Emergence delirium and intranasal dexmedetomidine premedication in pediatric anesthesia: a retrospective study in plastic surgery

Abstract

Background Dexmedetomidine is widely used in the treatment of emergency delirium (ED) in pediatric patients. However, further evidence on its use in pediatric anesthesia on potential differences in the reduction of ED according to patient’s age and type of anesthesia is required. Moreover, whether dexmedetomidine influences time of discharge from the surgical area remains unclear. We evaluated whether intranasal dexmedetomidine is effective in decreasing the incidence of ED in 106 children who had anesthesia for plastic surgery undergoing general or combined anesthesia at different ages. We also assessed if this drug has an impact on time to discharge from the surgical area. Methods In total, 106 children, aged 2–10 years, were enrolled in this retrospective study. Among them, 50 have been premedicated with dexmedetomidine (dexmedetomidine group); the remaining 56 patients served as controls (control group). The incidence of ED was evaluated according to the use of dexmedetomidine premedication, age and type of anesthesia (general vs combined). The length of anesthesia and duration of staying in the surgical area were also analyzed. Results Three patients who received dexmedetomidine premedication showed ED (6%), compared with 43 patients in the control group (77%; p<0.05). This lower incidence of ED was also present when stratifying patients according to the type of anesthesia or age. No difference between the dexmedetomidine group and control group were reported in timing of discharge from surgical area.Conclusions Premedication with dexmedetomidine is associated with decreased incidence of ED without increasing timing of discharge after surgery, regardless of patients’ age or type of anesthesia. In particular, patients subjected to combined anesthesia report benefit from the use of this molecule.