Pediatric anesthesia & critical care
Optimizing pediatric premedication for general anesthesia: A comprehensive Bayesian network meta-analysis
Authors' conclusion
Dexmedetomidine-, midazolam-, and ketamine-based combinations offer superior preoperative cooperation in pediatric patients, as demonstrated by higher success rates of mask acceptance, intravenous cannulation acceptance, and parental separation acceptance.
Study context
- Population
- Children aged 1–12 years, American Society of Anesthesiologists (ASA) I–III, undergoing elective surgery under GA, receiving premedication
- Participants
- 5,794 children · 69 trials
- Comparison
- Premedication strategies by drug, dose, route and timing
- Outcome
- Satisfactory mask acceptance (primary analysis: each drug, dose, route and timing combination as a distinct intervention)
Methodological detailsBayesian framework, meta-regression, sensitivity analyses, risk of bias assessment
- Bayesian framework
- Meta-regression
- Sensitivity analyses
- Risk of bias assessment
Pooled result
As reported in the abstract
Satisfactory mask acceptance (primary analysis)
- Combinations of dexmedetomidine, midazolam and ketamine had the highest probabilities of satisfactory mask acceptance
- Intranasal administration at shorter premedication intervals (15-30 min) showed greater efficacy
- Clonidine, melatonin and diazepam comparatively less effective
- Only mask acceptance could be evaluated in the primary analysis
Further pooled results
Mask, IV cannulation and parental separation acceptance (secondary analysis grouped by agent)
- Similar findings: dexmedetomidine- and midazolam-based combinations ranked highest; clonidine, melatonin and diazepam remained less effective
Original publication
Optimizing pediatric premedication for general anesthesia: A comprehensive Bayesian network meta-analysis. J Clin Anesth. Published 14 June 2025. doi:10.
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