midazolam (22%; P = 0.006) or placebo (29.4%; P
Choon Looi Bong - One of the best experts on this subject based on the ideXlab platform.
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a comparison of single dose dexmedetomidine or propofol on the incidence of Emergence Delirium in children undergoing general anaesthesia for magnetic resonance imaging
Anaesthesia, 2015Co-Authors: Choon Looi Bong, Evangeline H.l. Lim, J. C. Allen, W. L. H. Choo, Y. N. Siow, P. B. Y. Teo, J. S. K. TanAbstract:Summary Emergence Delirium is a significant problem in children regaining consciousness following general anaesthesia. We compared the Emergence characteristics of 120 patients randomly assigned to receive a single intravenous dose of dexmedetomidine 0.3 μg.kg−1, propofol 1 mg.kg−1, or 10 ml saline 0.9% before emerging from general anaesthesia following a magnetic resonance imaging scan. Emergence Delirium was diagnosed as a score of 10 or more on the Paediatric Anaesthesia Emergence Delirium scale. The incidence of Emergence Delirium was 42.5% in the dexmedetomidine group, 33.3% in the propofol group and 41.5% in the saline group (p = 0.671). Three patients in the dexmedetomidine group, none in the propofol group and two in the saline group required pharmacological intervention for Emergence Delirium (p = 0.202). Administration of neither dexmedetomidine nor propofol significantly reduced the incidence, or severity, of Emergence Delirium. The only significant predictor for Emergence Delirium was the time taken to awaken from general anaesthesia, with every minute increase in wake-up time reducing the odds of Emergence Delirium by 7%.
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A comparison of single‐dose dexmedetomidine or propofol on the incidence of Emergence Delirium in children undergoing general anaesthesia for magnetic resonance imaging
Anaesthesia, 2014Co-Authors: Choon Looi Bong, Evangeline H.l. Lim, J. C. Allen, W. L. H. Choo, Y. N. Siow, P. B. Y. Teo, J. S. K. TanAbstract:Summary Emergence Delirium is a significant problem in children regaining consciousness following general anaesthesia. We compared the Emergence characteristics of 120 patients randomly assigned to receive a single intravenous dose of dexmedetomidine 0.3 μg.kg−1, propofol 1 mg.kg−1, or 10 ml saline 0.9% before emerging from general anaesthesia following a magnetic resonance imaging scan. Emergence Delirium was diagnosed as a score of 10 or more on the Paediatric Anaesthesia Emergence Delirium scale. The incidence of Emergence Delirium was 42.5% in the dexmedetomidine group, 33.3% in the propofol group and 41.5% in the saline group (p = 0.671). Three patients in the dexmedetomidine group, none in the propofol group and two in the saline group required pharmacological intervention for Emergence Delirium (p = 0.202). Administration of neither dexmedetomidine nor propofol significantly reduced the incidence, or severity, of Emergence Delirium. The only significant predictor for Emergence Delirium was the time taken to awaken from general anaesthesia, with every minute increase in wake-up time reducing the odds of Emergence Delirium by 7%.
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Evaluation of Emergence Delirium in Asian children using the Pediatric Anesthesia Emergence Delirium Scale.
Paediatric anaesthesia, 2009Co-Authors: Choon Looi BongAbstract:Summary Background: Emergence Delirium (ED) is a common problem in children recovering from general anesthesia. ED causes disruption in the postanesthetic care unit, making nursing and monitoring more difficult, and is potentially dangerous to the child. The greatest hindrance to understanding ED was the lack of a standardized tool to assess it. The Pediatric Anesthesia Emergence Delirium (PAED) Scale was recently described to measure the degree of ED in children. In this prospective observational study, we sought to evaluate the incidence of ED by grading Emergence behavior using the PAED Score in healthy Asian children undergoing outpatient surgery. Methods: Three hundred sixteen children aged 2–12 years undergoing general anesthesia for elective outpatient surgery were included. No premedication was administered. Induction behavior was graded using the induction compliance checklist, and the presence of any excitation on induction documented. Emergence behavior was recorded using the PAED Scale, and the children were separately assessed for clinical agitation. Results: One hundred and thirty-six children (43%) had PAED Scores >0 and 33 (10.4%) had PAED Scores of ≥10. Only 28 children (8.9%) had clinical agitation consistent with ED, the rest were agitated for other reasons. A score of ≥10 on the PAED Scale was the best discriminator between presence and absence of clinical agitation. The area under the receiver operating characteristic curve for PAED Score of ≥10 was 0.98, with a true-positive rate (sensitivity) of 0.85 and a false-positive rate (1-specificity) of 0.041. Four factors were found to be predictive of ED. These include young age, poor compliance at induction, lack of intraoperative fentanyl use and rapid time to awakening. Conclusions: The incidence of ED is approximately 10% in our population of healthy, unpremedicated Asian children undergoing day surgery. Young age, poor compliance at induction, lack of intraoperative fentanyl use and rapid time to awakening were predictive risk factors for ED in our population. A PAED Score of ≥10 was correlated with clinically significant ED and appeared to be the ideal cutoff score for ED.
