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: 1.85). 12/2005; 15(12):1098-104. DOI: 10.1111/j.1460-9592.2005.01660.x
Source: PubMed


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.

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Available from: Usha Ramadhyani
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    • "Emergence delirium is often witnessed after sevoflurane anesthesia with an incidence of approximately 20%–60% [1] [2]. It is characterized by mental disturbance consisting of hallucinations , delusions, and confusion manifested by moaning , restlessness, involuntary physical activity, and thrashing about in bed during the recovery from general anaesthesia [3]. "
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    ABSTRACT: This randomized trial was conducted to assess the efficacy and recovery profile of low dose intravenous dexmedetomidine in prevention of post-sevoflurane emergence delirium in children undergoing cataract surgery. Sixty-three children aged 1–6 years were included. Anesthesia was induced with sevoflurane and airway was maintained with LMA. They were randomized to group D 0.15 (received intravenous dexmedetomidine 0.15 μ g/kg), group D 0.3 (received dexmedetomidine 0.3 μ g/kg), or group NS (received normal saline). The incidence of emergence delirium, intraoperative haemodynamic variables, Aldrete scoring, pain scoring, rescue medication, and discharge time were recorded. Emergence delirium was significantly reduced in dexmedetomidine treated groups with incidence being 10% in group D 0.15, none in group D 0.3, and 35% in the NS group ( p = 0.002 ). Significantly lower PAED scores were observed in D 0.15 and D 0.3 group compared to the NS group ( p = 0.004 ). Discharge time was significantly prolonged in the NS group compared to D 0.15 and D 0.3 (45.1 min ± 4.4 versus 36.8 min ± 3.8 versus 34.4 min ± 4.6), p < 0.02 . Intravenous dexmedetomidine in low doses (0.3 and 0.15 μ g/kg) was found to be effective in reducing emergence delirium in children undergoing unilateral cataract surgery.
    Full-text · Article · Nov 2015
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    • "EA was assessed using a 5-point scale of Agitation Cole score (ACS), Behavior Scale or Pediatric Anesthesia Emergence Delirium (PAED) scale. There were 12 trials [9]–[11], [16]–[24] that examined the incidence of EA in children under sevoflurane anesthesia. No statistically significant heterogeneity was observed according to the I2and Q tests (I2<0.1%, "
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    ABSTRACT: Objective Emergence agitation (EA) is a common complication in children under sevoflurane anesthesia. The aim of this meta-analysis was to evaluate the effects of intravenous dexmedetomidine on EA in children under sevoflurane anesthesia. Methods A comprehensive literature search was conducted to identify clinical trials that evaluated the effects of intravenous dexmedetomidine and placebo on EA in children under sevoflurane anesthesia. The search collected trials from MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science. Analysis was conducted using STATA version 12.0. Data from each trial were pooled using relative ratio (RR) for dichotomous data or weighted mean difference (WMD) for continuous data and corresponding 95% confidence interval (95% CI). Heterogeneity assessment, sensitivity analysis, and publication bias were performed. Results Twelve trials, in which 459 patients received dexmedetomidine and 353 patients received placebo, were included in this analysis. We found that intravenous dexmedetomidine decreased the incidences of EA (RR = 0.346, 95% CI 0.263 to 0.453, P<0.001), and postoperative pain (RR = 0.405, 95% CI 0.253 to 0.649, P<0.001). Intravenous dexmedetomidine also prolonged extubation time (WMD = 0.617, 95% CI 0.276 to 958, P<0.001), and emergence time (WMD = 0.997, 95% CI 0.392 to 1.561, P = 0.001). Further evidences are required to evaluate the incidence of postoperative nausea and vomiting (PONV). Sensitivity analysis strengthened evidences for lower incidences of EA, pain, and prolonged extubation time, and emergence time. Funnel plots did not detect any significant publication bias. Conclusion Meta-analysis demonstrated that dexmedetomidine decreased the incidence of EA in children under sevoflurane anesthesia.
    Full-text · Article · Jun 2014 · PLoS ONE
    • "Hyperactivity and attention deficit disorder are frequently seen in children with OSAS, possibly explaining or contributing to a high incidence of EA. Dexmedetomidine has been used successfully to prevent or reduce emergence delirium in children as an infusion (0.2 μg/kg/h) or single dose at the end of surgery (0.5 μg/kg).[1819] However, from our study and others, it remains difficult to discern whether the analgesic or sedative effects of α2 agonists are responsible for reducing EA in children. "
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    ABSTRACT: Children with obstructive sleep apnea (OSA) are particularly at risk under anesthesia after uvulopalatopharyngoplasty (UPPP). This prospective randomized double-blind study focused on the comparison of dexmedetomidine-ketamine and sevoflurane-sufentanil anesthesia on children with respect to safety, feasibility, and clinical effects. A total of 60 children, aged 2-10 years, classified as American Society of Anesthesiologists (ASA) status I and II scheduled for UPPP were prospectively studied. Patients were randomly allocated to receive either dexmedetomidine-ketamine-based anesthesia (group DK, n = 30) or sevoflurane-sufentanil-based anesthesia (group SS, n = 3 0). Heart rate (HR) and systolic blood pressure during the first 60 min of the procedure, Ramsay sedation score, the Pediatric Anesthesia Emergence Delirium (PAED) scale and a 5-point scale used to evaluate emergence agitation (EA) in postanesthesia care unit (PACU) and postoperative outcomes data were recorded. During the first 60 min of anesthesia, mean HR, and mean diastolic noninvasive arterial blood pressure (NIBP) were not statistically different in the two groups (P > 0.05) Compared with group SS, the patients in group DK had lower rescue tramadol requirement and lower pain score, PAED score, and EA score at 5, 10, 15, and 30 min in PACU; but had a higher Ramsay scale at 10, 15, 30, 45, and 60 min in PACU and the incidence of SpO2 below 95%, also the time of first bowel movement and ambulation in group DK was shorter. The dexmedetomidine-ketamine combination was not superior to a sevoflurane-sufentanil combination because of late awake time and a high potential for adverse respiratory events in PACU, the benefit of dexmedetomidine administration being a decreased incidence of EA and a lower recovery time of bowel movement and ambulation.
    No preview · Article · Mar 2014 · Journal of Anaesthesiology Clinical Pharmacology
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