Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients : a systematic review and meta-analysis of randomized controlled trials
© 2022. Canadian Anesthesiologists' Society..
PURPOSE: To compare the efficacy and safety of intranasal ketamine with intranasal dexmedetomidine as a premedication in pediatric patients undergoing general anesthesia for elective surgery or other procedures.
SOURCE: We conducted a systematic literature search in PubMed, PubMed Central, Scopus, LILACS, Google Scholar, the Cochrane Database of Systematic Reviews, and trial registries for randomized controlled trials (RCTs) comparing intranasal ketamine with intranasal dexmedetomidine as preanesthetic medication in elective surgery or other procedures in pediatric patients. We used Review Manager software version 5.4.1 for statistical analysis and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed the methodological quality of the included studies with the RoB 2 risk of bias tool. All outcomes were pooled using the Mantle-Haenszel method and a random-effects model. The quality of evidence was assessed using the GRADE approach.
PRINCIPAL FINDINGS: Out of 2,445 full texts assessed, we included ten RCTs in the analysis. The efficacy outcomes did not fulfill the comparability criteria between intranasal ketamine and intranasal dexmedetomidine for sedation at parental separation (risk ratio [RR], 0.90; 95% confidence interval [CI], 0.79 to 1.04; I2 = 89%; GRADE evidence, low), mask acceptance (RR, 0.86; 95% CI, 0.66 to 1.13; I2 = 50%; GRADE evidence, low), and iv canulation (RR, 1.16; 95% CI, 0.79 to 1.69; I2 = 69%; GRADE evidence, very low). Intranasal ketamine-treated patients showed a higher incidence of nausea and vomiting (RR, 2.47; 95% CI, 1.24 to 4.91; I2 = 0; GRADE evidence, moderate). Significantly more bradycardia was observed in the intranasal dexmedetomidine group (RR, 0.16; 95% CI, 0.04 to 0.70; I2 = 40%; GRADE evidence, moderate) than in the ketamine group.
CONCLUSION: The low to very low-quality evidence in this systematic review and meta-analysis of RCTs neither confirmed nor refuted comparable premedication efficacy of intranasal ketamine and dexmedetomidine in terms of parental separation, mask acceptance, and iv cannulation in a pediatric population. Clinical decision-making is likely to be influenced by differences in gastrointestinal and cardiovascular safety profiles.
STUDY REGISTRATION: PROSPERO (CRD42021262516); registered 22 July 2021.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:69 |
|---|---|
| Enthalten in: |
Canadian journal of anaesthesia = Journal canadien d'anesthesie - 69(2022), 11 vom: 13. Nov., Seite 1405-1418 |
| Sprache: |
Englisch |
|---|
| Weiterer Titel: |
Efficacité et innocuité de la kétamine intranasale comparée à la dexmédétomidine intranasale comme prémédication avant une anesthésie générale chez les patients pédiatriques : revue systématique et méta-analyse d’études randomisées contrôlées |
|---|
| Beteiligte Personen: |
Dwivedi, Priyanka [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
67VB76HONO |
|---|
| Anmerkungen: |
Date Completed 25.10.2022 Date Revised 26.12.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1007/s12630-022-02305-1 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM344896870 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM344896870 | ||
| 003 | DE-627 | ||
| 005 | 20231229123824.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1007/s12630-022-02305-1 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1240.xml |
| 035 | |a (DE-627)NLM344896870 | ||
| 035 | |a (NLM)35970989 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Dwivedi, Priyanka |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients |b a systematic review and meta-analysis of randomized controlled trials |