Yusheng Yao - One of the best experts on this subject based on the ideXlab platform.
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intranasal dexmedetomidine versus oral midazolam premedication to prevent Emergence Delirium in children undergoing strabismus surgery a randomised controlled trial
European Journal of Anaesthesiology, 2020Co-Authors: Yusheng Yao, Yang Sun, Jiancheng Lin, Wenjun Chen, Ying Lin, Xiaochun ZhengAbstract:BACKGROUND Dexmedetomidine is being used increasingly as a premedicant in the paediatric population. However, the effectiveness of pre-operative intranasal dexmedetomidine premedication, compared with oral midazolam, for Emergence Delirium is not well characterised. OBJECTIVE To identify the effectiveness of pre-operative intranasal dexmedetomidine for Emergence Delirium in the paediatric patient population following general anaesthesia. DESIGN A prospective, randomised, double-blind, parallel-group, placebo-controlled trial. SETTING Single university teaching hospital, from September 2013 to August 2014. PATIENTS One hundred and fifty-six patients undergoing anaesthesia for strabismus surgery were included in the study. INTERVENTION Patients were randomised in a 1 : 1 : 1 ratio to receive premedication with intranasal dexmedetomidine 2 μg kg (the dexmedetomidine group), oral midazolam 0.5 mg kg (the midazolam group), or 0.9% saline (the placebo group). MAIN OUTCOME MEASURES The primary outcome was the incidence of Emergence Delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included the quality of the inhalational induction, Emergence time, postoperative pain intensity, length of stay in the postanaesthesia care unit, the incidence of postoperative nausea or vomiting (PONV) and parents' satisfaction. RESULTS The incidence of Emergence Delirium was lower in patients given dexmedetomidine compared with that in patients given midazolam (11.5 versus 44%, relative risk = 0.262, 95% confidence interval 0.116 to 0.592) or 0.9% saline (11.5 versus 49%, relative risk = 0.235, 95% confidence interval 0.105 to 0.525). Likewise, the incidence of PONV was lower in the dexmedetomidine group (3.8%) than that in the midazolam (22%; P = 0.006) or placebo (29.4%; P < 0.001) groups. However, there was no difference among the groups concerning postoperative pain scores and length of postanaesthesia care unit stay. CONCLUSION In paediatric patients undergoing strabismus surgery intranasal dexmedetomidine 2 μg kg premedication decreases the incidence of Emergence Delirium and PONV, and improves parents' satisfaction compared with oral midazolam. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT01895023).
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Intranasal dexmedetomidine versus oral midazolam premedication to prevent Emergence Delirium in children undergoing strabismus surgery: A randomised controlled trial.
