Effects of intraoperative dexmedetomidine with intravenous anesthesia on postoperative emergence agitation/delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy

Abstract

Postoperative emergence agitation/delirium (POED) is a common complication in pediatric surgery patients, which increases the risk of developing postoperative airway obstruction and respiratory depression. This study aims to investigate the safety and efficacy of intraoperative infusion of dexmedetomidine (DEX) and its effects on POED in pediatric patients undergoing tonsillectomy with or without adenoidectomy.Sixty patients scheduled for tonsillectomy with or without adenoidectomy, aged 2 to 8 years, were randomly allocated into 2 groups (n = 30). Pediatric patients in the group DEX received intravenous (IV) DEX 1 μg/kg over 10 minutes, followed by 0.5 μg/kg/h continuous infusion, and the same volume of 0.9% saline was administrated in the group control. Anesthesia was maintained with target-controlled infusion (TCI) of propofol and remifentanyl. Intraoperative heart rate (HR), noninvasive blood pressure (NIBP), blood oxygen saturation (SPO2), recovery time, and extubation time were recorded. Pain level was evaluated using the objective pain score (OPS), pediatric anesthesia emergence delirium (PAED) scale and Cole 5-point scale (CPS) was used to evaluate POED when patients at 0, 5, 15 minutes, and then at intervals of 15 minutes for 60 minutes after parents arrival at postanesthesia care unit (PACU).The results showed that intraoperative HR was significantly lower in group DEX (P <0.05), mean diastolic and systolic NIBP was not statistically different between groups. Time to wake and time to extubation were lengthened in group DEX as compared with group control (P <0.05). OPS and CPS were lower in group DEX at 15, 30, and 45 minutes time points (P <0.05); however, there were no significantly differences in the PAED score at different time points in the PACU.The present data suggested that intraoperative infusion of dexmedetomidine combined with intravenous anesthetics can provide satisfactory intraoperative conditions for pediatric patients undergoing tonsillectomy with or without adenoidectomy, without adverse hemodynamic effects, though the lower incidence of POED was not observed.

Dexmedetomidine for the reduction of emergence delirium in children undergoing tonsillectomy with propofol anesthesia: A double‐blind, randomized study

“…A prolongation of the extubation time was not observed in our study when dexmedetomidine was administered, in contrast to the current literature . In their meta‐analysis of 9 trials regarding the effect of dexmedetomidine on extubation time under sevoflurane anesthesia, Zhang et al found that dexmedetomidine prolonged the extubation time compared to placebo ( P < .001).…”

“…Regarding blood pressure recordings, we presume that the dose of dexmedetomidine of 1 mcg kg −1 and the concomitant use of propofol instead of sevoflurane in our study may be responsible for the lack of significant difference in blood pressure drop between the 2 groups of our patients. Similar to our anesthetic plan, administration of dexmedetomidine 1 mcg kg −1 followed by 0.5 mcg kg −1 h −1 in children under TCI propofol and remifentanil anesthesia for adenotonsillectomy revealed a decrease in heart rate, but no difference in blood pressure compared to control in the study by Cao et al…”

“…Many studies have shown the safety and effectiveness of dexmedetomidine in reducing ED following sevoflurane anesthesia in children undergoing tonsillectomy . In contrast to those advantages, dexmedetomidine prolongs time to extubation, emergence, and discharge from postanesthesia care unit (PACU) …”

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

“…15 Because the terminal half-life of remifentanil is 3.5 min in children aged 2-7 years 16 and average operation time was about 20 min in remifentanil group, analgesic and sedative property of remifentanil were not likely to influence on EA. 22 There are some limitations to this study. Recent reports put forward the hypothesis of different brain networks in recovery phenomenon from sevoflurane anaesthesia in contrast with propofol.…”

Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: A metaanalysis

“…Fifteen studies with 1,552 participants were included for the meta-analysis, and the results of the study characteristics were described in Table I. Outcomes for analysis were postoperative pain (pain scores) in the postanesthesia care unit (PACU), [10][11][12][13][14][15][16][17][18] postoperative analgesic requirements (doses of postoperative opioids or nonopioid analgesics), 4,8,[10][11][12]16,17,[19][20][21][22][23][24][25][26][27][28][29][30] postoperative agitation (agitation scores and incidence during recovery), 8,10,11,13,[15][16][17][18][19][21][22][23]31 desaturation, 8,10,15,17,18,20,…”