A Systematic Review: Dexmedetomidine Versus Placebo to Decrease the Incidence of Emergence Delirium/Emergence Agitation (ED/EA) in Pediatric Patients
Background: Emergence delirium/emergence agitation (ED/EA) has a reported incidence of up to 73% after general anesthesia (GA) in children. The implications of ED/EA are broad and include patient complications, increased nursing care intensity, and increased hospital costs. Objective: The objective of this systematic review is to appraise available randomized control trials (RCTs) comparing intravenous dexmedetomidine to placebo in decreasing the incidence of ED/EA among children after GA. Method: We conducted a comprehensive search of the literature using Medline from 1950 through September 2007 and CINHAL from 1982 through September 2007, as well as PubMed and The Cochrane Library. Four RCTs were included in the review and were appraised for methodological quality by each author. Results: Evaluation of the primary study outcomes showed an overall decreased incidence of ED/EA in those groups that received dexmedetomidine versus placebo. Conclusion: Though these RCTs demonstrate statistically significant reduction of ED/EA after GA among children who receive dexmedetomidine, the clinical significance of this pharmacologic intervention is not clear. Further research is necessary to determine cost–benefit of dexmedetomidine to prevent ED/EA in children after GA and the effect of dexmedetomidine on ED/EA compared to other agents.