Dexmedetomidine Effect on Emergence Agitation and Delirium in Children Undergoing Laparoscopic Hernia Repair: a Preliminary Study

Yingying Sun, Yuanhai Li, Yajuan Sun, Xing Wang, Hongwu Ye, Xianren Yuan, Yingying Sun, Yuanhai Li, Yajuan Sun, Xing Wang, Hongwu Ye, Xianren Yuan

Abstract

Objective To evaluate the safety and efficacy of dexmedetomidine (Dex) to prevent emergence agitation (EA) and delirium (ED) in children undergoing laparoscopic hernia repair under general anesthesia. Methods 100 children (1-5 years, 10-25 kg) were randomized into four groups: controls (saline) and intravenous Dex at 0.25, 0.5, and 1.0 µg/kg (D1, D2, D3, respectively). Dex/saline infusion was started following anesthesia. EA and ED were evaluated on a 5-point scale. Results For the C, D1, D2, and D3 groups, respectively, EA frequencies were 45.8%, 30.4%, 12%, 4%; ED frequencies 29.1%, 13%, 4%, 4%; CHIPPS scores 8, 6, 3, 3; sevoflurane doses from 13.2 ± 3.4 (controls) to 9.4 ± 3.5 ml (D3). Intervals until mask removal/spontaneous eye opening were significantly longer for D2 and D3 than controls. PACU stay was longer for D3. Conclusions There was significantly less postoperative EA and pain, with less sevoflurane required, using Dex.

Keywords: Dexmedetomidine; children; emergency agitation; emergency delirium; general anesthesia; laparoscopic hernia repair.

Figures

Figure 1.
Figure 1.
Patients’ flowchart.
Figure 2.
Figure 2.
Occurrence of emergence agitation (EA) and delirium (ED). *P #P < 0.05 vs. dexmedetomidine 0.25 µg/kg.

References

    1. Pickard A, Davies P, Birnie K, et al. Systematic review and meta-analysis of the effect of intraoperative alpha(2)-adrenergic agonists on postoperative behaviour in children. Br J Anaesth 2014; 112: 982–990.
    1. Dahmani S, Stany I, Brasher C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth 2010; 104: 216–223.
    1. Akin A, Bayram A, Esmaoglu A, et al. Dexmedetomidine vs midazolam for premedication of pediatric patients undergoing anesthesia. Paediatr Anaesth 2012; 22: 871–876.
    1. Mountain BW, Smithson L, Cramolini M, et al. Dexmedetomidine as a pediatric anesthetic premedication to reduce anxiety and to deter emergence delirium. AANA J 2011; 79: 219–224.
    1. Mukherjee A, Das A, Basunia SR, et al. Emergence agitation prevention in paediatric ambulatory surgery: A comparison between intranasal Dexmedetomidine and Clonidine. J Res Pharm Pract 2015; 4: 24–30.
    1. Kamibayashi T, Maze M. Clinical uses of alpha2 -adrenergic agonists. Anesthesiology 2000; 93: 1345–1349.
    1. Piao G, Wu J. Systematic assessment of dexmedetomidine as an anesthetic agent: a meta-analysis of randomized controlled trials. Arch Med Sci 2014; 10: 19–24.
    1. Maldonado JR, Wysong A, van der Starre PJ, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics 2009; 50: 206–217.
    1. Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth 2005; 15: 1098–1104.
    1. Meng QT, Xia ZY, Luo T, et al. Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia: a case-control study. Int J Pediatr Otorhinolaryngol 2012; 76: 1036–1041.
    1. Cole JW, Murray DJ, McAllister JD, et al. Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia. Paediatr Anaesth 2002; 12: 442–447.
    1. Berthoud MC, Reilly CS. Adverse effects of general anaesthetics. Drug Saf 1992; 7: 434–459.
    1. Buttner W, Finke W. Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies. Paediatr Anaesth 2000; 10: 303–318.
    1. Isik B, Arslan M, Tunga AD, et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth 2006; 16: 748–753.
    1. Steward DJ. A simplified scoring system for the post-operative recovery room. Can Anaesth Soc J 1975; 22: 111–113.
    1. Ead H. From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery. J Perianesth Nurs 2006; 21: 259–267.
    1. Mizuno J, Nakata Y, Morita S, et al. Predisposing factors and prevention of emergence agitation. Masui 2011; 60: 425–435.
    1. Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg 2003; 96: 1625–1630.
    1. Chen JY, Jia JE, Liu TJ, 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. Ali MA, Abdellatif AA. Prevention of sevoflurane related emergence agitation in children undergoing adenotonsillectomy: A comparison of dexmedetomidine and propofol. Saudi J Anaesth 2013; 7: 296–300.
    1. Smania MC, Piva JP, Garcia PC. Dexmedetomidine in anesthesia of children submitted to videolaparoscopic appendectomy: a double-blind, randomized and placebo-controlled study. Rev Assoc Med Bras (1992) 2008; 54: 308–313.
    1. Fagin A, Palmieri T, Greenhalgh D, et al. A comparison of dexmedetomidine and midazolam for sedation in severe pediatric burn injury. J Burn Care Res 2012; 33: 759–763.
    1. Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth 2005; 15: 762–766.
    1. Simsek M, Bulut MO, Ozel D, et al. Comparison of sedation method in pediatrics cardiac catheterization. Eur Rev Med Pharmacol Sci 2016; 20: 1490–1494.
    1. Asaad OM, Hafez M, Mohamed MY, et al. Comparative study between prophylactic single dose of fentanyl and dexmedetomidine in the management of agitation after sevoflurane anesthesia without surgery. Egypt J Anaesth 2011; 27: 31–37.
    1. Mantz J, Josserand J, Hamada S. Dexmedetomidine: new insights. Eur J Anaesthesiol 2011; 28: 3–6.
    1. Jaakola ML, Salonen M, Lehtinen R, et al. The analgesic action of dexmedetomidine–a novel alpha 2-adrenoceptor agonist–in healthy volunteers. Pain 1991; 46: 281–285.
    1. Riker RR, Fraser GL. Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit. Pharmacotherapy 2005; 25: 8 S–18 S.
    1. Kim HS, Byon HJ, Kim JE, et al. Appropriate dose of dexmedetomidine for the prevention of emergence agitation after desflurane anesthesia for tonsillectomy or adenoidectomy in children: up and down sequential allocation. BMC Anesthesiol 2015; 15: 79–79.
    1. Pestieau SR, Quezado ZM, Johnson YJ, et al. The effect of dexmedetomidine during myringotomy and pressure-equalizing tube placement in children. Paediatr Anaesth 2011; 21: 1128–1135.

Source: PubMed

3
購読する