Melatonin for non-operating room sedation in paediatric population: a systematic review and meta-analysis.
Study Goal
The researchers aimed to systematically review the efficacy and safety of melatonin for non-operating room sedation in children.
Results Summary
The meta-analysis found no significant differences in successful procedure completion between melatonin and other methods (sleep deprivation, chloral hydrate, or combined melatonin and sleep deprivation) for EEG studies, but noted higher sedation failure with melatonin alone compared to combined melatonin and sleep deprivation. Melatonin showed lower sleep latency compared to sleep deprivation, and no major adverse events were reported.
Population
Children requiring non-operating room sedation for procedures like EEG, brainstem evoked response audiometry, and MRI.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
melatonin | no change | successful procedure completion for EEG | children | relative risk (RR) 1.06 (95% CI 0.99 to 1.12) | No significant differences were noted | #1 |
melatonin | no change | successful procedure completion for EEG | children | relative risk (RR) 0.97 (95% CI 0.89 to 1.05) | No significant differences were noted | #2 |
melatonin alone | no change | successful procedure completion for EEG | children | relative risk (RR) 1.03 (95% CI 0.97 to 1.10) | No significant differences were noted | #3 |
melatonin alone | increase | sedation failure for EEG | children | relative risk (RR) 1.55 (95% CI 1.02 to 2.33) | significantly higher sedation failure was noted | #4 |
melatonin | decrease | sleep latency for EEG | children | mean difference -10.21 (95% CI -11.53 to -8.89) | lower sleep latency | #5 |
melatonin | no change | major adverse events | children | - | No major adverse events were reported | #6 |
CONTEXT: The literature on melatonin as a sedative agent in children is limited. OBJECTIVE: To conduct a systematic review of studies assessing the efficacy and safety of melatonin for non-operating room sedation in children. METHODS: Medline, Embase, Cochrane Library and Cumulative Index to Nursing and Allied Health were searched until 9 April 2020 for studies using melatonin and reporting one of the prespecified outcomes of this review. Two authors independently assessed the eligibility, risk of bias and extracted the data. Studies with a similar study design, comparator and procedure were pooled using the fixed-effect model. RESULTS: 25 studies (clinical trials=3, observational studies=9, descriptive studies=13) were included. Melatonin was used for electroencephalogram (EEG) (n=12), brainstem evoked response audiometry (n=8) and magnetic resonance imaging (MRI) (n=5). No significant differences were noted on meta-analysis of EEG studies comparing melatonin with sleep deprivation (SD) (relative risk (RR) 1.06 (95% CI 0.99 to 1.12)), melatonin with chloral hydrate (RR 0.97 (95% CI 0.89 to 1.05)) and melatonin alone with melatonin and SD combined (RR 1.03 (95% CI 0.97 to 1.10)) for successful procedure completion. However, significantly higher sedation failure was noted in melatonin alone compared with melatonin and SD combined (RR 1.55 (95% CI 1.02 to 2.33)) for EEG. Additionally, meta-analysis showed lower sleep latency for melatonin compared with SD (mean difference -10.21 (95% CI -11.53 to -8.89) for EEG. No major adverse events were reported with melatonin. CONCLUSION: Although several studies were identified, and no serious safety concerns were noted, the evidence was not of high quality to establish melatonin's efficacy for non-operating room sedation in children.