Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy.

Associate Department of Anesthesiology and Perioperative Medicine, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Medical Science, Newark, NJ 07101, USA.
Anesthesia and analgesia (Impact Factor: 3.42). 10/2010; 111(4):1004-10. DOI: 10.1213/ANE.0b013e3181ee82fa
Source: PubMed

ABSTRACT Dexmedetomidine, a specific α(2) agonist, has an analgesic-sparing effect and reduces emergence agitation. We compared an intraoperative dexmedetomidine infusion with bolus fentanyl to reduce perioperative opioid use and decrease emergence agitation in children with obstructive sleep apnea syndrome undergoing adenotonsillectomy (T&A).
One hundred twenty-two patients with obstructive sleep apnea syndrome undergoing T&A, ages 2 to 10 years, completed this prospective, randomized, U.S. Food and Drug Administration-approved study. After mask induction with sevoflurane, group D received IV dexmedetomidine 2 μg · kg(-1) over 10 minutes, followed by 0.7 μg · kg(-1) · h(-1), and group F received IV fentanyl bolus 1 μg · kg(-1). Anesthesia was maintained with sevoflurane, oxygen, and nitrous oxide. Fentanyl 0.5 to 1 μg · kg(-1) was given to subjects in both groups for an increase in heart rate or systolic blood pressure 30% above preincision values that continued for 5 minutes. Observers in the postanesthesia care unit (PACU) were blinded to treatment groups. Pain was evaluated using the objective pain score in the PACU on arrival, at 5 minutes, at 15 minutes, then every 15 minutes for 120 minutes. Emergence agitation was evaluated at the same intervals by 2 scales: the Pediatric Anesthesia Emergence Delirium scale and a 5-point scale described by Cole. Morphine (0.05 to 0.1 mg · kg(-1)) was given for pain (score >4) or severe agitation (score 4 or 5) lasting more than 5 minutes.
In group D, 9.8% patients needed intraoperative rescue fentanyl in comparison with 36% in group F (P = 0.001). Mean systolic blood pressure and heart rate were significantly lower in group D (P < 0.05). Minimum alveolar concentration values were significantly different between the 2 groups (P = 0.015). The median objective pain score was 3 for group D and 5 for group F (P = 0.001). In group D, 10 (16.3%) patients required rescue morphine, in comparison with 29 (47.5%) in group F (P = 0.002). The frequency of severe emergence agitation on arrival in the PACU was 18% in group D and 45.9% in group F (P = 0.004); at 5 minutes and at 15 minutes, it was lower in group D (P = 0.028). The duration of agitation on the Cole scale was statistically lower in group D (P = 0.004). In group D, 18% of patients and 40.9% in group F had an episode of Spo(2) below 95% (P = 0.01).
An intraoperative infusion of dexmedetomidine combined with inhalation anesthetics provided satisfactory intraoperative conditions for T&A without adverse hemodynamic effects. Postoperative opioid requirements were significantly reduced, and the incidence and duration of severe emergence agitation was lower with fewer patients having desaturation episodes.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients undergoing orthognathic surgery are at high risk of developing emergence agitation. We hypothesised that a single-dose of dexmedetomidine would reduce emergence agitation in adults with nasotracheal intubation after orthognathic surgery.
    Acta Anaesthesiologica Scandinavica 09/2014; 58(8):955-60. · 2.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Tonsillectomy is an extremely common surgical procedure associated with significant morbidity and mortality. The post-operative challenges include: respiratory complications, post-tonsillectomy hemorrhage, nausea, vomiting and significant pain. The present model of care demands that most of these children are managed in an ambulatory setting. The recent Federal Drug Agency (FDA) warning contraindicating the use of codeine after tonsillectomy in children represents a significant change of practice for many pediatric otolaryngological surgeons. This introduces a number of other safety concerns when deciding on a safe alternative to codeine, especially since most tonsillectomy patients are managed by lay primary caregiver's at home. This review outlines the safety issues and proposes, based on currently available evidence, a preventative multi-modal strategy to manage pain, nausea and vomiting without increasing the risk of post-tonsillectomy bleeding.
    International Journal of Pediatric Otorhinolaryngology 08/2014; · 1.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of propofol injection pain is high in children, but no methods have been found to suppress it completely. This study intends to evaluate the efficacy of dexmedetomidine-midazolam in preventing propofol injection pain in children. One-hundred ASA I patients, aged 3-12 years, weighing 15-53 kg, undergoing elective surgery were randomized into two groups of 50 each, using computer-generated random numbers. Normal saline 0.15 ml/kg in Group C or dexmedetomidine 0.6 μg/kg in Group D was infused IV over 10 min. Then midazolam 0.06 mg/kg was administered immediately; 2 min after aforementioned treatments in each group, all patients received propofol 2 mg/kg (propofol was mixed with lidocaine 1 mg/ml in Group C) at an average rate of 0.2 ml per 1 s. Another anesthesiologist, blind to the pretreatment, recorded the occurrence of injection pain using a four-graded pain scale: 1 = no pain (no reaction to injection), 2 = slight pain (minor verbal/facial response or motor reaction to injection), 3 = moderate pain (clear verbal/facial response or motor reaction to injection) and 4 = severe pain (the patient both complained of pain and withdrew the arm). Forty (80 %) patients in Group C (control) had injection pain; however, none of patients in Group D had any injection pain. The total incidence of profol-induced pain in Group C was significantly higher (P < 0.01). There were no instances of bradycardia or low blood pressure with either treatment in this study. Pretreatment with dexmedetomidine 0.6 μg/kg, then midazolam 0.06 mg/kg could suppress propofol injection pain in children.
    Irish Journal of Medical Science 05/2014; · 0.51 Impact Factor


Available from