Intranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion and emergence delirium in children: a prospective, randomized, double‐blind, placebo‐controlled trial

Yao, Yusheng; Lin, Ying; Wu, Weilan; Ye, Huazhen; Chen, Yanqing

doi:10.1111/pan.12574

Cited by 60 publications

(72 citation statements)

References 25 publications

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“…Recovery time (defined as the time from the end of operation to spontaneous eye opening or response to verbal command) and extubation time (defined as the time from the completion of operation to extubation) was evaluated and recorded. Objective pain score (OPS) (as shown in Table 1) [22,23] was used for the evaluation of pain degree, and the PAED scale (as shown in Table 2) [24–27] and CPS (as shown in Table 3) [28–30] was employed to assess POED at the time points of 0, 5, 15, 30, 45, and 60 minutes after transfer into the PACU. One parent or guardian met the child on arrival in the recovery area and the child was allowed to regain consciousness undisturbed.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Methodsmentioning

confidence: 99%

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

et al. 2016

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“…Moreover, 1–2 µg/kg intranasal dexmedetomidine was found to attenuate the stress response caused by intubation in children [124]. Premedication with intranasal dexmedetomidine also reduced the minimum alveolar concentration of sevoflurane needed for laryngeal mask insertion or tracheal intubation [82, 125, 126]. …”

Section: New Clinical Applicationsmentioning

confidence: 99%

Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine

et al. 2017

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Dexmedetomidine is an α2-adrenoceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic-sparing effects, and minimal depression of respiratory function. It is potent and highly selective for α2-receptors with an α2:α1 ratio of 1620:1. Hemodynamic effects, which include transient hypertension, bradycardia, and hypotension, result from the drug’s peripheral vasoconstrictive and sympatholytic properties. Dexmedetomidine exerts its hypnotic action through activation of central pre- and postsynaptic α2-receptors in the locus coeruleus, thereby inducting a state of unconsciousness similar to natural sleep, with the unique aspect that patients remain easily rousable and cooperative. Dexmedetomidine is rapidly distributed and is mainly hepatically metabolized into inactive metabolites by glucuronidation and hydroxylation. A high inter-individual variability in dexmedetomidine pharmacokinetics has been described, especially in the intensive care unit population. In recent years, multiple pharmacokinetic non-compartmental analyses as well as population pharmacokinetic studies have been performed. Body size, hepatic impairment, and presumably plasma albumin and cardiac output have a significant impact on dexmedetomidine pharmacokinetics. Results regarding other covariates remain inconclusive and warrant further research. Although initially approved for intravenous use for up to 24 h in the adult intensive care unit population only, applications of dexmedetomidine in clinical practice have been widened over the past few years. Procedural sedation with dexmedetomidine was additionally approved by the US Food and Drug Administration in 2003 and dexmedetomidine has appeared useful in multiple off-label applications such as pediatric sedation, intranasal or buccal administration, and use as an adjuvant to local analgesia techniques.

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“…Our sample size estimation was based on the incidence of ED in children who received preoperative intranasal dexmedetomidine and in children who received only saline solution [16] In total, 27 patients were required in each group to detect a 45% difference in the incidence of ED between the groups with a statistical power of 90% and a type I error α equal to 1%. Considering a dropout rate of 20%, the minimum number of patients to include was increased to 34 per group.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, this molecule acts in the locus coeruleus determining a sedation pattern similar to natural sleep, without determining respiratory depression [12][13][14]. Recent studies suggest, among the remedies against ED, the use of dexmedetomidine intranasally as a premedication [10,11,15,16]. In particular, a recent meta-analysis showed that intranasal dexmedetomidine provides more satisfactory sedation and reduces the need for rescue analgesics and the incidence of nasal irritation and postoperative nausea and vomiting compared with other premedication treatments [10].…”

Section: Introductionmentioning

confidence: 99%

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

Palma

Maldarelli

Cimino

et al. 2019

Preprint

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Background Dexmedetomidine is increasingly used in the treatment of emergency delirium (ED) in pediatric patients. However, further evidence on its use in pediatric anesthesia and 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. We observed no significant difference between the dexmedetomidine group and control group in terms of discharge from surgical area. Conclusions Premedication with dexmedetomidine is associated with decreased incidence of ED, regardless of patients’ age or type of anesthesia and without seemingly increasing the timing of discharge after surgery.

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Intranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion and emergence delirium in children: a prospective, randomized, double‐blind, placebo‐controlled trial

Abstract: Intranasal dexmedetomidine premedication produces a dose-dependent decrease in the minimum alveolar concentration for laryngeal mask airway insertion of sevoflurane and emergence delirium in the PACU.

Cited by 60 publications

References 25 publications

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

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

Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine

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

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