Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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PloS one
Effects of nebulized dexmedetomidine for premedication on the parameters of oxidative and inflammatory stress in children undergoing tonsillotomy and adenoidectomy: A pilot randomized controlled trial
BACKGROUND: This prospective randomized clinical pilot study aimed to evaluate the effect of inhaled Dexmedetomidine in premedication in children after tonsillectomy with adenoidectomy on oxidative and inflammatory stress and the drugs impact on clinical parameters such as perioperative sedation, hemodynamics, respiratory function, postoperative delirium, analgesia, opioid consumption and frequency of complications. METHODS: Children aged 4-13 years with an indication for tonsillotomy with adenoidectomy were randomized into two groups: (D) - Dexmedetomidine treated group and (N) - control, non-treated group. Ramsey's sedation score, Bispectral index (BIS), and vital signs (heart rate, respiratory rate, noninvasive blood pressure and hemoglobin oxygen saturation) were monitored perioperatively in at defined time points. After 15 minutes of extubation, the postoperative delirium score (PEAD) and pain score (VAS) were noticed. Pain scores were monitored for up to 12 postoperative hours every three hours on the ward. Venous blood samples were taken before intervention and after surgery to evaluate redox homeostasis (levels of malondialdehyde - MDA, nitrogen monoxide, glutathione and sulfhydryl groups and the activity of superoxide dismutase and catalase) and inflammatory parameters (blood count, neutrophile/lymphocyte ratio, C-reactive protein and Interleukin 6). Perioperative complications in the induction phase, intraoperative and postoperative period, as well as the consumption of opioids, were noted. RESULTS: 16 patients in the D and 15 in the N groups participated in the study. There was no difference in age, sex, body weight and duration of surgery between the two groups. The obtained results of oxidative stress and inflammatory response markers showed that there was a statistically significant difference in the MDA level between compared groups (postoperative MDA 88.93 ± 1.19 vs. 95.05 ± 1.58, ΔMDA 0.014), with no difference observed in other investigated oxidative and inflammatory stress in plasma samples. Patients in both groups were hemodynamically and respiratory stable. Still, patients in the treated (D) group achieved the desired level of sedation compared to the control evaluated by the Ramsey sedation score (p < 0.001). The BIS values were statistically significantly different between the D and N groups 30 minutes after inhalation (86.6 ± 11.6 vs. 98.1 ± 1.2, P < 0.001), but showed no differences during and after the procedure. The two groups had a significant difference in pain control upon awakening and one hour after the operation, respectively (pain on awakening p = 0.024; pain during the first hour of stay in the ward p = 0.039). The consumption of intraoperative opioids was slightly lower in the D group than in the N group (D vs. N group: fentanyl in µg/kg mean 3.67 ± 0.78 vs. 3.94 ± 1.12, p = 0.445, i.e., alfentanil in µg/kg mean 2.02 ± 1.85 vs. 2.30 ± 2.08, p = 0.691). Also, there were no differences in observed perioperative complications between groups. CONCLUSION: Inhaled Dexmedetomidine at a dose of 2 µg/kg in premedication reduces oxidative stress. However, the statistical significance of this drugs effect on the level of markers of antioxidant defense and inflammation has not been proven in children operated on for tonsillar hypertrophy. This dose regimen and route of application of Dexmedetomidine significantly affect the degree of perioperative sedation and BIS values, provides perioperative hemodynamic and respiratory stability, significant immediate postoperative analgesia, and reduces the consumption of analgesics with minimal complications, which makes it useful for shorter surgical interventions.
