[Oral trans-mucosal dexmedetomidine for controlling of emergence agitation in children undergoing tonsillectomy: a randomized controlled trial]

Hala S Abdel-Ghaffar, Amani H Abdel-Wahab, Mohammed M Roushdy, Hala S Abdel-Ghaffar, Amani H Abdel-Wahab, Mohammed M Roushdy

Abstract

Objectives: Emergence agitation is a negative behavior commonly recorded after pediatric tonsillectomy. We investigated the efficacy of preoperative premedication with oral transmucosal buccal dexmedetomidine on the incidence and severity of emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia.

Methods: Ninety patients aged (3–6 years), ASA I‒II were enrolled into three groups (n = 30) to receive oral transmucosal dexmedetomidine 0.5 µg.kg−1 (Group DEX I), 1 µg.kg−1 (Group DEX II) or saline placebo (Group C). Our primary endpoint was the Watcha agitation score at emergence in PACU. Secondary outcomes were preoperative sedation score, intraoperative hemodynamics, postoperative Objective Pain Scale (OPS) and adverse effects.

Results: The patients’ demographics, preoperative sedation scores and extubation time showed no difference between groups. Significant differences between groups in incidence and frequency distribution of each grade of Watcha score were evident at 5 minutes (p = 0.007), 10 minutes (p = 0.034), 30 minutes (p = 0.022), 45 minutes (p = 0.034) and 60 minutes (p = 0.026), postoperatively with significant differences between DEX I and II groups. DEX groups showed lower OPS scores at 5 minutes (p = 0.011), 10 minutes (p = 0.037) and 30 minutes (p = 0.044) after arrival at PACU, with no difference between DEX I and II groups. Patients in DEX II group exhibited lower intraoperative mean heart rate at 15 min (p = 0.020), and lower mean arterial pressure at 30 minutes, (p = 0.040), 45 minutes (p = 0.002) and 60 minutes (p = 0.006) with no significant differences between groups in other time points.

Conclusion: This study demonstrates the clinical advantage and the simple technique of oral transmucosal DEX premedication for emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia compared with saline placebo.

Trial registration: Clinical Trials.gov trial registry: NCT02720705.

Keywords: Agitação ao despertar; Amigdalectomia; Children; Crianças; Dexmedetomidina transmucosa oral; Emergence agitation; Oral transmucosal buccal dexmedetomidine; Tonsillectomy.

Copyright © 2019 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
Participant flow diagram (Group C, Placebo Control; Group DEX I, 0.5 µg.kg−1; Group DEX II, 1 µg.kg−1).
Figure 2
Figure 2
Mean arterial blood pressure (Group C, Placebo Gontrol; Group DEX I, 0.5 µg.kg−1; Group DEX II, 1 µg.kg−1).
Figure 3
Figure 3
Heart rate (Group C, Placebo Gontrol; Group DEX I, 0.5 µg.kg−1; Group DEX II, 1 µg.kg−1).

