To Evaluate the Analgesic Adequacy and Safety of Dexmedetomidine for Intraoperative Sedation and Post-Operative Analgesia in Cerebral Palsy Children Undergoing Lower Limb Surgeries- A Prospective Randomized Single Blinded Case Control Study

Abstract

BACKGROUND Cerebral palsy is a neuromuscular disease. Issues that influence the anaesthetic care of children with cerebral palsy are seizures, spasticity, and sensitivity to pain medications, scoliosis, mental retardation, inability to communicate, excessive drooling of saliva and other associated medical conditions. 1 Due to these issues and lack of communication in these children assessing pain and treating pain is very challenging. Various analgesics like opioids, benzodiazepines, barbiturates have been used for analgesia and sedation. But all these have side effects mainly respiratory depression. Ketamine has been used for sedation, but it has side effects like emergence delirium, laryngospasm, vomiting and hallucinations. Dexmedetomidine is a centrally acting alpha 2 adrenergic agonist. Major advantage with dexmedetomidine is that it does not cause respiratory depression. Studies have shown that it is neuroprotective. 2 The aim of this study was to assess the adequacy of dexmedetomidine for sedation, safe recovery, adequate postoperative analgesia and to look for any adverse effects. METHODS 35 cases in each of the 2 groups of cerebral palsy children posted for limb deformity correction are described. Group A patients were given with IV ketamine 0.5 mg/Kg, IV midazolam 0.05 mg/Kg and IV dexmedetomidine 1 mcg/Kg and group B patients were given inj. midazolam 0.05 mg/Kg, IV ketamine 0.5 mg/Kg. Number of attempts of lumbar puncture was noted, intraoperative sedation was assessed by modified Ramsay score. Any extra dose of ketamine required during the surgery was noted, post op recovery score was assessed by Aldrete's score in POP room. Post op pain was assessed by CHEOPS score. RESULTS Dexmedetomidine proved to be a safe sedative and an adequate analgesic in cerebral palsy patients. CONCLUSIONS Dexmedetomidine IV can be used safely for intra op sedation with less side effects.