Risk factors and incidence of postoperative delirium after cardiac surgery in children: a systematic review and meta-analysis DOI Creative Commons

Maoling Fu,

Quan Yuan,

Qiaoyue Yang

et al.

˜The œItalian Journal of Pediatrics/Italian journal of pediatrics, Journal Year: 2024, Volume and Issue: 50(1)

Published: Feb. 8, 2024

Delirium, a form of acute cerebral dysfunction, is common complication postoperative cardiac surgery in children. It strongly associated with adverse outcomes, including prolonged hospitalization, increased mortality, and cognitive dysfunction. This study aimed to identify risk factors incidence delirium after children facilitate early identification provide reference for the implementation effective prevention management. A systematic literature search was conducted PubMed, Web Science, Embase, Cochrane Library, Scopus, CNKI, Sinomed, Wanfang studies published English or Chinese from inception each database November 2023. The PRISMA guidelines were followed all phases this review. Risk Bias Assessment Nonrandomized Studies tool used assess methodological quality. total twelve included analysis, four classified as overall low bias, seven moderate one high bias. reported 39 possible predictors delirium, categorized into broad groups: intrinsic parent-related factors, disease-related treatment-related clinical scores laboratory parameters. By conducting qualitative synthesis quantitative meta-analysis, we identified two definite 32 unclear related delirium. Definite age mechanical ventilation duration. Possible developmental delay, cyanotic heart disease, cardiopulmonary bypass time, pain score. With only few high-quality currently available, well-designed more extensive prospective are still needed investigate affecting explore strategies high-risk

Language: Английский

Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity DOI Open Access

Grégoire Blaudszun,

Christopher Lysakowski,

Nadia Elia

et al.

Anesthesiology, Journal Year: 2012, Volume and Issue: 116(6), P. 1312 - 1322

Published: May 1, 2012

Systemic α2 agonists are believed to reduce pain and opioid requirements after surgery, thus decreasing the incidence of opioid-related adverse effects, including hyperalgesia.The authors searched for randomized placebo-controlled trials testing systemic administrated in surgical patients reporting on postoperative cumulative consumption and/or intensity. Meta-analyses were performed when data from 5 or more 100 could be combined.Thirty studies (1,792 patients, 933 received clonidine dexmedetomidine) included. There was evidence morphine-sparing at 24 h; weighted mean difference -4.1 mg (95% confidence interval, -6.0 -2.2) with -14.5 (-22.1 -6.8) dexmedetomidine. also a decrease intensity -0.7 cm (-1.2 -0.1) 10-cm visual analog scale -0.6 (-0.9 -0.2) The early nausea decreased both (number needed treat, approximately nine). Clonidine increased risk intraoperative harm, nine) hypotension 20). Dexmedetomidine bradycardia three). Recovery times not prolonged. No trial reported chronic hyperalgesia.Perioperative consumption, intensity, nausea. Common effects arterial hypotension. impact hyperalgesia remains unclear because valid lacking.

Language: Английский

Citations

505
Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting DOI Open Access

Gillian M. Keating

Drugs, Journal Year: 2015, Volume and Issue: 75(10), P. 1119 - 1130

Published: June 10, 2015

Language: Английский

Citations

344
Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis DOI Creative Commons
Kun Wang, Mengge Wu, Jian Xu

et al.

British Journal of Anaesthesia, Journal Year: 2019, Volume and Issue: 123(6), P. 777 - 794

Published: Oct. 24, 2019

Language: Английский

Citations

259
A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study DOI Creative Commons

Vidhi Mahendru,

Anurag Tewari,

Sunil Katyal

et al.

Journal of Anaesthesiology Clinical Pharmacology, Journal Year: 2013, Volume and Issue: 29(4), P. 496 - 496

Published: Jan. 1, 2013

Background: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and postoperative analgesia. Dexmedetomidine, the highly selective 2 adrenergic agonist is a new neuraxial adjuvant gaining popularity. Settings Design: The study was conducted in prospective, double blind manner. It included 120 American Society Anesthesiology (ASA) class I II patients undergoing lower limb surgery under spinal anesthesia after approval from hospital ethics committee written informed consent patients. Materials Methods: were randomly allocated into four groups (30 each). Group BS received 12.5 mg hyperbaric bupivacaine normal saline, group BF 25 g fentanyl, BC supplemented 30 clonidine, BD plus 5 dexmedetomidine. onset time to reach peak sensory motor level, regression block, hemodynamic changes, side effects recorded. Results: Patients had significantly longer block times than Groups BC, BF, having comparable duration block. mean two segment 147 ± 21 min BD, 117 22 119 23 102 17 (P > 0.0001). modified Bromage zero (0) 275 25, 199 26, 196 27, 161 20 BS, respectively T8 dermatome 3 not different between groups. Dexmedetomidine showed less delayed requirement rescue analgesic. Conclusions: Intrathecal dexmedetomidine associated prolonged stability, reduced demand analgesics 24 h as compared or lone bupivacaine.