References

    1. Smessaert A., Schehr C.A., Artusio J.F., Jr. Observations in the immediate postanesthesia period. II. Mode of recovery. Br J Anaesth. 1960;32:181–185.
    1. Eckenhoff J.E., Kneale D.H., Dripps R.D. The incidence and etiology of postanesthetic excitement. A clinical survey. Anesthesiology. 1961;22:667–673.
    1. Voepel-Lewis T., Malviya S., Tait A.R. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg. 2003;96:1625–1630.
    1. Mason K.P. Pediatric emergence delirium: a comprehensive review and interpretation of the literature. Br J Anaesth. 2017;118:335–343.
    1. Moore A.D., Anghelescu D.L. Emergence delirium in pediatric anesthesia. Paediatr Drugs. 2017;19:11–20.
    1. Amorim M.A., Govêia C.S., Magalhães E., et al. Effect of dexmedetomidine in children undergoing general anesthesia with sevoflurane: a meta-analysis. Braz J Anesthesiol. 2017;67:193–198.
    1. Choi E.K., Lee S., Kim W.J., et al. Effects of remifentanil maintenance during recovery on emergence delirium in children with sevoflurane anesthesia. Paediatr Anaesth. 2018;28:739–744.
    1. Chen J.Y., Jia J.E., Liu T.J., et al. Comparison of the effects of dexmedetomidine, ketamine and placebo on emergence agitation after strabismus surgery in children. Can J Anaesth. 2013;60:385–392.
    1. Ydemann M., Nielsen B.N., Henneberg S., et al. Intraoperative clonidine for prevention of postoperative agitation in children anaesthetized with sevoflurane a randomized, placebo-controlled, double-blind trial. Lancet Child Adolesc Health. 2018;2:15–24.
    1. Aouad M.T., Yazbeck-Karam V.G., Nasr V.G., et al. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesthesiology. 2007;107:733–738.
    1. Chrysostomou C., Schmitt C.G. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol. 2008;4:619–627.
    1. Keles S., Kocaturk O. Comparison of oral dexmedetomidine and midazolam for premedication and emergence delirium in children after dental procedures under general anesthesia: a retrospective study. Drug Des Dev Ther. 2018;12:647–653.
    1. Li L.Q., Wang C., Xu H.Y., et al. Effects of different doses of intranasal dexmedetomidine on preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia undergoing adenoidectomy with or without tonsillectomy. Medicine (Baltimore) 2018;97
    1. Chen F., Wang C., Lu Y., et al. Efficacy of different doses of dexmedetomidine as a rapid bolus for children: a double-blind, prospective, randomized study. BMC Anesthesiol. 2018;18:103.
    1. Kim J.A., Ahn H.J., Yang M., et al. Intraoperative use of dexmedetomidine for the prevention of emergence agitation and postoperative delirium in thoracic surgery: a randomized-controlled trial. Can J Anaesth. 2019;66:371–379.
    1. Cimen Z.S., Hanci A., Sivrikaya G.U., et al. Comparison of buccal and nasal dexmedetomidine premedication for pediatric patients. Ped Anesth. 2013;23:134–138.
    1. Wilton N.C., Leigh J., Rosen D.R., et al. Pre-anesthetic sedation of preschool children using intranasal midazolam. Anesthesiology. 1988;69:972–975.
    1. Bajwa S.A., Costi D., Cyna A.M. A comparison of emergence delirium scales following general anesthesia in children. Pediatr Anesth. 2010;20:704–711.
    1. Suraseranivongse S., Santawat U., Kraiprasit K., et al. Cross-validation of a composite pain scale for preschool children within 24 hours of surgery. Br J Anaesth. 2001;87:400–405.
    1. Aldrete J.A. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7:89–91.
    1. Tsiotou A.G., Malisiova A., Kouptsova E., et al. Dexmedetomidine for the reduction of emergence delirium in children undergoing tonsillectomy with propofol anesthesia: a double-blind, randomized study. Pediatr Anesth. 2018;28:632–638.
    1. Ali M.A., Abdellatif A.A. Prevention of sevoflurane related emergence agitation in children undergoing adenotonsillectomy: a comparison of dexmedetomidine and propofol. Saudi J Anaesth. 2013;7:296–300.
    1. El-Hamid A.M.A., Yassin H.M. Effect of intranasal dexmedetomidine on emergence agitation after sevoflurane anesthesia in children undergoing tonsillectomy and/or adenoidectomy. Saudi J Anaesth. 2017;11:137–143.
    1. Sakurai Y., Obata T., Odaka A., et al. Buccal administration of dexmedetomidine as a preanesthetic in children. J Anesth. 2010;24:49–53.
    1. Somaini M., Engelhardt T., Fumagalli R., et al. Emergence delirium or pain after anaesthesia—how to distinguish between the two in young children: a retrospective analysis of observational studies. Br J Anaesth. 2016;116:377–383.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel