Effect of single-dose dexmedetomidine on emergence agitation and recovery profiles after sevoflurane anesthesia in pediatric ambulatory surgery

Sato, Masami; Shirakami, Gotaro; Tazuke-Nishimura, Misako; Matsuura, Shogo; Tanimoto, Keiji; Fukuda, Kazuhiko

doi:10.1007/s00540-010-0976-4

Cited by 74 publications

(100 citation statements)

References 24 publications

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“…In our study, the incidence and severity of agitation score were significantly lower in group D compared to group L. Previous studies [11][12][13] showed that dexmedetomidine reduces the incidence of EA after sevoflurane anesthesia in children because of their sedative and analgesic effects. In another study, done by El-Hennawy et al [14]; dexmedetomidine and clonidine were administrated in a dose of 2 lg/kg as adjuvant with 0.25% bupivacaine caudally.…”

Section: Discussioncontrasting

confidence: 43%

Prevention of sevoflurane agitation in children undergoing congenital hernia repair, impact of adding dexmedetomidine to caudal analgesia

Mohamed

2015

Egyptian Journal of Anaesthesia

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Background: Postoperative agitation is a common problem in pediatric sevofluranebased anesthesia. Dexmedetomidine has been described as a safe, long acting and effective additive in many anesthetic and analgesic techniques. The aim of present study was to evaluate the effect of adding dexmedetomidine to caudal lidocaine in sevoflurane-based anesthesia on the incidence and severity of emergency agitation (EA) in children after surgical repair of congenital hernia. Patients and methods: A total of 48 pediatric patients aged 18-38 months ASA I, II scheduled for congenital hernia surgery were randomly enrolled into 2 groups: Group L patients (n = 24) received 1% lidocaine 0.7 ml kg, while Group D patients (n = 24) received 1% lidocaine 0.7 ml kg + dexmedetomidine 2 lg/kg. Postoperatively, emergency agitation and modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores were observed and recorded. Results: The current study showed that the incidence and severity of agitation and modified CHEOPS scores were significantly lower in group D compared to group L. Also occurrence of EA in patients in group D was significantly lower. Conclusion: The present study suggested that use of dexmedetomidine in addition to lidocaine was effective to control emergency agitation after sevoflurane anesthesia.

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Section: Discussioncontrasting

confidence: 43%

Prevention of sevoflurane agitation in children undergoing congenital hernia repair, impact of adding dexmedetomidine to caudal analgesia

Mohamed

2015

Egyptian Journal of Anaesthesia

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“…Details of the selection process are summarized in Figure 1. Dexmedetomidine was administered by single dose in 9 trials [9]–[11], [16]–[21], continuous infusion in 3 trials [22]–[24]. The placebo included saline in 11 trials [9]–[11], [16]–[22], [24] and lactated Ringer's solution in 1 trial [23].…”

Section: Resultsmentioning

confidence: 99%

Effects of Intravenous Dexmedetomidine on Emergence Agitation in Children under Sevoflurane Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Zhang

Liu

et al. 2014

PLoS ONE

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ObjectiveEmergence agitation (EA) is a common complication in children under sevoflurane anesthesia. The aim of this meta-analysis was to evaluate the effects of intravenous dexmedetomidine on EA in children under sevoflurane anesthesia.MethodsA comprehensive literature search was conducted to identify clinical trials that evaluated the effects of intravenous dexmedetomidine and placebo on EA in children under sevoflurane anesthesia. The search collected trials from MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science. Analysis was conducted using STATA version 12.0. Data from each trial were pooled using relative ratio (RR) for dichotomous data or weighted mean difference (WMD) for continuous data and corresponding 95% confidence interval (95% CI). Heterogeneity assessment, sensitivity analysis, and publication bias were performed.ResultsTwelve trials, in which 459 patients received dexmedetomidine and 353 patients received placebo, were included in this analysis. We found that intravenous dexmedetomidine decreased the incidences of EA (RR = 0.346, 95% CI 0.263 to 0.453, P<0.001), and postoperative pain (RR = 0.405, 95% CI 0.253 to 0.649, P<0.001). Intravenous dexmedetomidine also prolonged extubation time (WMD = 0.617, 95% CI 0.276 to 958, P<0.001), and emergence time (WMD = 0.997, 95% CI 0.392 to 1.561, P = 0.001). Further evidences are required to evaluate the incidence of postoperative nausea and vomiting (PONV). Sensitivity analysis strengthened evidences for lower incidences of EA, pain, and prolonged extubation time, and emergence time. Funnel plots did not detect any significant publication bias.ConclusionMeta-analysis demonstrated that dexmedetomidine decreased the incidence of EA in children under sevoflurane anesthesia.

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“…25) Intravenous DEX significantly decreases the sevoflurane requirement 5,26) for anesthesia and EA during recovery. 5,27) Caudally administered DEX was also associated with a decreased sevoflurane requirement and increased the duration of postoperative sedation in children. 12,28) The sedative and analgesic properties of The proportion of the patients who did not request oral acetaminophen was significantly higher in the DEX than in Control group (p=0.029).…”

Section: Discussionmentioning

confidence: 99%

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Cho

Kim

Park

et al. 2015

Biological & Pharmaceutical Bulletin

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When local anesthetics are used, the administration of dexmedetomidine (DEX) can prolong analgesic duration. However, the effect of caudal DEX on high volume/low concentration (HVLC) local anesthetics has not been studied. We investigated the analgesic effect of DEX added to a HVLC of ropivacaine for caudal block in children. Eighty children (the American Society of Anesthesiologists (ASA) status I; age, 1-6 years) undergoing ambulatory orchiopexy were enrolled in the study. Children were randomly assigned to undergo a caudal block with 1.5 mL/kg of 0.15% ropivacaine and either 1 µg/kg of DEX (DEX group, n 40) or the same amount of saline (Control group, n 40) under general anesthesia. The results showed that the time to first analgesic request was significantly longer in the DEX group than in the control group. The sevoflurane requirement for anesthesia and frequency of emergence agitation (EA) were also significantly lower in the DEX group. There was no difference in adverse events between the two groups. In conclusion, a dose of 1 µg/ kg of caudal DEX prolonged the first analgesic request time, although the immediate postoperative pain scores were comparable in both groups. Furthermore, caudal DEX significantly reduced the sevoflurane requirement and the frequency of EA.Key words dexmedetomidine; caudal block; child; orchiopexy Caudal block is common method for postoperative analgesia in children undergoing infra-umbilical surgery. One major limitation of caudal block is a relatively short analgesic duration owing to the single-injection. Thus, adjuvants such as ketamine, clonidine, or opioids are frequently added to the local anesthetics in order to improve analgesic efficacy and duration.1,2) The effectiveness of local anesthetics using in caudal block is dependent upon the dose, volume, and concentration of the local anesthetic solution, but high-concentration local anesthetics can increase the incidence of motor weakness, delayed micturition, or urinary retention. In children undergoing ambulatory surgery, such adverse effects can prolong the discharge time and may result in inadvertent admission. Recently, high-volume/low-concentration (HVLC) regimens for caudal blocks in children (1.5 mL/kg of 0.1-0.2% local anesthetics) have gained popularity following a report by Silvani et al. that demonstrated that a HVLC regimen provides a longer analgesic duration with less adverse effects than conventional dose/concentration. [3][4][5][6][7][8] However, the analgesic duration is still limited in caudal block with single-injection.Dexmedetomidine (DEX) is a highly selective α 2 adrenoceptor agonist with an α2/α1 selectivity ratio of 1600 : 1, and is eight times more potent than clonidine. 9) DEX is successfully used as an adjuvant in caudal blocks for children in order to reduce pain without inducing any significant respiratory and hemodynamic effects. Several studies have reported that in children, caudal DEX (1-2 µg/kg) with 0.25% bupivacaine (1 mL/kg) prolongs postoperative analgesic duration by 2.5-3 fold comp...

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Effect of single-dose dexmedetomidine on emergence agitation and recovery profiles after sevoflurane anesthesia in pediatric ambulatory surgery

Abstract: Intravenous DEX at a dose of 0.3 μg kg⁻¹ after induction of anesthesia reduced sevoflurane-associated EA and postoperative pain in pediatric ambulatory surgery, with no increase in the incidence of adverse events and with no change in parents' satisfaction level.

Cited by 74 publications

References 24 publications

Prevention of sevoflurane agitation in children undergoing congenital hernia repair, impact of adding dexmedetomidine to caudal analgesia

Prevention of sevoflurane agitation in children undergoing congenital hernia repair, impact of adding dexmedetomidine to caudal analgesia

Effects of Intravenous Dexmedetomidine on Emergence Agitation in Children under Sevoflurane Anesthesia: A Meta-Analysis of Randomized Controlled Trials

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

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