| 246 | 3 | 3 | |a Efficacité et innocuité de la kétamine intranasale comparée à la dexmédétomidine intranasale comme prémédication avant une anesthésie générale chez les patients pédiatriques : revue systématique et méta-analyse d’études randomisées contrôlées |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 25.10.2022 | ||
| 500 | |a Date Revised 26.12.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022. Canadian Anesthesiologists' Society. | ||
| 520 | |a PURPOSE: To compare the efficacy and safety of intranasal ketamine with intranasal dexmedetomidine as a premedication in pediatric patients undergoing general anesthesia for elective surgery or other procedures | ||
| 520 | |a SOURCE: We conducted a systematic literature search in PubMed, PubMed Central, Scopus, LILACS, Google Scholar, the Cochrane Database of Systematic Reviews, and trial registries for randomized controlled trials (RCTs) comparing intranasal ketamine with intranasal dexmedetomidine as preanesthetic medication in elective surgery or other procedures in pediatric patients. We used Review Manager software version 5.4.1 for statistical analysis and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed the methodological quality of the included studies with the RoB 2 risk of bias tool. All outcomes were pooled using the Mantle-Haenszel method and a random-effects model. The quality of evidence was assessed using the GRADE approach | ||
| 520 | |a PRINCIPAL FINDINGS: Out of 2,445 full texts assessed, we included ten RCTs in the analysis. The efficacy outcomes did not fulfill the comparability criteria between intranasal ketamine and intranasal dexmedetomidine for sedation at parental separation (risk ratio [RR], 0.90; 95% confidence interval [CI], 0.79 to 1.04; I2 = 89%; GRADE evidence, low), mask acceptance (RR, 0.86; 95% CI, 0.66 to 1.13; I2 = 50%; GRADE evidence, low), and iv canulation (RR, 1.16; 95% CI, 0.79 to 1.69; I2 = 69%; GRADE evidence, very low). Intranasal ketamine-treated patients showed a higher incidence of nausea and vomiting (RR, 2.47; 95% CI, 1.24 to 4.91; I2 = 0; GRADE evidence, moderate). Significantly more bradycardia was observed in the intranasal dexmedetomidine group (RR, 0.16; 95% CI, 0.04 to 0.70; I2 = 40%; GRADE evidence, moderate) than in the ketamine group | ||
| 520 | |a CONCLUSION: The low to very low-quality evidence in this systematic review and meta-analysis of RCTs neither confirmed nor refuted comparable premedication efficacy of intranasal ketamine and dexmedetomidine in terms of parental separation, mask acceptance, and iv cannulation in a pediatric population. Clinical decision-making is likely to be influenced by differences in gastrointestinal and cardiovascular safety profiles | ||
| 520 | |a STUDY REGISTRATION: PROSPERO (CRD42021262516); registered 22 July 2021 | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a dexmedetomidine | |
| 650 | 4 | |a ketamine | |
| 650 | 4 | |a meta-analysis | |
| 650 | 4 | |a preanesthetic medication | |
| 650 | 7 | |a Dexmedetomidine |2 NLM | |
| 650 | 7 | |a 67VB76HONO |2 NLM | |
| 650 | 7 | |a Ketamine |2 NLM | |
| 650 | 7 | |a 690G0D6V8H |2 NLM | |
| 650 | 7 | |a Analgesics |2 NLM | |
| 700 | 1 | |a Patel, Tejas K |e verfasserin |4 aut | |
| 700 | 1 | |a Bajpai, Vijeta |e verfasserin |4 aut | |
| 700 | 1 | |a Singh, Yashpal |e verfasserin |4 aut | |
| 700 | 1 | |a Tripathi, Alka |e verfasserin |4 aut | |
| 700 | 1 | |a Kishore, Suerkha |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Canadian journal of anaesthesia = Journal canadien d'anesthesie |d 1987 |g 69(2022), 11 vom: 13. Nov., Seite 1405-1418 |w (DE-627)NLM012607282 |x 1496-8975 |7 nnns |
| 773 | 1 | 8 | |g volume:69 |g year:2022 |g number:11 |g day:13 |g month:11 |g pages:1405-1418 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1007/s12630-022-02305-1 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 69 |j 2022 |e 11 |b 13 |c 11 |h 1405-1418 | ||