Prophylactic midazolam and clonidine for emergence from agitation in children
after emergence from sevoflurane anesthesia: a meta-analysis.
Author(s): Zhang C(1), Li J, Zhao D, Wang Y.
Affiliation(s): Author information:
(1)Department of Anesthesiology, Xinhua Hospital, Shanghai Jiaotong University
School of Medicine, Shanghai, China.
Publication date & source: 2013, Clin Ther. , 35(10):1622-31
BACKGROUND: Emergence agitation (EA) after emergence from sevoflurane anesthesia
is a common phenomenon in children. The efficacy of prophylactic midazolam or
clonidine in preventing EA is controversial.
OBJECTIVE: We performed a meta-analysis of clinical trials of the 2 drugs to
evaluate their ability to prevent EA in pediatric patients after emergence from
sevoflurane anesthesia.
METHODS: A comprehensive literature search was conducted to identify clinical
trials that observed the effect of midazolam and clonidine on preventing EA in
children after their emergence from sevoflurane anesthesia. All data were
examined using the Mantel-Haenszel model to calculate the pooled odds ratio (OR)
and 95% CI. I(2) was used to assess heterogeneity. Subgroup analysis was used to
assess the effects of preoperative analgesics, routes of administration, and
dose, and funnel plots were used to check publication bias.
RESULTS: After a comprehensive literature search, we found 12 papers that met the
criteria for inclusion in this analysis, with a total of 447 children in the
midazolam group and 767 children in the clonidine group. We found that both
midazolam and clonidine decreased the incidence of EA (OR = 0.45 [95% CI,
0.29-0.70], P = 0.0004, I(2) = 46%; and OR = 0.24 [95% CI, 0.13-0.43], P <
0.00001, I(2) = 48%, respectively). Subgroup analysis indicated that preoperative
analgesia may decrease the effect of midazolam against EA, whereas for clonidine,
neither the route of administration (intravenous or caudal) nor the dose affected
the results. Funnel plots did not detect publication bias in the midazolam group,
but a bias was detected in the clonidine group.
CONCLUSIONS: This meta-analysis suggests that prophylactic administration of
midazolam or clonidine could significantly decrease the incidence of
sevoflurane-induced EA in pediatric patients.
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