European journal of anaesthesiology, 2020Co-Authors: Yusheng Yao, Yang Sun, Jiancheng Lin, Wenjun Chen, Ying Lin, Xiaochun ZhengAbstract:BACKGROUND Dexmedetomidine is being used increasingly as a premedicant in the paediatric population. However, the effectiveness of pre-operative intranasal dexmedetomidine premedication, compared with oral midazolam, for Emergence Delirium is not well characterised. OBJECTIVE To identify the effectiveness of pre-operative intranasal dexmedetomidine for Emergence Delirium in the paediatric patient population following general anaesthesia. DESIGN A prospective, randomised, double-blind, parallel-group, placebo-controlled trial. SETTING Single university teaching hospital, from September 2013 to August 2014. PATIENTS One hundred and fifty-six patients undergoing anaesthesia for strabismus surgery were included in the study. INTERVENTION Patients were randomised in a 1 : 1 : 1 ratio to receive premedication with intranasal dexmedetomidine 2 μg kg (the dexmedetomidine group), oral midazolam 0.5 mg kg (the midazolam group), or 0.9% saline (the placebo group). MAIN OUTCOME MEASURES The primary outcome was the incidence of Emergence Delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included the quality of the inhalational induction, Emergence time, postoperative pain intensity, length of stay in the postanaesthesia care unit, the incidence of postoperative nausea or vomiting (PONV) and parents' satisfaction. RESULTS The incidence of Emergence Delirium was lower in patients given dexmedetomidine compared with that in patients given midazolam (11.5 versus 44%, relative risk = 0.262, 95% confidence interval 0.116 to 0.592) or 0.9% saline (11.5 versus 49%, relative risk = 0.235, 95% confidence interval 0.105 to 0.525). Likewise, the incidence of PONV was lower in the dexmedetomidine group (3.8%) than that in the midazolam (22%; P = 0.006) or placebo (29.4%; P
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intranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion and Emergence Delirium in children a prospective randomized double blind placebo controlled trial
Pediatric Anesthesia, 2015Co-Authors: Yusheng Yao, Ying Lin, Bin Qian, Yanqing ChenAbstract:Summary Background We conducted a prospective, randomized, double-blind, placebo-controlled study to verify the hypothesis that intranasal dexmedetomidine premedication can reduce the minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion in children. Methods Ninety American Society of Anesthesiologists (ASA) physical status I subjects, aged 3–7 years, were randomized to three equal groups to receive saline (Group S), dexmedetomidine 1 μg·kg−1 (Group D1), or dexmedetomidine 2 μg·kg−1 (Group D2) approximately 45 min before anesthesia. The minimum alveolar concentration for laryngeal mask airway insertion of sevoflurane was determined according to the Dixon's up-and-down method. Emergence Delirium was evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scale in the postanesthesia care unit (PACU). Results Dexmedetomidine premedication of 1 and 2 μg·kg−1 was associated with reduction in sevoflurane from 1.92% to 1.53% and 1.23%, corresponding to decrease of 20% and 36%, respectively. The peak PAED scores (median [IQR]) were 9 [8–11.5], 5 [3–5.3], and 3 [2–4] in Group S, Group D1, and Group D2, respectively. The incidence of Emergence Delirium (defined as peak PAED score ≥10) was significantly lower in Groups D1 and D2 than in Group S (P < 0.001). Simultaneously, the induction qualities and the parent's satisfaction scores were significantly higher in Groups D1 and D2 than in Group S (P < 0.001). Conclusion Intranasal dexmedetomidine premedication produces a dose-dependent decrease in the minimum alveolar concentration for laryngeal mask airway insertion of sevoflurane and Emergence Delirium in the PACU.
Claudia Spies - One of the best experts on this subject based on the ideXlab platform.
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Emergence Delirium in children is not related to intraoperative Burst Suppression – prospective, observational Electrography study
2019Co-Authors: Susanne Koch, Annamaria Stegherr, Leopold Rupp, Christine Prager, Astrid V Fahlenkamp, Jochen Kruppa, Sylvia Kramer, Claudia SpiesAbstract:Abstract Background: Emergence-Delirium is the most frequent brain dysfunction in children recovering from general anaesthesia, though the pathophysiological background remains unclear. The presented study analysed an association between Emergence Delirium and intraoperative Burst Suppression activity in the electroencephalogram, a period of very deep hypnosis during general anaesthesia. Methods: In this prospective, observational cohort study at the Charité - university hospital in Berlin / Germany children aged 0.5 to 8 years, undergoing planned surgery, were included between September 2015 and February 2017. Intraoperative bi-frontal electroencephalograms were recorded. Occurrence and duration of Burst Suppression periods were visually analysed. Emergence Delirium was assessed using the Pediatric Assessment of Emergence Delirium Score. Results: From 97 children being analysed within this study, 40 children developed Emergence Delirium, and 57 children did not. Overall 52% of the children displayed intraoperative Burst Suppression periods; however, occurrence and duration of Burst Suppression (Emergence Delirium group 55% / 261+462sec vs. Non-Emergence Delirium group 49% / 318+531sec) did not differ significantly between both groups. Conclusions: Our data reveal no correlation between the occurrence and duration of intraoperative Burst Suppression activity and the incidence of Emergence Delirium. Burst Suppression occurrence is frequent; however, it does not seem to have an unfavourable impact on cerebral function at Emergence from general anaesthesia in children. Trail registration: NCT02481999, June 25, 2015
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Emergence Delirium in children is not related to intraoperative burst suppression prospective observational electrography study
BMC Anesthesiology, 2019Co-Authors: Susanne Koch, Annamaria Stegherr, Leopold Rupp, Christine Prager, Astrid V Fahlenkamp, Jochen Kruppa, Sylvia Kramer, Claudia SpiesAbstract:Background Emergence-Delirium is the most frequent brain dysfunction in children recovering from general anaesthesia, though the pathophysiological background remains unclear. The presented study analysed an association between Emergence Delirium and intraoperative Burst Suppression activity in the electroencephalogram, a period of very deep hypnosis during general anaesthesia.
