RETRACTED ARTICLE: Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery

Sep 3, 2015Der Anaesthesist

Comparing dexmedetomidine and remifentanil effects on recovery agitation after nasal surgery

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Abstract

The incidence of postoperative emergency agitation was 3.3% with remifentanil compared to 46.7% with placebo.

Remifentanil infusion significantly reduced the incidence of postoperative emergency agitation compared to placebo.
Dexmedetomidine also decreased agitation compared to placebo but was less effective than remifentanil.
Patients receiving dexmedetomidine experienced significantly lower rates of nausea or vomiting compared to those receiving remifentanil and placebo.
The use of remifentanil was associated with higher administration of analgesics in the post-anesthesia care unit compared to dexmedetomidine and placebo.
Residual sedation levels were similar across all treatment groups.

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BACKGROUND: Postoperative emergency agitation (EA) is a common problem. Dexmedetomidine and remifentanil may be used to prevent this problem. Our primary aim was to compare dexmedetomidine, remifentanil, and placebo with respect to their effectiveness in preventing postoperative EA.

MATERIAL AND METHODS: Ninety patients undergoing nasal surgery were randomized into three groups. The dexmedetomidine group (group D, n = 30) received dexmedetomidine infusion at a rate of 0.4 μg kg(-1 ) h(-1); the remifentanil group (group R, n = 30) received remifentanil infusion at a rate of 0.05 μg kg(-1) min(-1) from induction of anesthesia until extubation; and the control group (group S, n = 30) received a volume-matched normal saline infusion as a placebo. Propofol (1.5-2 mg kg(-1)) and fentanyl (1 μg kg(-1)) were used to initiate anesthesia, and desflurane was used to maintain anesthesia. The incidence of agitation, hemodynamic parameters, and recovery characteristics were evaluated during emergence.

RESULTS: The incidence of EA was significantly higher in group S (46.7%) compared with groups R and D (3.3 and 20%, respectively; p < 0.001). The lowest incidence of EA was detected in group R (p = 0.046). Residual sedation in the post-anesthesia care unit (PACU) was similar in all groups (p = 0.947). The incidence of nausea or vomiting was significantly lower in group D than in groups R and S (p = 0.043). Administration of analgesics in the PACU was higher in group R than in groups S and D (p = 0.015).

CONCLUSION: Anesthetic maintenance with either remifentanil or dexmedetomidine infusion until extubation provided a more smooth and hemodynamically stable emergence, without complications after nasal surgery. While remifentanil was superior to dexmedetomidine with regard to avoiding EA, dexmedetomidine was more effective than remifentanil regarding vomiting and pain.

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RETRACTED ARTICLE: Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery

Abstract

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