Dexmedetomidine for Emergence Agitation after Sevoflurane Anesthesia in Preschool Children Undergoing Day Case Surgery: Comparative Dose-Ranging Study
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- Category: Vol. 79, March 2011
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Dexmedetomidine for Emergence Agitation after Sevoflurane Anesthesia in Preschool Children Undergoing Day Case Surgery: Comparative Dose-Ranging Study,MANAL M. EL-GOHARY and SHERRY N. RIZK
Abstract
Background: The present study was designed to compare the efficacy and safety of two different doses of 0.3 and 0.5 μg/kg dexmedetomidine on emergence agitation (EA) after sevoflurane based anesthesia in children undergoing day case surgery.
Methods: 60 pediatric patients ASA physical status I or II, aged 3-6 years old, scheduled for day case surgery were studied. Children were randomly assigned to one of 3 groups (n=20), control (C) group received 10ml saline, (D1) group received dexmedetomidine 0.3μg/kg and (D2) group received dexmedetomidine 0.5μg/kg. Anesthesia was induced and maintained with sevoflurane inhalational anesthetic. Dexme-detomidine doses was diluted in 10ml saline and administered over 10min after induction of anesthesia. Heart rate (HR) and mean arterial blood pressure (MAP) were recorded after induction of anesthesia, after drug administration and then every 10min during the procedure and in the postanesthesia care unit (PACU) until discharge. Time to eye opening and to achieve full alderte score were recorded. Incidence and severity of EA was evaluated using Aono's and pediatric Anesthesia Emergence Delirium (PAED) scores respectively.
Results: MAP and HR decreased significantly in D2 group compared to its base line and to the control group till PACU admission (p<0.05). Hemodynamic values were comparable between D 1 and C groups throughout the study period (p>0.05). The incidence of severe EA was significantly lower in group D1 and D2 groups (30% and 20% respectively) than that in the control group (60%) (p<0.05). The PAED scales on PACU admission were significantly lower in D1 and D2 groups compared to C group (p<0.05). The time to eye opening and to achieve full alderte score were significantly longer in D2 group than C group (p<0.05).
Conclusion: Dexmedetomidine at a dose of 0.3 and 0.5 μg/kg reduced the incidence and severity of emergence agitation after sevoflurane anesthesia in the pre-school children. The lower dose of 0.3μg/kg was associated with better recovery profile and more hemodynamic stability than the dose of 0.5μ g/kg.