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Emergence Delirium in children is not related to intraoperative burst suppression – prospective, observational electrography study
BMC Anesthesiology, 2019Co-Authors: Susanne Koch, Annamaria Stegherr, Leopold Rupp, Christine Prager, Astrid V Fahlenkamp, Jochen Kruppa, Sylvia Kramer, Claudia SpiesAbstract:Background Emergence-Delirium is the most frequent brain dysfunction in children recovering from general anaesthesia, though the pathophysiological background remains unclear. The presented study analysed an association between Emergence Delirium and intraoperative Burst Suppression activity in the electroencephalogram, a period of very deep hypnosis during general anaesthesia.
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Emergence Delirium in children is not related to intraoperative Burst Suppression – prospective, observational Electrography study
2019Co-Authors: Susanne Koch, Annamaria Stegherr, Leopold Rupp, Christine Prager, Astrid V Fahlenkamp, Jochen Kruppa, Sylvia Kramer, Claudia SpiesAbstract:Abstract Background: Emergence-Delirium is the most frequent brain dysfunction in children recovering from general anaesthesia, though the pathophysiological background remains unclear. The presented study analysed an association between Emergence Delirium and intraoperative burst suppression activity in the electroencephalogram, a period of very deep hypnosis during general anaesthesia. Methods: In this prospective, observational cohort study at the Charité - university hospital in Berlin / Germany children aged 0.5 to 8 years, undergoing planned surgery, were included between September 2015 and February 2017. Intraoperative bi-frontal electroencephalogram were recorded. Occurrence and duration of burst suppression periods were visually analysed. Emergence Delirium was assessed with the Pediatric Assessment of Emergence Delirium Score. Results: From 97 children being analysed within this study, 40 children developed Emergence Delirium, and 57 children did not. Overall 52% of the children displayed intraoperative burst suppression periods; however, occurrence and duration of burst suppression (Emergence Delirium group 55% / 261+462sec vs. Non-Emergence Delirium group 49% / 318+531sec) did not differ between both groups. Conclusions: Our data reveal no correlation between the occurrence and duration of intraoperative burst suppression activity and the incidence of Emergence Delirium. Burst suppression occurrence is frequent; however, it does not seem to have an unfavourable impact on cerebral function at Emergence from general anaesthesia in children.
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Emergence Delirium in children and intraoperative Electroencephalogram Burst Suppression – findings from a prospective, observational study
2019Co-Authors: Susanne Koch, Annamaria Stegherr, Leopold Rupp, Christine Prager, Astrid V Fahlenkamp, Jochen Kruppa, Sylvia Kramer, Claudia SpiesAbstract:Abstract Background Emergence-Delirium is the most frequent brain dysfunction in children recovering from general anaesthesia, though the pathophysiological background remains unclear. The presented study analysed an association between Emergence Delirium and intraoperative burst suppression activity in the electroencephalogram, a period of very deep hypnosis during general anaesthesia. Methods In this prospective, observational cohort study at the Charité - university hospital in Berlin / Germany children aged 0.5 to 8 years old, undergoing planned surgery, were included between September 2015 and February 2017. Intraoperative bi-frontal electroencephalogram monitoring were recorded. Occurrence and duration of burst suppression periods were visually analysed. Emergence Delirium was assessed with the Pediatric Assessment of Emergence Delirium Score. Results From 97 children being analysed within this study, 40 children developed Emergence Delirium, and 57 children did not. Overall 52% of the children displayed intraoperative burst suppression periods; however, occurrence and duration of burst suppression (Emergence Delirium group 55% / 261+462sec vs. Non-Emergence Delirium group 49% / 318+531sec) did not differ in between both groups. Conclusions Our data reveal no correlation between the occurrence and duration of intraoperative burst suppression activity and the incidence of Emergence Delirium. Burst suppression occurrence is frequent; however, it does not seem to have an unfavourable impact on cerebral function at Emergence from general anaesthesia in children.
Kazuyoshi Aoyama - One of the best experts on this subject based on the ideXlab platform.
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Dexmedetomidine vs. total intravenous anaesthesia in paediatric Emergence Delirium: A network meta-analysis.