14 May 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Capnography With Integrated Pulmonary Index for Preventing Hypoxemia During Pediatric Urologic Surgery Under Sedation: A Randomized Controlled Trial
BACKGROUND Procedural sedation and analgesia (PSA) can relieve pain and anxiety during invasive procedures. Carbon dioxide (CO₂) monitoring or integrated pulmonary index (IPI) can reduce respiratory depression in adults with PSA, but the effect of the combination of these 2 methods on intraoperative hypoxemia in pediatric urologic surgery is unclear. This study was conducted to determine whether capnography combined with IPI could lessen intraoperative hypoxemia during pediatric urinary procedures with PSA. MATERIAL AND METHODS We conducted a randomized controlled trial (ChiCTR 2300073943). Children referred for urinary procedures with PSA were randomly assigned to either a control group with standard monitoring or an intervention group with standard monitoring combined with capnography and IPI monitoring. The primary outcome was intraoperative hypoxemia. Secondary outcomes were severe intraoperative hypoxemia, airway management, and perioperative complications. RESULTS A total of 133 patients completed the analysis (67 in the intervention group and 66 in the control group). Compared with the control group, the incidence of intraoperative oxygen saturation decline was significantly lower in the intervention group (34.33% vs 56.06%, odds ratio=0.410, 95% confidence interval: 0.203-0.825, P=0.012). Simultaneously, the incidence of severe oxygen desaturation (SpO₂ <90%) was also significantly reduced in the intervention group (19.40% vs 36.40%, odds ratio=0.421, 95% confidence interval: 0.192-0.925, P=0.034). Regarding airway management interventions, the intervention group exhibited a higher frequency of jaw thrust maneuvers (1.84±1.31 vs 1.17±1.12 times, P=0.004) and a significantly reduced need for invasive positive-pressure ventilation (1.64±1.31 vs 2.39±1.48, P=0.002). No differences in other airway management techniques or perioperative complications were observed between the 2 groups. CONCLUSIONS The addition of capnography and IPI monitoring to standard monitoring reduces the risk of intraoperative hypoxemia in pediatric urologic surgery and reduces the need for aggressive ventilation through early intervention.
12 May 2026
Read appraisal →European journal of pediatrics
Impact of protocolized restrictive versus liberal/usual maintenance fluid strategy on fluid overload among mechanically ventilated children: an open-label randomized trial (ReLiSCh-II trial)
UNLABELLED: Fluid overload (FO) is associated with poor clinical outcomes among critically ill children. The objective of this trial was to assess the impact of a protocolized restrictive maintenance fluid strategy on FO among mechanically ventilated children. This open-label randomized controlled trial was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital in North India over 13 months (November 2023-November 2024). Hemodynamically stable mechanically ventilated children were randomized to protocolized restrictive (n = 64) (40-50% of maintenance fluids with diuretic infusion if FO% > 10%); and liberal/usual (n = 66) (70-80% of maintenance fluid) groups. The primary outcome was the proportion of children with cumulative FO% > 10% through day 5. Secondary outcomes were daily cumulative FO%; inferior vena cava variability index (∆IVC) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at 48 h; safety parameters (requirement of fluid boluses or vasoactive drugs); 28-day ventilator and PICU-free days (VFDs and PFDs), and mortality. Significantly fewer children in the protocolized restrictive group had cumulative FO% > 10% than in the liberal/usual group (22% vs. 47%, p = 0.003). Also, the restrictive group had significantly lower daily cumulative FO% on the first 5 days. ∆IVC and NT-proBNP levels at 48 h, as well as safety parameters, were similar between the two groups. Protocolized restrictive and liberal/usual groups had similar VFDs [20 (8-24) vs. 16 (0-23), p = 0.076], PFDs [16 (3-21) vs. 13 (0-19), p = 0.071], and mortality (14% vs. 24%, p = 0.14). CONCLUSION: A protocolized restrictive maintenance fluid strategy resulted in significantly lower FO among hemodynamically stable, mechanically ventilated children without a measurable impact on short-term clinical outcomes. WHAT IS KNOWN: • Fluid overload (FO) is associated with poor clinical outcomes among critically ill mechanically ventilated children. WHAT IS NEW: • Among hemodynamically stable, mechanically ventilated children, a restrictive maintenance fluid strategy may be a useful intervention to limit FO and improve clinical outcomes in LMICs.
10 May 2026
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