Dexmedetomidine Injection during Strabismus Surgery Reduces Emergence Agitation without Increasing the Oculocardiac Reflex in Children: A Randomized Controlled Trial

Abstract

ObjectiveDexmedetomidine is known to reduce the incidence of emergence agitation, which is a common complication after inhalational anesthesia like sevoflurane or desflurane in children. However, the dose of dexmedetomidine used for this purpose is reported variously and the most effective dose is not known. In this study, we tried to find the most effective dose of dexmedetomidine to reduce the incidence of emergence agitation in children undergoing strabismus surgery without the complications like oculocardiac reflex (OCR) or postoperative vomiting.MethodsWe randomized 103 pediatric patients aged 2–6 years and undergoing elective strabismus surgery into four groups. Anesthesia was induced with sevoflurane and maintained with desflurane. At the start of induction, dexmedetomidine, delivered at 0.25, 0.5, or 1 μg/kg, or saline was infused intravenously in the D0.25, D0.5, D1 groups, respectively. The primary outcome measure was the incidence of emergence agitation and the secondary outcome measure was the incidence of intraoperative OCR, postoperative vomiting, and desaturation events.ResultsThe incidence of emergence agitation was 60, 48, 44, and 21% (P = 0.005) and the incidence of intraoperative OCR was 36, 36, 36, and 37% (P = 0.988) in the control, D0.25, D0.5, and D1 groups, respectively. And, postoperative vomiting rate and desaturation events were low in the all groups.ConclusionDexmedetomidine decreased the incidence of emergence agitation without increasing intraoperative oculocardiac reflex. Dexmedetomidine delivered at 1 μg/kg was more effective at reducing emergence agitation than lower doses in children undergoing strabismus surgery under desflurane anesthesia.Trial RegistrationClinical Research Information Service KCT0000141

Effects of scalp nerve block on pain and emergence agitation after paediatric nevus surgery: a clinical trial

“…This may be explained by the fact that spontaneous pain after skin incision, determined by a visual analogue scale, decreased rapidly. 21 Dexmedetomidine is known to decrease anaesthetic requirements and to induce emergence sedation 20 without respiratory depression. Consequently, under the clinical setting of this study that a similar end-tidal concentration of sevoflurane was maintained in both block and remifentanil groups during surgery, simple elimination of post-operative pain did not affect the incidence of EA after sevoflurane anaesthesia.…”

“…In this context, dexmedetomidine, a selective a2-adrenergic receptor agonist, investigated widely for preventing EA, may be a promising drug. 21 Dexmedetomidine is known to decrease anaesthetic requirements and to induce emergence sedation 20 without respiratory depression. 22 There are some limitations to this study.…”

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

“…Therefore, whether dexmedetomidine can reduce EA, PONV, and postoperative pain incidence in pediatric patients undergoing strabismus surgery remains unclear. Moreover, relevant studies, which have only used small sample populations, have reported conflicting results [11][12][13][14][15][16][17][18][19]. Thus, meta-analyses evaluating the safety and efficacy of dexmedetomidine in pediatric strabismus surgery are lacking.…”

The safety and efficacy of dexmedetomidine-remifentanil in children undergoing flexible bronchoscopy

“…Previous studies have reported that DEX can both decrease the incidence of desaturation and reduce the secretions. [31,32] …”