Melatonin or its analogs as premedication to prevent emergence agitation in children: a systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#child #humans #adolescent #midazolam #dexmedetomidine

Melatonin or its analogs as premedication to prevent emergence agitation in children: a systematic review and meta-analysis

Zhang et al., 2023 | BMC Anesthesiol | Meta Analysis

Citation

Zhang Dongni, Jia Xiaotong, ... Ma Jun. Melatonin or its analogs as premedication to prevent emergence agitation in children: a systematic review and meta-analysis. BMC Anesthesiol. 2023-Nov-30;23(1):392. doi:10.1186/s12871-023-02356-x

Abstract

BACKGROUND: Emergence agitation (EA) is a prevalent complication in children following general anesthesia. Several studies have assessed the relationship between melatonin or its analogs and the incidence of pediatric EA, yielding conflicting results. This meta-analysis aims to assess the effects of premedication with melatonin or its analogs on preventing EA in children after general anesthesia. METHODS: PubMed, EMBASE, the Cochrane Library, ProQuest Dissertations & Theses Global, Web of Science, CNKI, Wanfang Data, clinicaltrials.gov, and WHO International Clinical Trials Registry Platform were searched until 25 November 2022. We included randomized controlled trials that assessed EA in patients less than 18 years old who underwent general anesthesia. We excluded studies that did not use a specific evaluation to assess EA. RESULTS: Nine studies (951 participants) were included in this systematic review. Melatonin significantly reduced the incidence of EA compared with placebos (risk ratio 0.40, 95% CI 0.26 to 0.61, P < 0.01) and midazolam (risk ratio 0.48, 95% CI 0.32 to 0.73, P < 0.01). Dexmedetomidine remarkably decreased the incidence of EA compared with melatonin (risk ratio 2.04, 95% CI 1.11 to 3.73, P = 0.02). CONCLUSIONS: Melatonin premedication significantly decreases the incidence of EA compared with placebos and midazolam. Dexmedetomidine premedication has a stronger effect than melatonin in preventing EA. Nevertheless, further studies are warranted to reinforce and validate the conclusion on the efficacy of melatonin premedication in mitigating EA in pediatric patients.

Key Findings

Nine studies (951 participants) were included in this systematic review. Melatonin significantly reduced the incidence of EA compared with placebos (risk ratio 0.40, 95% CI 0.26 to 0.61, P < 0.01) and midazolam (risk ratio 0.48, 95% CI 0.32 to 0.73, P < 0.01). Dexmedetomidine remarkably decreased the incidence of EA compared with melatonin (risk ratio 2.04, 95% CI 1.11 to 3.73, P = 0.02).

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 951
Age Range See abstract
Condition See abstract

MeSH Terms

  • Child
  • Humans
  • Adolescent
  • Midazolam
  • Dexmedetomidine
  • Emergence Delirium
  • Melatonin
  • Sevoflurane
  • Methyl Ethers
  • Premedication

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Meta-Analysis, Systematic Review, Journal Article, Research Support, Non-U.S. Gov't
  • Vertical: melatonin

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09