Prophylactic pharmacological interventions against perioperative respiratory adverse events in children undergoing noncardiac surgery: a systematic review and meta-analysis.

Summary

Across 29 RCTs (n=4452), prophylactic lidocaine and dexmedetomidine significantly reduced overall perioperative respiratory adverse events in children, with reductions observed for laryngospasm, coughing, and oxygen desaturation versus placebo. Findings support structured prophylactic strategies in high-risk pediatric anesthesia.

Key Findings

• Included 29 randomized controlled trials with 4452 pediatric patients undergoing noncardiac surgery.
• Lidocaine reduced overall PRAE (OR 0.27, 95% CI 0.17–0.42) and laryngospasm (OR 0.38, 95% CI 0.22–0.67) versus placebo.
• Dexmedetomidine reduced overall PRAE (OR 0.31, 95% CI 0.12–0.76), laryngospasm (OR 0.31, 95% CI 0.10–0.91), coughing (OR 0.24, 95% CI 0.14–0.41), and oxygen desaturation (OR 0.54, 95% CI 0.35–0.84).

Clinical Implications

Consider prophylactic lidocaine or dexmedetomidine in children at high risk of PRAE, integrating dosing and monitoring protocols within multimodal airway safety pathways. Tailor to surgical context and comorbidities.

Limitations

• Heterogeneity across dosing regimens, timing, and routes may limit direct protocol adoption.
• Abstract truncation precludes full appraisal of all intervention classes and comparative efficacy.

Future Directions

Standardize dosing and timing in future RCTs; perform network meta-analysis for head-to-head comparisons; evaluate safety profiles and long-term outcomes.