Comparison of IV Dexmedetomidine Versus Clonidine Versus no Alpha 2 Agonist on Emergency Delirium, PACU Length of Stay and Time to Hospital Discharge in Children Undergoing (Adeno)Tonsillectomy: a Prospective Observational Study (CLONIDEX)
Comparison of Intravenously Administered Dexmedetomidine Versus Clonidine Versus No Alpha-2 Agonist on Emergence Delirium, PACU Length of Stay, and Time to Hospital Discharge in Children Undergoing (Adeno)Tonsillectomy: A Prospective Observational Study
Emergence delirium (ED) is a frequent complication in children undergoing general anesthesia, particularly following ENT procedures such as adenotonsillectomy. Alpha-2 adrenergic agonists, such as clonidine and dexmedetomidine, are commonly used in pediatric anesthesia for their sedative, analgesic, and ED-reducing properties.The purpose of this prospective observational study (CLONIDEX) is to evaluate and compare the occurrence of emergence delirium, Post-Anesthesia Care Unit (PACU) length of stay, and overall time to hospital discharge in pediatric patients undergoing (adeno)tonsillectomy with or without placement of myringotomy tubes who receive intravenous dexmedetomidine, intravenous clonidine, or no alpha-2 agonist as part of their standard anesthetic care.
Studieoversigt
Status
Betingelser
Detaljeret beskrivelse
Background:
Emergence delirium (ED) in pediatric patients leads to increased post-anesthesia care unit (PACU) complications, distress for parents and staff, and potential physical injury. While both clonidine and dexmedetomidine are widely utilized alpha-2 agonists in pediatric practice, real-world prospective comparative data regarding their relative efficacy on ED incidence and recovery timelines remain limited.
Study Design and Methodology This is a single-center, prospective observational cohort study conducted at UZ Brussel. Because this is an observational study evaluating standard-of-care practices, the administration and choice of alpha-2-agonist (IV dexmedetomidine, IV clonidine, or no alpha-2-agonist) are left entirely to the discretion of the attending pediatric anesthesiologist.
Data Collection and Outcomes:
Pediatric patients undergoing elective (adeno)tonsillectomy with or without placement of myringotomy tubes will be observed. Key demographic data, anesthetic techniques, and intraoperative co-analgesics will be recorded. Upon arrival in the PACU, emergence delirium will be systematically assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale at set time intervals (arrival, 15, 30, 45, and 60 minutes). Secondary endpoints include PACU length of stay (measured against standardized discharge readiness criteria), total time to hospital discharge, requirement for rescue medication, and incidence of perioperative adverse events (such as postoperative nausea and vomiting, desaturation, or laryngospasm).
Undersøgelsestype
Tilmelding (Anslået)
Kontakter og lokationer
Studiekontakt
- Navn: Hélène De Cuyper, MD
- Telefonnummer: +3224749765
- E-mail: helene.decuyper@uzbrussel.be
Undersøgelse Kontakt Backup
- Navn: Liza De Dobbeleer, Study Nurse
- E-mail: liza.dedobbeleer@uzbrussel.be
Studiesteder
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Brussels Capital
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Jette, Brussels Capital, Belgien, 1090
- Universitair Ziekenhuis Brussel
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Kontakt:
- Hélène De Cuyper, MD
- Telefonnummer: +3224749765
- E-mail: helene.decuyper@uzbrussel.be
-
-
Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Prøveudtagningsmetode
Studiebefolkning
The study population consists of pediatric patients aged 2 to 12 years (ASA I-II) scheduled for elective ambulatory (adeno)tonsillectomy with or without placement of myringotomy tubes under general anesthesia at UZ Brussel. Participants are selected from the daily operating room list in the day-surgery unit.
Beskrivelse
Inclusion Criteria:
- Children aged 2 to 12 years old.
- Scheduled for elective (adeno)tonsillectomy or tonsillectomy (with or without concurrent myringotomy/tympanostomy tube insertion).
- American Society of Anesthesiologists (ASA) physical status I or II.
- Surgery performed in an ambulatory / day-surgery setting under general anesthesia.
- Written informed consent provided by parents or legal guardians.
Exclusion Criteria:
- Known hypersensitivity or allergy to clonidine, dexmedetomidine, or other alpha-2 adrenergic agonists.
- Pre-existing severe cardiac conduction abnormalities, severe bradycardia, or hemodynamic instability.
- Severe neurodevelopmental impairment, severe cognitive impairment, or active central nervous system disorders that preclude reliable assessment using the PAED scale.
- Emergency tonsillectomy or active tonsillar hemorrhage.
- Patients requiring planned postoperative intensive care unit (PICU) admission or extended inpatient monitoring.
