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Melatonin for pre-medication in children: a systematic review

Abstract:

Background: Melatonin’s effectiveness as an anxiolytic medication has been confirmed in adults; however, its efficacy in a paediatric population is unclear. A number of small studies have assessed its use in children as a pre-operative anxiolytic, with conflicting results.

Methods: We undertook a systematic review of pre-operative melatonin use in children. Four databases (MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Web of Science), and ‘ClinicalTrials.gov’ were searched for ongoing and completed clinical trials of relevance. Citation tracking reference lists and relevant articles were also accessed. The review was unrestricted by comparator or outcomes. Eleven studies were judged eligible for inclusion. There were high levels of heterogeneity in melatonin administration (in terms of dose and timing). Variable outcomes were reported and included: anxiety; anaesthetic success; analgesia; sedation; post-operative recovery; and safety. Outcomes were not always assessed with the same measures.

Results: Evidence to support melatonin’s anxiolytic properties in this setting is conflicting. Melatonin was associated with reduced sedative effects, post-operative excitement and improved emergence behaviour, compared to comparator drugs. One study reported the benefit of melatonin use on sleep disturbance at two weeks post-surgery. No adverse safety events were identified to be significantly associated with melatonin, affirming its excellent safety profile.

Conclusion: Despite potential advantages, including improved emergence behaviour, based on current evidence we cannot confirm whether melatonin is non-inferior to current “usual care” pre-medications. Further consideration of melatonin as an anxiolytic pre-medication in paediatric surgery is needed.

Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1186/s12887-022-03149-w

Authors


More by this author
Institution:
University of Oxford
Division:
MSD
Department:
NDORMS
Oxford college:
Somerville College
Role:
Author
ORCID:
0000-0002-4054-5975


Publisher:
BioMed Central
Journal:
BMC Pediatrics More from this journal
Volume:
22
Article number:
107
Publication date:
2022-02-24
Acceptance date:
2022-02-02
DOI:
EISSN:
1471-2431
Pmid:
35209863


Language:
English
Keywords:
Pubs id:
1242405
Local pid:
pubs:1242405
Deposit date:
2022-11-12

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