European journal of anaesthesiology, 2021Co-Authors: Maria-alexandra Petre, David N Levin, Marina Englesakis, Jason T Maynes, Petros Pechlivanoglou, Kazuyoshi AoyamaAbstract:Emergence Delirium is a common complication in paediatric anaesthesia associated with significant morbidity. Total intravenous anaesthesia (TIVA) and intra-operative dexmedetomidine as an adjuvant to sevoflurane anaesthesia can both reduce the incidence of Emergence Delirium compared with sevoflurane alone, but no studies have directly compared their relative efficacy. The study objective was to compare the effects of TIVA and dexmedetomidine on the incidence of paediatric Emergence Delirium. The current study is a systematic review and network meta-analysis (NMA) of randomised controlled trials. We conducted a systematic search of 12 databases including Medline (Ovid) and Web of Science (Clarivate Analytics) from their respective inception to December 2020. Inclusion criteria were randomised controlled trials of paediatric patients undergoing general anaesthesia using sevoflurane, sevoflurane with dexmedetomidine or TIVA. Data were extracted by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and analysed using NMA methodology. Risk ratios and 95% credible intervals (CrI) were calculated for all outcomes [Emergence Delirium, postoperative nausea and vomiting (PONV), and time to Emergence and extubation]. The protocol was registered with PROSPERO (CRD42018091237). The systematic review returned 66 eligible studies comprising 5257 patients with crude median Emergence Delirium incidences of 12.8, 9.1 and 40% in the dexmedetomidine with sevoflurane, TIVA and sevoflurane alone groups, respectively. NMA indicated that compared with TIVA, sevoflurane with adjuvant dexmedetomidine decreased the incidence of Emergence Delirium without statistical difference (risk ratio 0.88, 95% CrI 0.61 to 1.20, low quality of evidence), but resulted in a higher incidence of PONV (risk ratio: 2.3, 95% CrI 1.1 to 5.6, low quality of evidence). Clinical judgement, considering the patient's risk factors for the development of clinically significant outcomes such as Emergence Delirium and PONV, should be used when choosing between TIVA and sevoflurane with adjuvant dexmedetomidine. These findings are limited by the low quality of evidence (conditional recommendation). Copyright © 2021 European Society of Anaesthesiology.
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dexmedetomidine vs total intravenous anaesthesia in paediatric Emergence Delirium a network meta analysis
European Journal of Anaesthesiology, 2021Co-Authors: Maria-alexandra Petre, David N Levin, Marina Englesakis, Jason T Maynes, Petros Pechlivanoglou, Kazuyoshi AoyamaAbstract:BACKGROUND Emergence Delirium is a common complication in paediatric anaesthesia associated with significant morbidity. Total intravenous anaesthesia (TIVA) and intra-operative dexmedetomidine as an adjuvant to sevoflurane anaesthesia can both reduce the incidence of Emergence Delirium compared with sevoflurane alone, but no studies have directly compared their relative efficacy. OBJECTIVE The study objective was to compare the effects of TIVA and dexmedetomidine on the incidence of paediatric Emergence Delirium. STUDY DESIGN The current study is a systematic review and network meta-analysis (NMA) of randomised controlled trials. DATA SOURCES We conducted a systematic search of 12 databases including Medline (Ovid) and Web of Science (Clarivate Analytics) from their respective inception to December 2020. ELIGIBILITY Inclusion criteria were randomised controlled trials of paediatric patients undergoing general anaesthesia using sevoflurane, sevoflurane with dexmedetomidine or TIVA. Data were extracted by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and analysed using NMA methodology. Risk ratios and 95% credible intervals (CrI) were calculated for all outcomes [Emergence Delirium, postoperative nausea and vomiting (PONV), and time to Emergence and extubation]. The protocol was registered with PROSPERO (CRD42018091237). RESULTS The systematic review returned 66 eligible studies comprising 5257 patients with crude median Emergence Delirium incidences of 12.8, 9.1 and 40% in the dexmedetomidine with sevoflurane, TIVA and sevoflurane alone groups, respectively. NMA indicated that compared with TIVA, sevoflurane with adjuvant dexmedetomidine decreased the incidence of Emergence Delirium without statistical difference (risk ratio 0.88, 95% CrI 0.61 to 1.20, low quality of evidence), but resulted in a higher incidence of PONV (risk ratio: 2.3, 95% CrI 1.1 to 5.6, low quality of evidence). CONCLUSION Clinical judgement, considering the patient's risk factors for the development of clinically significant outcomes such as Emergence Delirium and PONV, should be used when choosing between TIVA and sevoflurane with adjuvant dexmedetomidine. These findings are limited by the low quality of evidence (conditional recommendation).