Efficacy of different doses of dexmedetomidine as a rapid bolus for children: a double-blind, prospective, randomized study

Abstract

BackgroundDexmedetomidine (DEX), a highly sensitive α2-adrenoceptor agonist that possesses anxiolytic, sedative, and analgesic effects, has been documented as a preventative and treatment for emergence agitation (EA). The therapeutic should be given as a loading dose that is infused during a 10 min period, but if a rapid bolus injection is deemed to be hemodynamically appropriate, it would be a more opportune route of administration. So we studied the efficacy of different doses of DEX as a rapid bolus for children to prevent and treat EA.MethodsOne hundred patients were enrolled and randomly divided into five groups: the control group (group D1), the 0.25 μg/kg DEX group (group D2), the 0.5 μg/kg DEX group (group D3), the 0.75 μg/kg DEX group (group D4), and the 1 μg/kg DEX group (group D5). Heart rate (HR), mean blood pressure (MBP) and blood oxygen saturation (SaO2) were recorded immediately before the study drug injection (baseline) and every minute for 5 min thereafter and at the time points of the skin cut and hernial sac pull. EA and pain were assessed in the post -anesthesia care unit, and any complementary medicine and adverse events were recorded too.ResultsThe incidence of EA was significantly decreased in group D4 and group D5 compared with D1.All groups exhibited similar baseline HR and MBP. After administered, HR and MBP were significantly decreased in all DEX group compared with group D1.In groups D3, D4 and D5, the minimal HR was decreased significantly compared with the groups D1 and duration time of minimal HR significantly prolonged in group D5, but no patient needed treatment. As the dosage increased, the recovery time was significantly prolonged. There were no significant differences in occurrence time of minimal HR, the incidence of complementary medicine and adverse events among groups.ConclusionRapid intravenous injection (IV) bolus administration of 0.75 and 1.0 μg/kg of DEX could improve the recovery profile by reducing the incidence of EA in children. Although its use resulted in a transient decreases in HR and MBP, DEX was clinically well-tolerated in children.Trial registrationNo. ChiCTR-IPR-17010658. Registered 17 February 2017.

Effect of different administration and dosage of dexmedetomidine in the reduction of emergence agitation in children: a meta-analysis of randomized controlled trials with sequential trial analysis

“…In our included studies, DEX showed its effect in decreasing EA from the lowest dose of 0.15 μg/kg (26) to the highest dose of 1.86 μg/kg (41). Nine studies directly compared the effects of different doses of DEX on EA in children (22,30,33,43,44,56,75,76,79). The meta-regression analysis for these nine studies showed a statistically significant association between EA incidence and DEX dose (P<0.05).…”

“…Nine studies reported the incidence of EA according to the different dose of DEX compared to placebo (22,30,33,43,44,56,75,76,79). We conducted a metaregression analysis to show the relationship between the dose of DEX and EA incidence, which revealed statistically significant evidence for an association between the log risk ratio for EA and the dose of DEX (P=0.013) (Figure 11).…”

The Effect of Dexmedetomidine on Emergence Agitation or Delirium in Children After Anesthesia—A Systematic Review and Meta-Analysis of Clinical Studies

“…Dexmedetomidine, as a highly selective α 2 adrenergic receptor agonist, can produce pharmacological effects of anti-anxiety, sedation, and analgesia without overt respiratory and circulatory inhibition in a routine dose ( 94 , 95 ). Meanwhile, dexmedetomidine can improve the cognitive function in children during recovery from general anesthesia ( 96 ) and contributes to dose-dependent inhibition of EA or ED after medical procedures ( 97 ). The optimal dose (ED 95 ) of dexmedetomidine for preventing EA was 0.30 μg/kg (95% CI: 0.21–1.00 μg/kg) ( 83 ).…”

Dexmedetomidine Provides Fewer Respiratory Events Compared With Propofol and Fentanyl During Third Molar Surgery: A Randomized Clinical Trial

“…30 Further investigation into different bolus and maintenance infusion doses and rates needs to be conducted in procedural IVS. Rapid IV boluses of up to 1 mg/kg have been effective in reducing the incidence of emergence agitation at the end of general anesthesia in intubated children 31 ; this was seen with transient decreases in heart rate and MAP but was well tolerated in healthy children. This practice is not recommended in nonintubated patients or in adults who will not tolerate the rapid bolus.…”