Premedication with dexmedetomidine to reduce emergence agitation: a randomized controlled trial

Abstract

Background Nasal bone fracture is the most common type of facial fracture, and the high incidence of severe emergence agitation occurring after closed reduction of the nasal bone fracture can be challenging to manage. The purpose of this trial was to evaluate whether pre-operative administration of dexmedetomidine is effective in reducing the incidence and severity of emergence agitation in adults undergoing closed reduction of nasal bone fractures. Methods In this randomized controlled trial, 90 patients who were scheduled to undergo closed reduction of a nasal bone fracture were prospectively included and were randomly assigned to either the control group ( n = 45; 0.9% saline infusion) or the dexmedetomidine group (n = 45; 1 μ/kg over 10 min, pre-operatively). The primary endpoint was Aono’s four-point scale scores after anesthesia. The recovery time and numeric rating scale score were assessed as secondary endpoints. Results Aono’s four-point scale scores were lower in the dexmedetomidine group than in the control group (median: 1 [1] vs. 1 [1, 2], 95% confidence interval of difference: 0.01 to 0.02, P = 0.02). The number, severity, and duration of agitation episodes were significantly lower in the dexmedetomidine group than in the control group. Furthermore, the number of patients exhibiting intraoperative movement was lower in the dexmedetomidine group. Conclusions Pre-operative administration of dexmedetomidine demonstrated several significant benefits, such as a lower incidence of emergence agitation, reduced agitation severity, and a shorter duration of agitation. Additionally, we observed more stable maintenance of intraoperative anesthesia with less movement during the surgery. Trial registration Identifier: KCT0000585 (registration date: 12–19- 2012).

Comparison of Sedation with Dexmedetomidine Alfentanil Versus Ketamine-Alfentanil in Patients Undergoing Closed Reduction of Nasal Fractures

“…One of the most common problems in the recovery ward is delayed recovery and longer discharge time of patients receiving pre-operative or intra-operative dexmedetomidine infusion. ( 19 , 21 , 22 ) In our research, the duration of the recovery ward stay was significantly longer in the DA group than in the KA group. However, two groups were similar in terms of total anesthesia time and awakening time.…”

“…Kim et al ( 22 ) stated that pre-operative administration of dexmedetomidine in a closed reduction of nasal bone fractures reduces agitation severity and shortens the duration of agitation and also provided more stable maintenance of anesthesia with less movement during the operation.…”

Effects of lidocaine, dexmedetomidine, and their combination infusion on postoperative nausea and vomiting following laparoscopic hysterectomy: a randomized controlled trial

“…Lidocaine constant rate infusion (CRI) is associated with sedation [ 31 ]. Clinical trials proved that dexmedetomidine administration decreased the rate of agitation [ 32 , 33 ] and shivering [ 34 ]. In our study, severe bradycardia was not observed during the combined infusion of lidocaine plus dexmedetomidine and dexmedetomidine alone.…”

Neural signatures of α2-Adrenergic agonist-induced unconsciousness and awakening by antagonist

“…Immediate restoration of the top task performance by an α2-adrenergic antagonist in the current study is promising and suggests its future clinical role in active awakening. Although dexmedetomidine per se has been shown to reduce emergence delirium and agitation in humans ( Kim et al, 2019 ; Shi et al, 2019 ), it is possible that other anesthetics could benefit from active awakening and bypassing an intermediate recovery state where delirium and agitation are often observed.…”