| Background and Objective: It is estimated that 60% of children undergoing anesthesia develop severe preoperative anxiety.The anxiety is associated with postoperative adverse reactions.Sedatives such as dexmedetomidine,midazolam,clonidine,ketamine,and melatonin can be used as premedication against preoperative anxiety.However,no consensus has been reached on the choice of pre-anesthetic sedatives in children before selective surgery.Therefore,the current Bayesian network meta-analysis(NMA)was carried out to evaluate different sedatives in children aged between 1 and 7 before general anesthesia for selective surgery.Methods: Randomized controlled trials(RCTs)were retrieved from Pubmed,Embase,Cochrane Central Register of Controlled Trials(CENTRAL),Web of Science,CNKI,Chinese biomedical literature database(CBM)and Wanfang from inception to November 30,2022.Six different interventions were studied,including dexmedetomidine,midazolam,ketamine,clonidine,melatonin,and placebo.Primary outcomes showed satisfactory sedation at parent separation and also at induction or mask acceptance.Secondary outcomes were those related to the correlative side effects after interventions or surgery.The present Bayesian NMA was conducted based on random effects model using the R software.Results of the study were reported as Relative Risk(RR)or Mean Difference(MD)at a 95%CI.Subgroup analyses and meta regression were performed for pairwise meta analyses with significant heterogeneity。Results: 84 RCTs were included in the present study.It was found that the effectiveness of dexmedetomidine,midazolam,and ketamine were superior to that of placebo in satisfactory sedation at parent separation and also at induction or mask acceptance.Dexmedetomidine,ketamine,clonidine and melatonin were superior to placebo in reducing the emergence delirium(ED).Dexmedetomidine can also reduce the incidence of postoperative nausea and vomiting(PONV).In addition,midazolam can prolong the length of stay in the postanesthesia care unit(PACU).Dexmedetomidine caused a significant reduction in mean arterial pressure(MAP)and heart rate.Nevertheless,it was noted that the hemodynamic changes were roughly within safety limits.Conclusion: It was evident that dexmedetomidine,midazolam and ketamine can provide effective sedation.However,it was found that midazolam and ketamine lead to severe side effects.The findings of the present study supported that dexmedetomidine,especially intranasal administration with 1 μg/kg at 30 min before separation,has potential in the optimal selection of the sedatives for premedication in children.This is because the strategy has effective sedation,reduced incidence of ED,side effects,and onset time. |
