Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia?

Department of Anesthesiology, Tulane University, New Orleans, LA, USA.
Pediatric Anesthesia (Impact Factor: 1.74). 12/2005; 15(12):1098-104. DOI: 10.1111/j.1460-9592.2005.01660.x
Source: PubMed

ABSTRACT Emergence agitation or delirium (ED) is a frequent phenomenon in children recovering from general anesthesia (GA). Dexmedetomidine, an alpha2 receptor agonist, has analgesic and sedative properties that might be helpful in the management of ED. We studied the effects of a continuous perioperative infusion of 0.2 dexmedetomidine on the incidence of ED in 50 children aged 1-10 years scheduled for sevoflurane-based GA.
Following inhalation induction of GA, the children were randomly assigned into dexmedetomidine or placebo Groups D and S, respectively. The infusion of 0.2 dexmedetomidine or equal volume of saline was started after securing the airway. Depth of anesthesia was maintained by adjusting the concentration of sevoflurane to achieve a Bispectral Index Score of 40-60. Intraoperative hemodynamics were recorded every 5 min and the trachea was extubated at the end of the procedure. Perioperative pain management was determined by the blinded anesthesia team, and the study drug infusion was maintained for 15 min following the postanesthesia care unit (PACU) admission. ED and pain scores were evaluated by a blinded observer.
The incidence of ED was statistically significantly different between the two groups, 26% in Group D Vs 60.8% in Group S (P = 0.036). Additionally, the number of episodes of ED was lower in Group D (P < 0.017). Pain scores and the times to extubate and discharge from PACU were the same.
The perioperative infusion of 0.2 dexmedetomidine decreases the incidence and frequency of ED in children after sevoflurane-based GA without prolonging the time to extubate or discharge.

Download full-text


Available from: Usha Ramadhyani, Jun 28, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Emergence agitation (EA) in children is increased after sevoflurane anaesthesia. The efficacy of prophylactic treatment is controversial. The aim of this study was to provide a meta-analysis of the studies of the pharmacological prevention of EA in children. A comprehensive literature search was conducted to identify clinical trials that focused on the prevention of EA in children anaesthetized with sevoflurane, desflurane, or both. The data from each trial were combined using the Mantel-Haenszel model to calculate the pooled odds ratio (OR) and 95% confidence interval. I(2) statistics were used to assess statistics heterogeneity and the funnel plot and the Begg-Mazumdar test to assess bias. Thirty-seven articles were found which included a total of 1695 patients in the intervention groups and 1477 in the control ones. Midazolam and 5HT(3) inhibitors were not found to have a protective effect against EA [OR=0.88 (0.44, 1.76); OR=0.39 (0.12, 1.31), respectively], whereas propofol [OR=0.21 (0.16, 0.28)], ketamine [OR=0.28 (0.13, 0.60)], alpha(2)-adrenoceptors [OR=0.23 (0.17, 0.33)], fentanyl [OR=0.31 (0.18, 0.56)], and peroperative analgesia [OR=0.15 (0.07, 0.34)] were all found to have a preventive effect. Subgroup analysis according to the peroperative analgesia given does not affect the results. This meta-analysis found that propofol, ketamine, fentanyl, and preoperative analgesia had a prophylactic effect in preventing EA. The analgesic properties of these drugs do not seem to have a role in this effect.
    BJA British Journal of Anaesthesia 02/2010; 104(2):216-23. DOI:10.1093/bja/aep376 · 4.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Emergence delirium (ED), also referred to in the literature as emergence agitation (EA) or post-anesthetic excitement, is a well-documented phenomenon occurring in children and adults in the immediate postoperative period and lasting 5-15 minutes. Emergence delirium is a clinical condition in which patients are “awake” but experience alterations in disorientation and other mental status changes that range from confusion and lethargy to violent and harmful behavior. First addressed on a large scale in the 1960s, ED continues to gain recognition among anesthesiologists who have begun to document the potential pharmacological association and other pre-morbid predictors that increase the risk of developing ED. Investigators have attempted to define ED, validate appropriate assessment tools, distinguish potential risk factors, and identify acute management. The current paper reviews ED and explores theoretical subtypes of ED with and without pain/agitation for clinical assessment.
    Seminars in Anesthesia Perioperative Medicine and Pain 09/2006; 25(3):100-104. DOI:10.1053/j.sane.2006.05.013
  • Source
    Korean Journal of Anesthesiology 01/2007; 52(1). DOI:10.4097/kjae.2007.52.1.1