SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Obstetric and Pediatric Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1573640
This article is part of the Research TopicPrecision Medicine in Pediatrics - Volume IIView all 22 articles
Optimizing Adjuvant Strategies for Sevoflurane-Related Emergence Delirium: A Bayesian Network Meta-Analysis in Pediatric Surgery
Provisionally accepted
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Objective: To compare the efficacy of different anesthetic adjuvants combined with sevoflurane across specific surgical sites using a Bayesian network metaanalysis.Methods: A systematic review was conducted, following PRISMA guidelines, including 100 randomized controlled trials (RCTs) involving 8,800 pediatric patients undergoing various surgeries. The network meta-analysis evaluated 22 drug interventions, with log risk ratios (logRR) and Surface Under the Cumulative Ranking (SUCRA) probabilities calculated for each drug or combination.Results: Among all interventions, dexmedetomidine combined with alfentanil was the most effective in reducing ED risk for tonsillectomy/adenoidectomy, achieving a SUCRA ranking of 94.63% (logRR = -2.82). For ophthalmic surgery, propofol and midazolam showed the highest efficacy (logRR = -1.83, SUCRA: 86.03%). Dexmedetomidine combined with midazolam was the optimal combination for inguinal hernia/hypospadias (logRR = -2.16, SUCRA: 81.73%) and dental/oral repairs (logRR = -1.83, SUCRA: 94.85%). For cleft lip/palate repair, dexmedetomidine alone showed significant efficacy (logRR = -1.65, SUCRA: 89.15%). In myringotomy/cochlear implantation, fentanyl was the most effective adjuvant (logRR = -1.17, SUCRA: 80.02%).Targeted use of dexmedetomidine-based combinations was found 2 to be particularly effective across various surgeries, while fentanyl and propofol-midazolam combinations excelled in specific contexts. This study underscores the importance of tailoring anesthetic adjuvant strategies to specific surgical sites to reduce the risk of ED in pediatric patients, and provides a valuable reference for optimizing anesthetic care in this vulnerable population.
Keywords: emergence delirium, pediatric, adjuvant, Sevoflurane-Related, Network meta-analysis
Received: 09 Feb 2025; Accepted: 02 Jun 2025.
Copyright: © 2025 Zhang, Chen, Zou and Qu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hong Chen, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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