Rédacteur : Johan Nguyen
Emergence agitation
Agitation au reveil
1. Systematic Reviews and Meta-Analysis
1.1. Generic acupuncture
Chen 2025 Chen YC, Foster J, Rohmah I, Schmied V, Marks A, Wang ML, Chiu HY. Comparative effect of nonpharmacological interventions on emergence delirium prevention in children following sevoflurane general anesthesia: A systematic review and network meta-analysis of randomized controlled trials. Int J Nurs Stud. 2025 Feb 22;165:105035. https://doi.org/10.1016/j.ijnurstu.2025.105035
| Backgound | Children receiving general anesthesia while undergoing surgery have a significantly high incidence of emergence delirium (ED). Nonpharmacological interventions yield beneficial effects on preventing pediatric ED. However, the relative effects of nonpharmacological interventions on pediatric ED prevention based on various perioperative phases remain unknown. |
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| Objective | To compare the effects of nonpharmacological interventions on pediatric ED prevention at different surgical phases. Design: A systematic review and network meta-analysis. Data sources: A comprehensive search of five electronic databases (PubMed, CINAHL via EBSCOhost, Embase via Elsevier, Cochrane Trials, and ProQuest Dissertations and theses) for identifying randomized control trials published from inception to October 15, 2023. |
| Methods | Two reviewers independently screened, assessed, and extracted data from the eligible studies. A random-effects network meta-analysis was used to determine the comparative effect of nonpharmacological interventions on preventing pediatric ED. |
| Results | A total of 19 studies involving 2522 children were included in this network meta-analysis. Thirteen studies reported on the prevention of pediatric ED in the preoperative phase, and six studies reported on the prevention of pediatric ED in the intraoperative phases. Multimedia devices (OR 0.39, 95 % CIs 0.20-0.74), a multicomponent program (OR 0.20, 95 % CI 0.14-0.28) significantly reduced the incidence of pediatric ED during the preoperative phase compared with usual care. During the intraoperative phase, listening to regular heartbeat sounds significantly reduced the risk of pediatric ED compared with usual care (OR 0.06, 95 % CI 0.02-0.22), placebo (OR 0.11, 95 % CI 0.03-0.36), acupuncture (OR 0.17, 95 % CI 0.03-0.88), acupuncture with electrical stimulus (OR 0.16, 95 % CI 0.04-0.68), and acupuncture with midazolam (OR 0.04, 95 % CI 0.00-0.41). |
| Conclusions | Our study results suggest that the multicomponent program and listening to heartbeat sounds are relatively effective nonpharmacological interventions for preventing pediatric ED during the perioperative phase. This study compared the effectiveness and ranking of various interventions, and the findings can serve as a guide to assist health professionals in choosing the optimal strategy for preventing ED. |
1.1.1. Mihara 2023
Mihara T, Nakajima D, Hijikata T, Tomita M, Goto T. Effectiveness of acupuncture therapy for the prevention of emergence agitation in children: A systematic review and meta-analysis with trial sequential analysis. PLoS One. 2023 Jun 6;18(6):e0286790. https://doi.org/10.1371/journal.pone.0286790
| Objective | This study aimed to evaluate the effectiveness of acupuncture therapy in preventing emergence agitation (EA) in children. |
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| Methods | A systematic review and meta-analysis were conducted across multiple locations according to the articles searched. Seven databases, including trial registration sites, were searched. |
| Results | A total of six trials were included involving 489 patients; of them, 244 received acupuncture therapy. Randomized clinical trials (RCTs) evaluating the incidence of EA compared with placebo/sham or standard care in children were included. The primary outcome was the incidence of EA, as evaluated using a specific assessment tool. Data about the incidence rate of EA, heterogeneity, quality of trials and evidence, and adverse events were collected. Additionally, data about patient demographic characteristics, type of anesthesia, duration and onset of acupuncture therapy, EA and pain score, time taken for extubation, and post-anesthesia care unit length of stay were collected. The results indicated that the overall incidence of EA in the acupuncture therapy group and the control group was 23.4% and 39.5%, respectively, with no significant difference (risk ratio, 0.62; 95% confidence interval, 0.26-1.48; I2 = 63%). Subgroup analysis showed a significant difference in the overall incidence of EA in the acupuncture therapy and control groups according to surgery type (high-risk vs. low-risk surgery), suggesting that acupuncture therapy may be effective in reducing EA for patients undergoing high-risk surgery. The quality of evidence was downgraded to “very low” due to the study designs, inconsistency, and possible publication bias. |
| Conclusions | In conclusion, this meta-analysis shows that the currently available RCTs are insufficient to determine the effectiveness of acupuncture therapy in preventing EA in children undergoing general anesthesia. |
