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

Table 2 Summary of the findings

Outcomes	Anticipated absolute effects (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)
Outcomes	Risk with control	Risk with melatonin	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)
Incidence of EA
Melatonin and its analogs vs. placebos	471 per 1000	240 fewer per 1000 (from 349 fewer to 47 fewer)	0.49 (0.26 to 0.90)	307 (5)	⨁◯◯◯ Very low ^abc
Melatonin vs. placebos	430 per 1000	258 fewer per 1000 (from 318 fewer to 168 fewer)	0.40 (0.26 to 0.61)	259 (4)	⨁⨁⨁◯ Moderate ^c
Melatonin vs. midazolam	311 per 1000	162 fewer per 1000 (from 212 fewer to 84 fewer)	0.48 (0.32 to 0.73)	346 (4)	⨁⨁⨁◯ Moderate ^b
Melatonin vs. dexmedetomidine	100 per 1000	104 more per 1000 (from 11 more to 273 more)	2.04 (1.11 to 3.73)	240 (3)	⨁⨁⨁◯ Moderate ^b

a. For high I² scores, the level of certainty was downgraded to “serious” for “inconsistency.”
b. For the wide range of TSA-adjusted 95% CI, the certainty of evidence was downgraded to “serious” for “imprecision.”
c. Publication bias was strongly suspected
Abbreviations: EA, Emergence agitation; CI, Confidence interval; GRADE, Grading of Recommendations Assessment, Development, and Evaluation

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