- Patient or parent/guardian refusal to participate.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Observationsmodeller: COHORT
- Tidsperspektiver: PROSPECTIVE
Kohorter og interventioner
Gruppe / kohorte |
Intervention / Behandling |
|---|---|
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Dexmedetomidine Group
Pediatric patients undergoing elective (adeno)tonsillectomy with or without placement of myringotomy tubes who receive intraoperative intravenous dexmedetomidine as part of standard anesthetic care, at the discretion of the attending anesthesiologist. |
Standard of care intraoperative intravenous administration of dexmedetomidine. Dose, timing, and administration are determined solely by the attending anesthesiologist. |
|
Clonidine Group
Pediatric patients undergoing elective (adeno)tonsillectomy with or without placement of myringotomy tubes who receive intraoperative intravenous clonidine as part of standard anesthetic care, at the discretion of the attending anesthesiologist. |
Standard of care intraoperative intravenous administration of clonidine. Dose, timing, and administration are determined solely by the attending anesthesiologist. |
|
Control Group (No Alpha-2 Agonist)
Pediatric patients undergoing elective (adeno)tonsillectomy with or without placement of myringotomy tubes who do not receive any intraoperative alpha-2 adrenergic agonist (dexmedetomidine or clonidine) as part of standard anesthetic care. |
Standard anesthetic care during pediatric (adeno)tonsillectomy without administration of intraoperative alpha-2 adrenergic agonists. |
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Incidence and Severity of Emergence Delirium (ED)
Tidsramme: Assessed at PACU arrival (T0), and at 15 (T15), 30 (T30), 45 (T45), and 60 (T60) minutes post-operatively until PACU discharge.
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Emergence delirium will be assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale. The PAED scale consists of 5 items, with total scores ranging from 0 to 20, where higher scores indicate greater severity of delirium. A PAED score >= 10 (or >= 12) is defined as the presence of emergence delirium. |
Assessed at PACU arrival (T0), and at 15 (T15), 30 (T30), 45 (T45), and 60 (T60) minutes post-operatively until PACU discharge.
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Post-Anesthesia Care Unit (PACU) Length of Stay
Tidsramme: From arrival at PACU until discharge readiness, assessed up to 2 hours post-operatively.
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Time duration (in minutes) from arrival at the PACU until meeting formal criteria for discharge readiness (e.g., modified Aldrete or PADSS score). |
From arrival at PACU until discharge readiness, assessed up to 2 hours post-operatively.
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Total Time to Hospital Discharge
Tidsramme: From end of surgery until hospital discharge on Day 1 (up to 24 hours).
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Time duration (in hours) from the end of anesthesia/surgery until actual discharge from the day-surgery clinic. |
From end of surgery until hospital discharge on Day 1 (up to 24 hours).
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Incidence of Rescue Medication Administration
Tidsramme: During the PACU stay, up to 2 hours post-operatively.
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Proportion of patients requiring rescue medication in the PACU for severe emergence delirium or acute postoperative pain (e.g., propofol, opioids, or additional alpha-2 agonists). |
During the PACU stay, up to 2 hours post-operatively.
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Incidence of Perioperative Adverse Events
Tidsramme: From anesthesia induction until discharge from the day-surgery clinic (up to 24 hours).
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Occurrence of airway or recovery complications including laryngospasm, oxygen desaturation (<92%), severe postoperative nausea and vomiting (PONV), or excessive sedation. |
From anesthesia induction until discharge from the day-surgery clinic (up to 24 hours).
|
Samarbejdspartnere og efterforskere
Sponsor
Efterforskere
- Ledende efterforsker: Hélène De Cuyper, MD, Department of Anesthesiology & Perioperative Medicine
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Primær færdiggørelse (Anslået)
Studieafslutning (Anslået)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Smerte
- Neurologiske manifestationer
- Sygdomme i nervesystemet
- Psykiske lidelser
- Postoperative komplikationer
- Patologiske processer
- Forvirring
- Neuroadfærdsmæssige manifestationer
- Neurokognitive lidelser
- Delirium
- Patologiske tilstande, tegn og symptomer
- Tegn og symptomer
- Emergence Delirium
- Smerter, postoperativ
Andre undersøgelses-id-numre
- CLONIDEX
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
Patient Privacy & GDPR Compliance:
The study involves a vulnerable pediatric population. Full individual participant data sets, even if pseudonymized, carry a risk of re-identification when combined with detailed clinical and surgical variables, which violates strict European General Data Protection Regulation (GDPR) standards and institutional patient privacy policies.
Absence of Informed Consent for Broad Public Data Sharing:
The informed consent process and ethics committee approval approved for this study specifically cover data collection and analysis by the designated investigation team at UZ Brussel. Participants' legal guardians did not consent to open-access public repository sharing or secondary use of their children's raw individual data by external third parties.
Institutional & Regulatory Restrictions:
In accordance with hospital policy and national regulatory frameworks governing single-center observational clinical research, raw patient-level data remain restricted.
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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