Melatonin for anaesthetic indications in paediatric patients: a systematic review

Edition: May-June 2021

Procaccini D, Lobner K, Azamfirei R, Kudchadkar SR. Anaesthesia. 2021;76(6):837-849. doi:10.1111/anae.15249

Study Type: Systematic Review

Method:

  • PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Scopus databases, last searched 6 June 2020. Keywords – melatonin, inpatients, paediatric unit, neonatal unit, intensive care unit, post-anaesthesia care
  • Included if Melatonin for analgesia, diagnostic sedation, or anaesthesia adjuvant
  • Excluded if Melatonin for sleep encephalogram or emergence delirium, non-human, >18yo, chronic sleep or neurobehavioral disorders, outside medical setting, non-English publications

Findings:

  • 27 studies included
  • 2 studies on analgesic melatonin – suggests antinociceptive effects and reduced anxiety
  • 17 studies on diagnostic sedation – for ABR and MRI, successful sedation to undertake the study between 44% and 96%
  • 8 studies on use as an anaesthetic adjunct – mixed results for anxiolysis and sedation

Commentary:

The studies in this systematic review address melatonin use for anaesthetic indications in paediatric patients.

There was significant heterogeneity in patient populations and clinical settings between studies. The conjunction of melatonin with sleep deprivation seems encouraging. Melatonin may be considered as an alternative to general anaesthesia before ABR or MRI procedures, with or without sleep deprivation, but the studies show there may be an unacceptable risk of failure of successful anaesthesia to complete the investigations. Melatonin combined with other sedatives is equivocal.

Only 7 studies (26%) were placebo controlled, limiting the strength of data. Other weaknesses of the studies included the dosing variability of melatonin, some studies using a dose per kg and others using a fixed dose. Melatonin has variable oral bioavailability (1-56%, mean 15%), and even the formulation may cause a difference in bioavailability. This limits the reproducibility of the results. There is also potential publication bias due to many of the studies being published by the same authors.

Melatonin may have benefit as an adjunctive analgesic for procedural pain and inflammation in premature infants, and diminish procedural pain associated with phlebotomy in children and adolescents. Melatonin, with or without sleep deprivation, may be an alternative to general anaesthesia in infants and children undergoing non-invasive diagnostic examinations. Melatonin may replace or reduce the other sedatives for diagnostic or procedural sedation.

Reviewed by Dr Solomon C. Yogendran

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