Language: Английский

Citations

148
Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients DOI
Ken Chen, Zhijun Lü, Xin Yi

et al.

Cochrane library, Journal Year: 2015, Volume and Issue: 2019(1)

Published: Jan. 6, 2015

Language: Английский

Citations

138
Special indications for Opioid Free Anaesthesia and Analgesia, patient and procedure related: Including obesity, sleep apnoea, chronic obstructive pulmonary disease, complex regional pain syndromes, opioid addiction and cancer surgery DOI
Adrian Sultana, David Torres, Roman Schumann

et al.

Best Practice & Research Clinical Anaesthesiology, Journal Year: 2017, Volume and Issue: 31(4), P. 547 - 560

Published: Nov. 20, 2017

Language: Английский

Citations

124
Dexmedetomidine promotes metastasis in rodent models of breast, lung, and colon cancers DOI Creative Commons
Hagar Lavon, Pini Matzner, Amit Benbenishty

et al.

British Journal of Anaesthesia, Journal Year: 2017, Volume and Issue: 120(1), P. 188 - 196

Published: Dec. 16, 2017

Language: Английский

Citations

99
Perioperative dexmedetomidine for acute pain after abdominal surgery in adults DOI

Luise Jessen Lundorf,

Helene Korvenius Nedergaard, Ann Merete Møller

et al.

Cochrane library, Journal Year: 2016, Volume and Issue: 2016(2)

Published: Feb. 18, 2016

Language: Английский

Citations

98
Mechanisms of Dexmedetomidine in Neuropathic Pain DOI Creative Commons
Yang Zhao, Jianshuai He, Ning Yu

et al.

Frontiers in Neuroscience, Journal Year: 2020, Volume and Issue: 14

Published: May 5, 2020

Dexmedetomidine is a new-generation, highly selective α2 adrenergic receptor agonist with large number of advantages, including its sedative and analgesic properties, ability to inhibit sympathetic nerves, reduced anesthetic dosage, hemodynamic stability, mild respiratory depression abilities improve postoperative recognition. Its safety effectiveness, as well provide certain degree comfort patients, make it useful adjuvant for wide range clinical applications. For example, dexmedetomidine commonly used in patients undergoing general anesthesia, also exerts effects during tracheal intubation or mechanical ventilation intensive care unit patients. In recent years, the deepening research on dexmedetomidine, drug still applied treatment spastic pain, myofascial neuropathic complex pain syndrome chronic headache multimodal analgesia. However, we must note that appropriateness patient dose selection should be given attention when using this drug; furthermore, observed adverse reactions such hypotension bradycardia. Therefore, effectiveness long-term use remain studied. addition, basic experimental studies have found can protect important organs, brain, heart, kidney, liver lung, through various mechanisms, anti-sympathetic effects, inhibition apoptosis oxidative stress reduction inflammatory response. Moreover, neuroprotective properties received most from scholars. Hence, review, mainly focus characteristics applications especially role nervous system relief pain.

Language: Английский

Citations

94
Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies DOI Creative Commons

Myriam Bellon,

Alix Le Bot,

Daphnée Michelet

et al.

Pain and Therapy, Journal Year: 2016, Volume and Issue: 5(1), P. 63 - 80

Published: Feb. 10, 2016

Dexmedetomidine (Dex) has sedative, analgesic, and anesthetic-sparing effects. This meta-analysis examines demonstrated intraoperative postoperative effects of Dex administration during pediatric surgery.A search for randomized placebo-controlled trials was conducted to identify clinical examining use in children, infants, neonates. Primary outcome opioid consumption; secondary outcomes were: pain intensity nausea vomiting (PONV).Fourteen controlled performed painful procedures were analyzed. Intraoperative associated with significantly reduced consumption the postanesthesia care unit [PACU; risk ratio (RR) = 0.31 (0.17, 0.59), I (2) 76%, p < 0.0001 cumulative z score using trial sequential analysis], decreased PACU [standardized mean difference (SMD) -1.18 (-1.88, -0.48), 91%, 0.0001] but had no effect upon PONV incidence [RR 0.67 (0.41, 1.08), 0%, 0.48]. Subgroup analyses found administering adenotonsillectomy a bolus <0.5 µg/kg (irrespective continuous administration) without on studies outcomes. Heterogeneity high among results suspicion publication bias present all analyzed outcomes.This shows that children reduces opioids PACU. According our results, optimal dose be ≥0.5 µg/kg. Future have explore this particular point analgesic longer periods.

Language: Английский

Citations

87