Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane

Aug 25, 2016Journal of clinical anesthesia

Effects of nasal dexmedetomidine before surgery on anesthesia and recovery behavior in children having cataract surgery with sevoflurane

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Abstract

Premedication with intranasal dexmedetomidine significantly reduced emergence agitation in children undergoing cataract surgery.

Children receiving 1 or 2 μg/kg of intranasal dexmedetomidine showed lower incidences of emergence agitation compared to those receiving saline.
The saline group experienced emergence agitation in 24 out of 30 patients, while only 7 in the 1 μg/kg group and 3 in the 2 μg/kg group were affected.
Mask induction scores were significantly higher in the dexmedetomidine groups compared to the saline group.
Emergence time and postanesthesia care unit stay time were comparable across all groups, indicating no delays associated with dexmedetomidine.
No significant clinical complications were reported in any of the treatment groups.

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STUDY OBJECTIVES: This study aimed to test the hypothesis that premedication with a single dose of intranasal dexmedetomidine (DEX) could not only reduce preoperative anxiety but also minimize the emergence agitation in children undergoing cataract surgery with sevoflurane anesthesia.

DESIGN: Single-blinded, randomized, placebo-controlled clinical comparison study.

SETTING: Academic medical center.

PATIENTS: Ninety American Society of Anesthesiologists physical status 1 and 2 children scheduled for cataract surgery.

INTERVENTIONS: Patients were randomized into 3 groups: group D1, group D2, and saline group (group C), in which the children received 1 or 2 μg/kg of intranasal DEX or saline, respectively, and each group comprises 30 patients.

MEASUREMENTS: The mask induction score and the incidences of postoperative emergence agitation evaluated by the Pediatric Anesthesia Emergence Delirium scale were assessed. The emergence time, postanesthesia care unit (PACU) stay time, and any adverse events were recorded.

MAIN RESULTS: The mask induction scores were significantly higher in the saline group than those in the D1 and D2 groups (P<.001). The incidences of emergence agitation in the D1 and D2 groups were significantly lower than that in the saline group (7/30 in group D1 and 3/30 in group D2 vs 24/30 in group C, P<.001). The emergence time and PACU stay time were comparable among the 3 groups (P>.05). The emergence time and PACU stay time did not differ significantly in DEX-treated groups as compared with the saline group; there were no differences between 1- and 2-μg/kg groups. None of the patients exhibited significant clinical complications.

CONCLUSION: Intranasal DEX (1 or 2 μg/kg) dose independently improves the incidences of mask acceptance and prevents the incidences of postoperative emergency agitation mainly from sevoflurane without delaying the emergency time or inducing severe adverse events.

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Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane

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