Influence of Dexmedetomidine on Clinical Efficacy of General Anesthesia and Stress Response in Children

Abstract

This study was aimed to explore the effect of dexmedetomidine (DEX) nose drops on paediatric general anaesthesia in the resuscitation room and its influence on children's postoperative stress. Sixty-eight children undergoing general anaesthesia were enrolled. They were randomly divided into two groups according to admission, with 34 cases in each group. Children in the experimental group received DEX at a 1µg/kg dose as nasal drops, combined with sevoflurane (SEV) anaesthesia. Children in the control group received 0.4 mL saline as nasal drops, combined with SEV anaesthesia. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction of anaesthesia (T0), during extubation (T1), 5 min (T2), and 15 min after extubation (T3). In addition, venous blood was sampled at each of the above time points to determine the plasma epinephrine (E), norepinephrine (NE), and cortisol (Cor) levels to evaluate the postoperative stress response. The incidence of adverse reactions in the two groups was counted. The rate of crying at T1, restlessness after awakening, and adverse reactions were significantly reduced in children from the experimental group compared with the control group. The induction time of anaesthesia in children in the experimental group was significantly decreased compared with the control group. There was no considerable difference in the awakening time of the two groups of children, and the stay time in the post-anaesthesia care unit (PACU) was not extended. In addition, the children in the experimental group had lower MAP and HR at the time of extubation and 5 minutes after extubation compared with the control group. At T1 and T2, the changes of plasma E, NE, and Cor in children from the experimental group were significantly decreased compared with the levels in the control group. RezumatAcest studiu și-a propus să exploreze efectul picăturilor nazale cu dexmedetomidină (DEX) asupra anesteziei generale pediatrice și influența acestuia asupra stresului postoperator al copiilor. În studiu au fost incluși 68 de copii, randomizați în două grupuri. Copiii din grupul experimental au primit DEX la o doză de 1 µg/kg sub formă de picături nazale, în combinație cu anestezie cu sevofluran (SEV). Copiii din grupul de control au primit 0,4 mL ser fiziologic sub formă de picături nazale, combinate cu anestezie SEV. S-au înregistrat valorile tensiunii arteriale medii (MAP) și frecvența cardiacă (HR) înainte de inducerea anesteziei (T0), în timpul extubației (T1), la 5 minute (T2) și la 15 minute după extubare (T3). În plus, s-au recoltat probe de sânge pentru fiecare dintre momentele de mai sus pentru a determina nivelurile plasmatice de epinefrină (E), norepinefrină (NE) și cortizol (Cor), în scopul evaluării răspunsului la stres postoperator. S-a evaluat, de asemenea, incidența reacțiilor adverse în cele două grupuri. Timpul de inducere a anesteziei la copiii din grupul experimental a fost semnificativ redus comparativ cu grupul de control. Nu a existat o diferență considerabilă în timpul de trezire al ce...

The effect of intranasal dexmedetomidine administration on emergence agitation or delirium in pediatric patients after general anesthesia: A meta‐analysis of randomized controlled trials

“…Subgroup analysis showed that intranasal dexmedetomidine significantly reduced the incidence of EA/ED compared to placebo or no drug (13 studies 4,8,16–22,27,28,30 ; OR 0.18, 95% CI 0.12–0.27; p = .0000; I 2 = 25.30%; Figure 2) and midazolam (7 studies 4,7–9,25,26,29 ; OR 0.36, 95% CI 0.19–0.71; p = .003; I 2 = 37.59%; Figure 2), whereas no significant differences were observed in the comparison between the intranasal dexmedetomidine and clonidine (1 study 24 ; OR 0.54, 95% CI 0.20–1.45; p = .220; I 2 = not applicable; Figure 2), esketamine (1 study 23 ; OR 0.47, 95% CI 0.17–1.33; p = .155; I 2 = not applicable; Figure 2), and ketamine (2 studies 7,10 ; OR 0.37, 95% CI 0.04–3.23; p = .365; I 2 = 61.42%; Figure 2).…”

“…The incidence of EA/ED was 13.6% in the dexmedetomidine group and 33.2% in the control group. The pooled effect size revealed that dexmedetomidine administration significantly lowered the incidence of postoperative EA/ED in pediatric patients undergoing surgery under general anesthesia (20 studies 4,7–10,16–30 ; OR 0.25, 95% CI 0.18–0.34; p = .0000; I 2 = 37.74%; Figure 2).…”

“…The incidence of EA/ED was reported in 20 RCTs, 4,7–10,16–30 and 27 comparisons were made (two different comparisons were made in seven studies 4,7,8,20,22,28,29 ). The incidence of EA/ED was 13.6% in the dexmedetomidine group and 33.2% in the control group.…”

“…All patients were randomly assigned to the groups in all included RCTs, but in the six studies, the authors did not describe whether the allocation sequence was concealed until participants were enrolled and assigned to the intervention 19,21–23,27 . Bias due to deviations from the intended intervention 21 and bias in the measurement of outcomes 27 were a concern in one study, respectively. Figure S8 shows the overall risk of bias in the summary plot.…”

“…RCTs were included in the final analysis (Figure 1). 4,[7][8][9][10][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The characteristics of the RCTs included in the final analysis are summarized in Table 1. A total of 2103 pediatric patients were included, with 984 and 1119 patients assigned to the intranasal dexmedetomidine and control groups, respectively.…”