Non-pharmacological preoperative interventions for the prevention of emergence delirium in children under general anesthesia: a systematic review and network meta-analysis.

Authors

Xiyao Zhang, Shan Dai, Qian Li, Huaping Huang

Published in

BMC anesthesiology. Jul 20, 2026. Epub Jul 20, 2026.

Abstract

Emergence delirium (ED) is among the most distressing complications of general anesthesia. Although numerous studies have demonstrated the effectiveness of non-pharmacological interventions in managing pediatric ED, the relative efficacies of these interventions remain unclear. This study aimed to systematically evaluate the efficacies of different non-pharmacological preoperative interventions to prevent ED in children undergoing general anesthesia.
The Embase, Cochrane Library, PubMed, Scopus, and Web of Science databases were searched from their inception to December 31, 2025, to identify relevant randomized controlled trials of non-pharmacological preoperative interventions to prevent ED in children undergoing general anesthesia. Two reviewers independently evaluated the literature, extracted data, and assessed risk of bias. STATA 18.0 software was used for network meta-analysis. Network and contribution plots were generated, inconsistency tests were performed, and interventions were ranked by efficacy using the surface under the cumulative ranking (SUCRA) curve.
Eleven randomized controlled trials that involved 1,294 children were included. Network meta-analysis showed that compared to usual care, multimodal preoperative anxiety intervention (odds ratio [OR] = 0.08, 95% confidence interval [CI]: 0.02 to 0.45), preoperative 30-min eye patch training (OR = 0.10, 95%CI: 0.05 to 0.22), and preoperative operating room visitation (OR = 0.10, 95%CI: 0.03 to 0.38) significantly reduced the incidence of ED. SUCRA ranking indicated that the multimodal preoperative anxiety intervention (SUCRA = 85.5%) was likely to perform better in preventing ED, while virtual reality ranked lowest. The inconsistency tests showed no significant inconsistency between direct and indirect evidence (P = 0.09). Considerable heterogeneity was present (I² = 68.7%), which could not be explained by prespecified moderators.
Among the included interventions, the multimodal preoperative anxiety intervention showed the most favorable effect in reducing ED, although this finding is based on a single trial and should be considered exploratory. Preoperative operating room visits and eye-patch training have also demonstrated promising applicability under specific conditions. Based on the current evidence, virtual reality showed no significant benefit in this analysis, and no firm recommendation can be made. Further high-quality studies are warranted to validate and refine personalized intervention strategies.

PMID:
42477534
Bibliographic data and abstract were imported from PubMed on 21 Jul 2026.

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